術前復健治療對於高危險開心手術之病人其住院日的影響

The Effect of Pre-operative Rehabilitation in High Risk Open Heart Surgery Patients on the Length of Hospital Stay

林彣芷(Wen-Chih Lin) ； 陳怡如(Yi-Ru Chen) ； 陳喬馨(Chiao-Hsin Chen) ； 楊舒涵(Shu-Han Yang) ； 黃景燦(Chin-Tsan Huang) ； 吳美宜(Mei-Yi Wu) ； 周偉倪(Willy Chou)

《台灣復健醫學雜誌》 39卷3期 (2011/09) Pp. 157-165

https://doi.org/10.6315/2011.39(3)04

摘要

研究目的：本研究是爲了評估病人進行選擇性開心手術前，給予橫膈肌呼吸運動及咳嗽技巧的教導，是否能夠有效減少開心手術術後的肺部併發症、插管時間及住院天數。研究方法：病例回溯2008年3月至2009年4月間，進行選擇性開心手術的病人共27位，紀錄基本資料及術後肺部併發症危險指數。比較有接受術前復健與未接受術前復健兩組之間其術後肺部併發症、插管時間及住院天數是否有差異。並根據術後肺部併發症發生危險分數分爲高危險群及非高危險群兩組作進一步的比較。結果：接受術前復健組（13位）與未接受術前復健組（14位）在基本資料上無差異。至出院前，接受術前復健組有8位(61.5%)病人發生術後肺部併發症，相對於未接受術前復健組有12位(85.7%)，然而兩組之間並沒有顯著的差異(p=0.476)。比較兩組病人術後之插管時間、加護病房住院時間、一般病房住院時間及術後總住院時間，接受術前復健訓練組皆較短，但並無顯著差異。其中術後肺部併發症發生之高危險群的病人（危險指數大於等於2分），接受術前復健組相較未接受術前復健組的平均術後住院天數有顯著的下降（6.03±1.03天 vs. 9.24±3.29天，p=0.012）。結論：接受開心手術術前橫膈肌呼吸運動及咳嗽技巧教導，對於術後肺部併發症發生之高危險群病人可縮短其住院天數，並因此降低醫療費用的消耗。

關鍵字

開心手術 ； 術前復健 ； 住院時間 ； 術後肺部併發症

並列摘要

The study was to evaluate the effect of pre-operative education for diaphragmatic breathing and coughing techniques in elective open heart surgery patients on the post-operative pulmonary complications, ventilator use duration and post-operative hospital days.The retrospective chart review of the 27 elective open heart surgery patients was from March 2008 to April 2009. The basic data and risk factors of post-operative complications were recorded. The complications, mechanical ventilation duration, and hospital days in the two groups with and without the education were compared; so were the high risk and nonhigh risk group according to the risk score of the post-operative pulmonary complications.The 13 patients were pre-operatively educated for the diaphragmatic breathing and coughing techniques; the 12 patients were as the control group. Before hospital discharge, the post-operative pulmonary complications developed in the 8 (61.5%) patients in the former group and 12 (85.7%) in the latter group (p=0.476), both of which also showed no significant difference in the durations of: ventilator use; ICU stay; general ward stay; post-operative hospital stay. But in the high risk group (risk score ＞ 2) of the post-operative pulmonary complications, the mean duration of postoperative hospitalization was reduced more significantly in Group 1 than 2 (6.03±1.03 vs. 9.24±3.29 days; p=0.012).The education for diaphragmatic breathing and coughing techniques before open-heart surgery in high risk patients of post-operative pulmonary complications decreased hospitalization and medical care costs.

並列關鍵字

open heart surgery ； pre-operative rehabilitation ； hospital days ； post-operative pulmonary complications