探討冠狀動脈繞道手術後病患身體功能的改變

Abstract

身體功能下降是冠狀動脈繞道手術後常見的現象，影響病患日常活動的獨立，增加未來失能的機率，因此本研究目的主要在探討冠狀動脈繞道手術前、後，病患身體功能改變的趨勢及其相關因素。本研究為結構性觀察研究，以北部某醫學中心預定施行冠狀動脈繞道手術的住院病患為對象，自2010年4月至2010年9月共收案42位，使用結構式問卷收集其基本資料和疾病特性，並利用身體活動問卷、疼痛量表、巴氏量表、手握式肌力測量儀和六分鐘步行測試，分別於術前、出院前及出院後2-4週測量其日常活動功能、肌肉力量及行動能力等相關資料，經由三次之縱貫式資料收集，分析病患於冠狀動脈繞道手術後，其身體功能改變的程度以及變化曲線。以曼惠尼U檢定（Manne Whitney U test）、Wilcoxon符號等級檢定（Wilcoxon signed-rank test）、史皮爾曼相關（Spearman’s correlation）及皮爾森積差相關(Pearson’s correlation)分析基本屬性及疾病特性與日常活動功能、肌肉力量及行動能力之差異及相關性，並以p<0.05為統計上顯著差異。結果顯示（1）日常活動功能方面，相較於II級，手術前NYHA(New York Heart Association)Ⅲ級者，出院後2-4週的巴氏量表分數改善較明顯（p=0.009）。當病患存在共病症種類越多，或是共病症越嚴重（查爾森共病症量表得分高），其出院後2-4週的巴氏量表分數改善（T2-T１）更多（p=0.011, 0.034）。（2）行動能力部分，出院後2-4週的六分鐘步行距離顯著高於手術前（p=0.015），其中LVEF較高（≧60%）者，恢復越顯著（p=0.019），亦發現有從事家事活動與運動習慣者，步行距離進步越多。整體而言，日常活動功能及行動能力可在出院後2-4週恢復至術前水準，唯肌肉力量恢復時間較長，建議護理人員及復健師可針對此部分加強病患指導，亦提供未來臨床人員照護此類病患之參考。

Decline in physical function is common among patients undergoing coronary artery bypass graft (CABG) surgery. The purpose of this study was to explore the changes of physical function 2-4 weeks following hospitalization and their correlates in patients underwent CABG surgery. From April to September 2010, 42 subjects who scheduled for an elective CABG were enrolled from a 2200-bed medical center in Taipei. Data on demographics, severity of illness, perception of pain, activities of daily function (ADLs; measured by Barthel Index), hand muscle strength (measured by hand-held dynamometer), and functional capacity (measured by 6-minute walking test) were assessed at three time points: admission, discharge, and 2-4 weeks after discharge. The results showed that physical function including ADLs, hand muscle strength, and functional capacity were at the lowest point by discharge but ADLs and functional capacity recovered to admission baseline by 2-4 weeks after discharge. Subjects with lower NYHA functional levels had significant more improvement on Barthel Index (p=0.009). Conversely, more improvement on functional capacity were seen in the subjects whose LVEF ≧60% compared to their counterparts (65.3 m vs. -8.2 m; p=0.019). These findings provided insights on changes of physical function for Taiwanese patients underwent CABG surgery.