接受冠狀動脈繞道手術或心臟瓣膜手術患者第一期心肺復健－某醫學中心之經驗

Cardiac Rehabilitation after Coronary Artery Bypass Graft or Heart Valve Replacement Surgery-Experience of a Medical Center

劉鼎浩(Ding-Hao Liu) ； 陳怡蓁(Yi-Cheng Chen) ； 洪素鶯(Su-Ying Hung) ； 周正亮(Chen-Liang Chou)

《台灣復健醫學雜誌》 41卷3期 (2013/09) Pp. 181-188

https://doi.org/10.6315/2013.41(3)04

摘要

研究背景及目的：心臟復健的目的在穩定病人狀況、減少病人因臥床產生的合併症，減少焦慮及提供衛教，並做出院準備，使病人能勝任日常生活的活動。但是在台灣接受心臟復健的比例卻不高。此研究在探討本院經冠狀動脈疾病經繞道手術及心臟瓣膜手術的病人，接受心臟復健的現況。研究方法：本研究以病歷回顧的方法，回溯2011年1月到6月於台北榮民總醫院接受經冠狀動脈疾病繞道手術及心臟瓣膜手術的病人，總共101人納入統計資料，其中依據排除標準排除了26人。最後病人依疾病及開刀的方式分為兩組，分別是經冠狀動脈繞道手術組37人及心臟瓣膜手術組38人。資料收集包括了加護病房及一般病房住院天數、心臟外科醫師照會復健部時間、復健部醫師評估時間、物理治療人員開始治療時間及總治療次數、出院後門診追蹤情形之紀錄等。研究結果：兩組住院時間接受心臟復健治療（100%）。經冠狀動脈繞道手術組病人平均住院天數為28.5±19.2天，心臟瓣膜手術組則是22.9±8.8天。病人入院到開立會診復健科醫師的時間，冠狀動脈組37.3±56.0小時；心臟瓣膜組18.7±26.4小時。復健科醫師會診完至第一次做到心臟復健時間為冠狀動脈組10.6±22.4小時，心臟瓣膜組15.6±20.6小時。經冠狀動脈繞道組出院後六個月內在復健科接受第二期心臟復健者7人（18.9%）。心臟瓣膜手術組在出院後六個月內在復健科接受第二期心臟復健者5人（13.1%）。結論：病人接受第一期心肺復健比率為百分之百，治療次數與一般病房住院天數、加護病房住院天數及總住院天數成正相關。病患出院後之第二期心臟復健比率不高。未來應加強對病患及心臟外科醫師宣導第二期心臟復健之重要性，建議病人出院時能例行性轉介至心臟復健門診就醫，改善第二期心臟復健之參與率。

關鍵字

心臟復健（cardiac rehabilitation） ； 經冠狀動脈繞道手術（coronary artery bypass graft surgery） ； 心臟瓣膜手術（heart valve replacement） ； 醫療品質（healthcare quality）

並列摘要

Background and Purpose: Cardiac rehabilitation (CR) is a long-term program that includes exercise prescription, education, and counseling on the limitation of physiological and psychological effects of cardiac disease and to enhance the psychosocial and vocational status of selected patients. In spite of CR being approved for patients who have experienced the consequences of coronary artery disease and for those who have had heart valve surgery, CR is widely underused. The aim of this study was to research the current status of CR for patients receiving coronary artery bypass graft (CABG) or heart valve replacement (HVR) in a medical center in Taiwan.Methods: We retrospectively reviewed the medical records of 101 patients who received CABG or HVR at our hospital from January to June 2011 to investigate the consultation process and participation in CR. We excluded 26 patients who did not meet our criteria. 75 patients were enrolled and divided into two groups (CABG: 37; HVR: 38). Baseline information, hospital duration, and the phase I CR process were all recorded.Results: Both groups had received phase I CR (100%) during hospitalization. The mean hospitalization duration was 28.5±19.2 hours (CABG) and 22.9±8.8 hours (HVR). Mean duration from admission to consultation was 37.3±56.0 hours (CABG) and 18.7±26.4 hours (HVR); for completing consultation, 18.8±12.5 (CABG) and 19.3±10.9 hours (HRV); for initiating therapy after CR prescription, 10.6±22.4 (CABG) and 15.6±20.6 hours (HRV). Only 12 patients 7(CABG) and 5(HVR) continued regular follow-up and entered phase II CR.Conclusions: All patients receiving CABG or HVR participated in the phase I CR programs. The participation rate in phase II CR was very low. To improve the phase II CR participation rate in the further, emphasizing the importance of phase II CR to the patient and the cardiac surgeon and facilitating the process of outpatient transfer should be considered.