Clinical Study Of Early Mobilization After Pacemaker Implantation Based On Evidence-based Medicine

Part 1Objective: To Meta-analysis the safety and comfort of early versus late ambulation after pacemaker implantation,and to determine the optimal duration of bed rest.Methods: Resources are from Pub Med,Cochrane Library,EMBASE,Web of science,CBM,CNKI,Wanfang database,and supplemented by other retrievals.collected all randomized controlled trials(RCTs)on early postoperative mobilization within 3~6h versus mobilization after 24 h.Assessed the quality of the included RCTs according to " Risk of bias assessment " from Cochrane Handbook 5.0,used Rev Man5.3 software to run meta-analysis.Results: Seven RCTs were collected including 991 cases.The results of Meta analysis: Safety Assessment,there was no statistically significant difference in electrode dislocation and pocket bleeding between early postoperative mobilization within 3~6h and mobilization after 24h(all P > 0.05);Comfort Assessment,shoulder and elbow ache [RR=0.21,95%CI(0.12,0.36),P<0.01],back aches [RR=0.19,95%CI(0.13,0.28),P<0.01],difficulty in urinating or urinary retention [RR=0.09,95%CI(0.05,0.17),P<0.01],defecation difficulties or constipation [RR=0.17,95%CI(0.09,0.31),P<0.01],sleep disorder [RR=0.25,95%CI(0.16,0.38),P<0.01],the differences are statistically significant.Conclusion: The early mobilization within 3~6h after pacemaker implantation does not increase the risk of lead dislocation and pocket bleeding,and may enhance patient comfort.It's the optimal duration of bed rest.Part 2Objective: Based on evidence-based medicine,to investigate the feasibility of early mobilization(three hours after implantation of pacemaker)of patients.Methods: Among permanent pacemaker implantations and replacement surgeries conducted in The First Hospital of Lanzhou University from June 2016 to March 2017,240 cases meeting the inclusion and exclusion criteria of patients are taken as the research subjects,and they are randomly divided into experimental group(117 cases,mobilization after 3 hours)and control group(123 cases,mobilization after 24 hours).Comparisons have been made in terms of safety,comfort and economy between the early 3 h and the routine 24 h after pacemaker implantation.Results: the early mobilization after 3 hours versus the mobilization after 24 hours : there were no statistically significant differences between the two groups(P >0.05)in terms of the changes of heart rate and blood pressure(before and after the first bed ambulation),the electronic parameters(after the implantation,before discharge and on1,3,6 months later),incidence of postoperative complications;the back pain scores at different times after operation are lower,the time after implantation for first defecation is less,the occurrences of first defecation difficulties are less,the actual sleep time at night is longer,the postoperative hospital stay is less(P=0.000),and the total hospitalization expenses by the early mobilization after 3 hours are less(P=0.015).Conclusion: It is safe to permit the mobilization of patients three hours after pacemaker implantation,which can improve the comfort of patients and reduce the economic burden of patients' families.It is suggested that it could be popularized in clinical practice.