多学科协作对冠状动脉旁路移植术患者术后康复效果及出院准备度的影响

doi:10.3760/cma.j.issn.1007-1245.2022.20.009

摘要/Abstract

摘要： 目的　探讨多学科协作（MDT）对冠状动脉旁路移植术（CABG）患者术后康复效果及出院准备度的影响。方法　前瞻性选择2019年10月至2021年10月阜外华中心血管病医院收治的冠心病患者86例，根据盲抽法将其分为两组。观察组43例中男25例、女18例，年龄（63.36±3.11）岁，病程（3.15±0.87）年；对照组43例中男29例、女14例，年龄（63.71±3.28）岁，病程（3.32±0.90）年。两组患者均采用CABG治疗，对照组采用常规干预，观察组在对照组基础上采用MDT干预。比较两组术后康复效果、出院准备度水平［出院准备度量表（RHDS）］、出院前心肺功能恢复情况［2 min踏步试验、6 min步行试验（6MWT）］，及两组干预前、出院前心理状况［焦虑自评量表（SAS）、抑郁自评量表（SDS）］。统计学方法采用χ²检验、t检验。结果　观察组排气时间（22.63±2.35）h、进食时间（24.58±2.11）h、下床活动时间（81.28±4.82）h、住院时间（6.82±1.12）d，均短于对照组的（30.17±2.84）h、（32.48±2.65）h、（98.32±5.22）h、（8.27±1.59）d，差异均有统计学意义（t=13.413、15.293、15.727、4.889，均P<0.001）；观察组疾病知识评分（65.32±5.62）分、自身状况评分（58.42±5.39）分、出院后期望得到的社会支持评分（30.36±4.69）分、出院后应对方式评分（19.52±3.65）分及RHDS总分（173.62±21.08）分，均高于对照组的（51.48±5.47）分、（46.98±5.15）分、（26.38±4.12）分、（13.64±3.08）分、（138.48±20.74）分，差异均有统计学意义（t=11.572、10.063、4.181、8.074、7.792，均P<0.001）；观察组2 min踏步试验步数多于对照组［（82.62±8.82）次比（73.54±7.59）次］，6MWT距离长于对照组［（278.32±35.14）m比（243.19±32.08）m］，差异均有统计学意义（t=5.117、4.842，均P<0.001）；两组出院前SAS、SDS评分低于干预前，且观察组低于对照组［（35.62±3.12）分比（42.05±3.87）分、（37.51±3.54）分比（43.11±3.49）分］，差异均有统计学意义（t=4.482、7.378，均P<0.001）。结论　MDT可改善冠心病患者心肺功能，促进患者术后康复，并缓解患者负性情绪，提高其出院准备度。

关键词: 冠状动脉旁路移植术, 多学科协作, 术后康复效果, 出院准备度

Abstract: Objective　To explore the effect of multidisciplinary team (MDT) on postoperative rehabilitation effect and discharge readiness in patients undergoing coronary artery bypass grafting (CABG). Methods　A total of 86 patients with coronary heart disease who were treated in Fuwai Huazhong Cardiovascular Hospital from October 2019 to October 2021 were prospectively selected, and they were divided into two groups with the blind sampling method. In the observation group, there were 25 males and 18 females, with an age of (63.36±3.11) years old and a course of disease of (3.15±0.87) years; in the control group, there were 29 males and 14 females, with an age of (63.71±3.28) years old and a course of disease of (3.32±0.90) years. Both groups were treated with CABG, the control group was treated with routine intervention, and the observation group was treated with MDT intervention on the basis of the control group. The postoperative rehabilitation effects, the levels of discharge readiness [Readiness for Hospital Discharge Scale (RHDS)], the recovery of cardiopulmonary function before discharge [2-min stepping test, 6-min walking test (6MWT)], and the psychological status before intervention and before discharge [Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS)] of the two groups were compared. χ² test and t test were used for statistical analysis. Results　In the observation group, the exhaust time was (22.63±2.35) h, the feeding time was (24.58±2.11) h, the getting out of bed activity time was (81.28±4.82) h, and the hospital stay was (6.82±1.12) d, which were shorter than (30.17±2.84) h, (32.48±2.65) h, (98.32±5.22) h, and (8.27±1.59) d in the control group, with statistically significant differences (t=13.413, 15.293, 15.727, and 4.889; all P<0.001). In the observation group, the score of disease related knowledge was (65.32±5.62) points, the score of self-condition was (58.42±5.39) points, the score of expected social support after discharge was (30.36±4.69) points, the score of coping style after discharge was (19.52±3.65) points, and the total score of RHDS was (173.62±21.08) points, which were higher than (51.48±5.47), (46.98±5.15), (26.38±4.12), (13.64±3.08), and (138.48±20.74) points in the control group, with statistically significant differences (t=11.572, 10.063, 4.181, 8.074, and 7.792; all P<0.001). The step number in the 2-min stepping test in the observation group was more than that in the control group [(82.62±8.82) times vs. (73.54±7.59) times], and the distance of 6MWT was longer than that in the control group [(278.32±35.14) m vs. (243.19±32.08) m], with statistically significant differences (t=5.117 and 4.842; both P<0.001). The scores of SAS and SDS in the two groups before discharge were lower than those before intervention, and those in the observation group were lower than those in the control group [(35.62±3.12) vs. (42.05±3.87), (37.51±3.54) vs. (43.11±3.49)], with statistically significant differences (t=4.482 and 7.378; both P<0.001). Conclusion　MDT can improve coronary heart disease patients' cardiopulmonary function, promote their postoperative rehabilitation, alleviate their negative emotions, and improve their discharge readiness.

Key words: Coronary artery bypass grafting, Multidisciplinary team, Postoperative rehabilitation effect, Discharge readiness

朱怡欣樊龙会. 多学科协作对冠状动脉旁路移植术患者术后康复效果及出院准备度的影响[J]. 国际医药卫生导报, 2022, 28(20): 2858-2862.

Zhu Yixin, Fan Longhui. Effect of multidisciplinary team on postoperative rehabilitation effect and discharge readiness in patients undergoing coronary artery bypass grafting[J]. International Medicine and Health Guidance News, 2022, 28(20): 2858-2862.

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