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Objective:To study the effect of cardiac rehabilitation program on recovery of patients after small incision aortic valve replacement.Methods:600 patients who underwent small incision aortic valve replacement in our hospital from January 2015 to January 2020 were retrospectively collected and divided into Cardiac rehabilitation group(CR) and control group by propensity matching analysis. Clinical data of CR group and control group were collected 6 months and 12 months after the beginning of Cardiac rehabilitation program. The primary outcome measures were the peak oxygen uptake(VO 2 Peak) of cardiopulmonary function test and the number of patients attending cardiovascular specialty in tertiary hospitals after the rehabilitation program began. The secondary outcome measures were 6-minute Walk test(6-MWT), psychological evaluation, and assessment of cardiovascular disease risk factors. Results:After 6 months and 12 months of cardiac rehabilitation program, the VO2 peak in CR group was statistically significant compared with the control group, and the 6-MWT index after 12 months was statistically significant.The cardiovascular specialist visits in tertiary hospitals in the two groups were statistically significant. The comparison of psychological self-rating scale and cardiovascular disease risk factors between the two groups was statistically significant after propensity matching analysis.Conclusion:Cardiac rehabilitation has a positive effect on postoperative recovery after small incision aortic valve replacement, and can improve patients’ motor ability.
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Objective:To investigate the effect of remote ischemic preconditioning combined with postconditioning (RIPC+ RIPostC) on postoperative delirium (POD) in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods:Eighty patients aged 44-64 years old and scheduled to elective heart valve replacement under CPB in the operating room of our hospital were recruited and divided into control group (group C) and group R according to random number table method, with 40 cases in each group. Patients in group R underwent RIPC 30 minutes before the start of CPB and RIPostC 30 minutes before the end of CPB. The specific treatment measures were as follows: tie an inflatable cuff on the patient' s lower limb, inflate and pressurize until the pressure to 200 mmHg, hold for 5 minutes, and then completely deflate the cuff until the pressure to 0; after 5 minutes, inflate and pressurize again, and repeat for 3 cycles. The cuff was tied to the patient' s lower limb, but no inflation and deflation were performed in group C. Peripheral venous blood was drawn 1 day before operation and 1 day and 3 days after operation, and blood routine was determined. POD was assessed by the intensive care unit (ICU) consciousness disturbance assessment method (CAM-ICU) within 3 days after the operation. Neurocognitive testing was performed preoperatively, at discharge, and 3 months postoperatively, and postoperative cognitive dysfunction (POCD) and dementia (AD) were assessed using the Mini-Mental State Examination Scale (MMSE), with exclusion of preoperative patients with <24 points. Intraoperative and postoperative adverse events including sinus bradycardia or hypotension/hypertension, postoperative infection, etc. were recorded. The length of hospital stay and 90-day mortality were recorded. After 3 months, data related to sleep, quality of life, anxiety and pain were collected using questionnaires.Results:The white blood cell count, neutrophil count and percentage of neutrophils in the two groups at 1 day and 3 days after operation were all higher than those at 1 day before operation, but the indexes in group R was significantly lower than those in group C ( P<0.05). A total of 13 patients (32.5%) in group C developed POD within 3 days after surgery, while 27 patients (67.5%) did not develop POD, and there was a significant difference between the groups ( P<0.05). A total of 5 patients (12.5%) in group R developed POD within 3 days after surgery, and 35 patients (87.5%) did not develop POD. At the 90-day follow-up, there was no difference in the MMSE score compared with the baseline ( P>0.05). A total of 4 patients (10%) developed neurocognitive dysfunction after surgery. There was no difference in the incidence of POCD between the two groups ( P>0.05). The incidence of adverse events such as bradykinesia, hypotension/hypertension, and postoperative infection were similar between the two groups, and there was no significant difference ( P>0.05). During the 90-day follow-up period after surgery, no patient died in either group. There was no significant difference in postoperative hospital stay between the two groups ( P>0.05). Using the EQ-5D questionnaire to evaluate the quality of life of the two groups of patients, the results showed that there was no statistically significant difference between the two groups ( P>0.05). At 3 months after operation, there was no significant difference in sleep quality between the two groups ( P>0.05). Conclusion:RIPC+ RIPostC can reduce the inflammatory response, reduce the incidence of POD and improve the quality of life after operation in patients with heart valve replacement under CPB.