经导管主动脉瓣植入术后的早期动员:观察性队列研究。

IF 2.9 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS European Journal of Cardiovascular Nursing Pub Date : 2024-04-12 DOI:10.1093/eurjcn/zvad081
Sandra B Lauck, Maggie Yu, Carrie Bancroft, Britt Borregaard, Jopie Polderman, Anna L Stephenson, Eric Durand, Mariama Akodad, David Meier, Holly Andrews, Leslie Achtem, Erin Tang, David A Wood, Janarthanan Sathananthan, John G Webb
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引用次数: 0

摘要

目的:早期动员与改善住院老年患者的预后有关。我们试图确定在不同的护理单元中,由护士主导的方案对经食道经导管主动脉瓣植入术(TAVI)术后 4 小时动员的影响:我们对连续患者进行了前瞻性单中心队列观察研究。我们在重症监护室和心脏遥测室实施了安全早期恢复和逐步移动的标准化方案。我们测量了首次移动的时间,并进行了描述性统计,以确定患者和系统在及时移动方面的障碍。我们招募了 139 名患者(82.5 岁,SD = 6.7;46% 为女性)。基线时,早期动员(≤4 小时)和晚期动员(>4 小时)的患者没有差异,只是晚期动员组的糖尿病(25.5% 对 43.9%,P = 0.032)和外周动脉疾病(8.2% 对 26.8%,P = 0.003)发病率更高。动员时间的中位数为4小时[四分位数间距(IQR)为3.25,4];98名患者(70.5%)在卧床4小时后成功动员;118名患者(84.9%)在术后当晚就能行走(结论:在没有临床并发症和系统障碍的情况下,TF TAVI术后4小时在护士指导下进行标准化移动是可行的。
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Early mobilization after transcatheter aortic valve implantation: observational cohort study.

Aims: Early mobilization is associated with improved outcomes in hospitalized older patients. We sought to determine the effect of a nurse-led protocol on mobilization 4 h after transfemoral transcatheter aortic valve implantation (TAVI) across different units of care.

Methods and results: We conducted a prospective observational cohort single-centre study of consecutive patients. We implemented a standardized protocol for safe early recovery and progressive mobilization in the critical care and cardiac telemetry units. We measured the time to first mobilization and conducted descriptive statistics to identify patient and system barriers to timely ambulation. We recruited 139 patients (82.5 years, SD = 6.7; 46% women). At baseline, patients who were mobilized early (≤4 h) and late (>4 h) did not differ, except for higher rates of diabetes (25.5% vs. 43.9%, P = 0.032) and peripheral arterial disease (8.2% vs. 26.8%, P = 0.003) in the late mobilization group. The median time to mobilization was 4 h [inter-quartile range (IQR) 3.25, 4]; 98 patients (70.5%) were mobilized successfully after 4 h of bedrest; 118 (84.9%) were walking by the evening of the procedure (<8 h bedrest); and 21 (15.1%) were on bedrest overnight and mobilized the following day. Primary reasons for overnight bedrest were arrhythmia monitoring (n = 10, 7.2%) and haemodynamic and/or neurological instability (n = 6, 4.3%); six patients (4.3%) experienced delayed ambulation due to system issues. Procedure location in the hybrid operating room and transfer to critical care were associated with longer bedrest times.

Conclusion: Standardized nurse-led mobilization 4 h after TF TAVI is feasible in the absence of clinical complications and system barriers.

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来源期刊
European Journal of Cardiovascular Nursing
European Journal of Cardiovascular Nursing CARDIAC & CARDIOVASCULAR SYSTEMS-NURSING
CiteScore
5.10
自引率
10.30%
发文量
247
审稿时长
6-12 weeks
期刊介绍: The peer-reviewed journal of the European Society of Cardiology’s Council on Cardiovascular Nursing and Allied Professions (CCNAP) covering the broad field of cardiovascular nursing including chronic and acute care, cardiac rehabilitation, primary and secondary prevention, heart failure, acute coronary syndromes, interventional cardiology, cardiac care, and vascular nursing.
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