Effect Of Early Rehabilitation Treatment On ICU Acquired Weakness,delirium And Cardiac Function In Patients After Coronary Artery Bypass Grafting

BackgroundCoronary artery bypass graft(CABG)is one of the main treatments for Coronary artery disease.Postoperative patients generally have varying degrees of ICU-acquired weakness,delirium,and cardiac insufficiency.Early rehabilitation treatment has achieved good clinical results in non-cardiac surgery patients,but the safety of Early rehabilitation treatment in CABG patients and the effect on ICU-AW and delirium incidence remain to be studied.ObjectiveTo observe the safety of early rehabilitation treatment for patients after coronary artery bypass grafting,and to explore the effect of early rehabilitation treatment on the incidence of acquired weakness and delirium in ICU and cardiac function of patients after coronary artery bypass grafting.MethodsA total of 60 patients undergoing coronary artery bypass grafting from October2017 to October 2018 in a top-level cardiovascular hospital were selected as the control group,and routine rehabilitation programs were adopted;63 patients from November2018 to December 2019 after coronary artery bypass grafting were selected as the observation group,received early rehabilitation on the basis of conventional rehabilitation.The study used t-test,u-test,or x~2 test to analyze the effects of early rehabilitation treatment on ICU-AW,delirium and therapy safety in patients after coronary artery bypass grafting by using the following indicators:1.Adverse events:vomiting/aspiration,deep vein thrombosis(DVT),accidental prolapse of catheterization,bed falling/falling;2.The indicators to evaluate ICU-AW:(1)ICU-AW incidence,British Medical Research Council(MRC)muscle strength scale score;(2)Mechanical ventilation time,time length of ICU treatment and hospital stay;3.The indicators to evaluate delirium:the incidence of delirium and the duration time of delirium;4.Heart function indicators:Left ventricular ejection fraction(LVEF),Left ventricular end diastolic diameter(LVEDD),B-type brain natriuretic peptide(BNP),6-minute walking distance(6-MWT);Acute physiology and chronic health evaluation-II(APACHE II)score.Results1.The incidence of vomiting/aspiration and DVT of the observation group was significantly lower than that of the control group,and the difference was statistically significant(P<0.05);the incidence differences of accidental tube prolapse,bed falling/falling between two groups were not statistically significant(P>0.05);2.The incidence of ICU-AW in the observation group was lower than that of the control group(6.35%vs 25.00%),and the difference was statistically significant(OR=4.917,95%CI:1.527-15.828,P<0.01);The MRC muscle strength score of the observation group was 52.68±3.13,which was higher than the control group(49.13±3.05),and the difference was statistically significant(u=-5.549,P<0.05);The mechanical ventilation time of the observation group was(57.00±17.24)hours,the ICU stay time was(8.06±1.81)days and the total hospital stay time was(16.13±2.56)days.By comparison,the mechanical ventilation time of the control group was(71.75±19.04)hours,ICU stay time was(10.73±2.14)days and the total hospital stay time was(19.23±3.77)days.All the differences between two groups were statistically significant(P<0.01);3.The incidence of delirium in the observation group was lower than that of the control group(9.52%vs 26.67%),and the difference was statistically significant(OR=3.455,95%CI:1.249-9.555,P<0.05);The duration time of delirium in the observation group was shorter than that of the control group(3.40±1.09 d vs 2.02±0.89d),and the difference was statistically significant(t=-2.867,P<0.05);4.The LVEF(55.83±3.88)%and 6-MWT(476.55±69.67)m of the observation group were higher than that of the control group three months after the CABG,which were LVEF(53.20±4.04)%and 6-MWT(438.55±53.48)m.And it is statistically significant(P<0.01);the APACHE II score of the observation group was lower than that of the control group when out of the ICU(8.08±0.97 vs.8.56±1.33),and the difference was statistically significant(u=-2.475,P<0.05).ConclusionsEarly rehabilitation therapy can reduce the incidence of ICU-AW and delirium in patients after coronary artery bypass grafting,and it can reduce the duration time of delirium,and improve cardiac function and quality of life.It is safe and reliable to promote clinically.