| Background: Coronary artery disease(CAD)continues to be a major cause of morbidity and mortality around the world and is a growing problem in many countries.Coronary artery bypass graft surgery(CABG)is commonly used on patients with severe coronary artery disease either on the left anterior descending artery,circumflex artery,and/or right coronary artery.The benefits of cardiac rehabilitation(CR)for patients with cardiovascular disease have been fully recognized internationally,but early cardiac rehabilitation treatment for patients undergoing coronary artery bypass grafting has not been included in clinical pathways in China,and patient functional outcomes are often overlooked in previous studies.In addition,there is still controversy about whether patients should be rehabilitated in the intensive care unit(ICU)as soon as possible after CABG.Therefore,there are three purposes of this study.1.Conducting randomized controlled trials of early CR in patients with CABG,to provide data support for the promotion of early CR;2.Exploring the benefits of early CR in patients after CABG,especially in terms of functional outcomes;3.Exploring the safety and importance of cardiac rehabilitation in the ICU.Methods: A three-arm randomized controlled trial was conducted in patients after CABG.There were no significant differences in baseline demographic and perioperative variables between the groups.The age of the UC group was 63.0±8.7 years,the mean age of the SGR group was 64.1±5.3 years,and the mean age of the IGR group was 63.6±6.5 years.One hundred and forty patients aged ≥ 60 years were randomly assigned to the usual care(UC)group(n=46),the single general ward rehabilitation(SGR)group(n=47),or the ICU plus general ward rehabilitation(IGR)group(n=47).The primary outcomes were the 6-minute walk distance(6-MWD)and the Barthel Index scores at discharge from the hospital.The secondary outcomes were postoperative complications,length of ICU stay,and hospital stay.Results: The 6-MWD for UC(144.4±20.9 m)was significantly lower than that of both the SGR(210.6±35.1 m,p=0.002)and the IGR(230.1±40.6 m,p=0.001).There was no significant difference in the 6MWT distance between the SGR and the IGR(p=0.144).Similar results were found in the Barthel Index scores for the UC(75.3±12.1),the SGR(86.2±14.1),and the IGR(89.1±15.5).The length of ICU stay and hospital stay for the IGR was the shortest among the three groups.The differences between the IGR and the SGR in ICU stay and hospital stay were significant(44.2±13.0 hours vs.49.3±14.2 hours,p=0.022;6.84±1.24 days vs.7.01±1.32 days,p=0.040,respectively).Statistically significant differences were not found in postoperative in-hospital complications among the three groups.Conclusions: Early CR during hospitalization after CABG can significantly improve the functional ability and functional independence of elderly patients at discharge,so that patients have a better psychological and emotional state,which helps patients return to their families and society.We also validated that patients with CABG are safe and effective in early cardiac rehabilitation in the ICU,and ICU rehabilitation is an integral part of the overall cardiac rehabilitation process. |
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