Koroner arter bypass greft cerrahisi sonrası erken dönemde uygulanan kardiyak rehabilitasyonun etkinliği
Effectiveness of early cardiac rehabilitation after coronary artery bypass graft surgery
Yazar: RAZİYE CEYLAN
Danışman: PROF. DR. RENGİN DEMİR
İstanbul Üniversitesi-Cerrahpaşa / Lisansüstü Eğitim Enstitüsü / Kardiyoloji Ana Bilim Dalı
Derece: Doktora, 2024
Konu: Fizyoterapi ve Rehabilitasyon = Physiotherapy and Rehabilitation

Özet:
Amaç: Çalışmanın amacı, koroner arter bypass greft (CABG) cerrahisi geçiren yaşlı hastalarda taburculuk sonrası erken dönemde (post-op 2. hafta) uygulanan faz II kardiyak rehabilitasyon (KR) programının fonksiyonel kapasite, yaşam kalitesi, dispne, kas kuvveti, kırılganlık ve vücut kompozisyonu üzerine etkilerinin incelenmesidir. 
Yöntem: Çalışmaya CABG cerrahisi geçirmiş klinik durumu stabil 65-86 yaşları arasında 44 hasta dahil edildi. Hastalar randomize olarak tedavi (n=22) ve kontrol (n=22) gruplarına ayrıldı. Tüm hastalar başlangıçta ve 8 hafta sonra değerlendirildi. İlk değerlendirmelerden sonra tüm hastalara sekonder korunma yaklaşımları konusunda eğitim ve ev egzersiz programı verildi. Bunlara ek olarak tedavi grubundaki hastalara 8 hafta boyunca haftada 3 seans 60 dakika gözetim altında KR programı uygulandı. Hastaların fonksiyonel kapasitesi '6 Dakika Yürüme Testi' (6DYT), yaşam kalitesi 'Macnew Kalp Hastalığı Sağlıkla İlgili Yaşam Kalitesi Ölçeği' (MYKÖ), dispne düzeyi 'Modifiye Medical Research Council (MMRC) Dispne Skalası', el kavrama kuvveti 'Dijital El Dinamometresi', kırılganlık düzeyi 'Frail Kırılganlık Ölçeği' ve 'Kısa Fiziksel Performans Bataryası (KFPB)' ve vücut kompozisyonu 'Biyoelektriksel Empedans Analizi Cihazı' ile değerlendirildi. 
Bulgular: Dispne düzeyi, el kavrama kuvveti, frail kırılganlık ölçeği skorunda görülen anlamlı iyileşmelerin her iki grup için de benzer olduğu saptandı (p>0.05). Tedavi grubunda kontrol grubuna göre 6DYM, yaşam kalitesi ve kısa fiziksel performans bataryası total skorunda istatistiksel olarak daha fazla anlamlı gelişme elde edildi (p<0.05). Vücut yağ yüzdesinde tedavi grubunda anlamlı azalma görülürken (p<0.05), kontrol grubunda anlamlı artış (p<0.05) olduğu ve vücut yağ yüzdesinde görülen değişimin tedavi grubunun lehine olduğu (p<0.05) saptandı. 
Sonuç: CABG cerrahisi sonrası erken dönemde ev programı ile birlikte hastanede gözetim altında uygulanan Faz II KR programının fonksiyonel kapasite, yaşam kalitesi, fiziksel performans parametreleri ve vücut yağ yüzdesinde sadece evde uygulanan programa göre daha fazla iyileşme sağlayabileceği sonucuna varıldı.

Abstract:
Objective: The aim of this study is to investigate the effects of phase II cardiac rehabilitation (CR) program, applied during the early post-discharge period (2nd week post-op), on functional capacity, quality of life, dyspnea, muscle strength, frailty and body composition in elderly patients who have undergone coronary artery bypass graft (CABG) surgery. 
Method: The study included 44 clinically stable patients, aged 65-86 years, who had undergone CABG surgery. Patients were randomly divided into treatment (n=22) and control (n=22) groups. All patients were evaluated at baseline and after 8 weeks. After the initial evaluations, all patients were given education on secondary prevention approaches and a home exercise program. In addition, patients in the treatment group underwent a supervised CR program for 60 minutes, 3 sessions per week for 8 weeks. Patients were assessed by measurement of functional capacity levels with '6 Minute Walk Test (6MWT)', quality of life with 'Macnew Heart Disease Health-Related Quality of Life Scale (MHQOL)', dyspnea level with 'Modified Medical Research Council (MMRC) Dyspnea Scale', hand grip strength with 'Digital Hand Dynamometer', frailty level with 'Frail Frailty Scale' and 'Short Physical Performance Battery (SPPB)' and body composition with 'Bioelectrical Impedance Analysis Device'. 
Findings: Significant improvements in dyspnea level, hand grip strength, frailty scale score were found to be similar for both groups (p>0.05). Statistically significant improvements were achieved in the treatment group compared to the control group in 6MWD, quality of life and short physical performance battery total score (p<0.05). While there was a significant decrease in body fat percentage in the treatment group (p<0.05), there was a significant increase in the control group (p<0.05) and the change in body fat percentage was in favor of the treatment group (p<0.05). 
Conclusion: It was concluded that the Phase II CR program applied under hospital supervision together with the home program in the early period after CABG surgery could provide greater improvements in functional capacity, quality of life, physical performance parameters and body fat percentage than the program applied only at home.