KORONER ARTER BYPASS GREFT CERRAHİSİ SONRASI KARDİYOPULMONER REHABİLİTASYON VE NÖROMÜSKÜLER ELEKTRİK STİMÜLASYONUN FONKSİYONEL KAPASİTE, MİYOKARDİAL DOKU DOPPLERİ ÜZERİNDEKİ KISA DÖNEM ETKİLERİ

Öz

Amaç: Egzersiz kapasitesi diyastolik fonksiyonla ilişkilidir. Çalışmamızın amacı, koroner arter cerrahisi sonrası kardiyopulmoner rehabilitasyon ve NMES'in fonksiyonel kapasite ve miyokard doku doppleri (MDD) üzerine kısa dönem etkilerini araştırmaktır. Yöntemler: Koroner arter baypas greftli kırk hasta rastgele iki gruba ayrıldı: CPR+NMES ve CPR. Fonksiyonel kapasite 2 dakika yürüme testi (2DYT) ve otur kalk testi (SST), sol ventrikül diyastolik (LV) fonksiyonları MDD ile, göğüs ekspansiyonu göğüs duvarı ölçümü ile postoperatif 2. ve 7. günlerde analiz edildi. Sonuçlar: Gruplar arasında, 2DYTmesafe (CPR+NMES, Zt*p=0,000*), SST (CPR, Zt*p=0,000*), E’ (CPR+NMES, Zt*p=0,002*), E (CPR+NMES, Zt*p=0,025*), E/E’ (CPR+NMES, Zt*p=0,007*), A (CPR, Zt*p=0,006*) istatistiksel olarak anlamlı fark tanımlanmıştır (p<0,05). Grup içi karşılaştırmalarda E’ (CPR+NMES, G*p=0,000*) ve E/E’ (CPR+NMES, G*p=0,007* postoperatif 2. gün; G*p=0,019* postoperatif 7.gün) istatistiksel olarak anlamlı fark gözlenmiştir (p<0,05). E' (Zg*p=0,000*), E/E' (Zg*p=0,003*) parametreleri hariç (p<0,05), 2DYT mesafe, kalp hızı, kan basıncı, solunum frekansı, saturasyon ve Borg dispne-yorgunluk ölçümleri zamana göre gruplar arasında istatistiksel farklılık göstermedi (p>0,05). Tartışma: Erken dönem kardiyopulmoner rehabilitasyona ek olarak uyguladığımız NMES'in, CPR + NMES grubundaki LV dolum basıncına ve LV dolum hızına olumlu bir katkı yaptığı görülmüştür. Ayrıca CPR + NMES grubunun gruplar arası karşılaştırmalarında, postoperatif 7. günde postoperatif 2. güne kıyasla 2DYT mesafesinde istatistiksel olarak anlamlı bir artış olduğu görülmüştür.

Anahtar Kelimeler

• Kardiyopulmoner Rehabilitasyon
• Koroner Arter Baypas Greft
• Fonksiyonel Kapasite
• NMES
• Doku Doppleri

SHORT TERM EFFECTS OF CARDIOPULMONARY REHABILITATION AND NEUROMUSCULAR ELECTRICAL STIMULATION ON FUNCTIONAL CAPACITY, MYOCARDIAL TISSUE DOPPLER AFTER CORONARY ARTERY BYPASS GRAFT SURGERY

Abstract

Purpose: Exercise capacity is associated with diastolic function. The aim of our study is to investigate the short term effects of cardiopulmonary rehabilitation and NMES on functional capacity and myocardial tissue doppler (MTD) after coronary artery surgery. Methods: Forty patients with coronary artery bypass graft were randomly divided into two groups: CPR+NMES and CPR. Functional capacity were analyzed through 2 minutes walk test (2MWT) and sit to stand test (SST), left ventricular (LV) diastolic functions were analyzed with MTD and thoracic expansion was analyzed with chest wall measurement on the 2nd and 7th postoperative days. Results: Statistically significant difference was identified between the groups in 2MWT distance (CPR+NMES, Zt*p=0.000*), SST (CPR, Zt*p=0.000*), E’ (CPR+NMES, Zt*p=0.002*), E (CPR+NMES, Zt*p=0.025*), E/E’ (CPR+NMES, Zt*p=0.007*), A (CPR, Zt*p=0.006*) (p<0.05). Statistically significant difference has been observed in group comparisons in E’ (CPR+NMES, G*p=0.000*) ve E/E’(CPR+NMES, G*p=0.007* postoperative 2nd day; G*p=0.019* postoperative 7th day) (p<0.05). The temporal changes of 2MWT distance, heart rate, blood pressures, respiratory frequency, saturation and Borg dyspnea-fatigue measurements did not show a statistically significant difference between groups (p>0.05), except for E'(Zg*p=0.000*), E/E' (Zg*p=0.003*) parameters (p<0.05). Conclusion: It was seen that NMES, which we applied in addition to early cardiopulmonary rehabilitation, made a positive contribution to LV filling pressure and LV filling rate in the CPR+NMES group. Additionally, in the intergroup comparisons of the CPR+NMES group, it was observed that there was a statistically significant increase in the 2 MWT distance on the postoperative 7th day compared to the postoperative 2nd day.

Keywords

• Cardiopulmonary Rehabilitation
• Coronary Artery Bypass Graft
• Functional Capacity
• NMES
• Tissue Doppler

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