Comparison of the effect of implementation of two protocols of early movement on pain intensity, arterial blood oxygenation saturation level, hemodynamic indices in patients undergoing coronary bypass surgery: a single-blind clinical trial.
Abstract
Background: immobility in patients undergoing coronary artery bypass surgery after surgery due to long-term general anesthesia, wide surgical incision of the sternum, involvement of vital organs during surgery, tracheal intubation can lead to numerous complications. Among other things, hemodynamic, pulmonary, muscular, and neurological complications should be recognized.
Although many evidences show that starting early movements can reduce postoperative complications in different patients, there is still no consensus on the application of the standard protocol of early movements in this group of patients. The purpose of this study is to compare the effect of two early movement protocols (early movement with pulmonary-respiratory physiotherapy exercises) and progressive early movement protocol on pain intensity, arterial blood oxygenation saturation level, hemodynamic indicators, frequency of postoperative complications and duration. The stay in the hospital in patients undergoing coronary artery bypass surgery after the surgery was in order to achieve the best method in performing early movement in this group of these patients.
method: This study is a three-arm, single-blind clinical trial with the participation of 105 patients undergoing coronary artery bypass surgery. the first intervention group; progressive early movement (n=34), second intervention group; early movement along with lung exercises-respiratory physiotherapy (n=35), control group; hospital routine intervention (n=36).The ratio was 1:1:1. Allocation sequence was generated by a person not involved in the research using RAS software for allocation in three groups. The study variables were measured in the first five days after surgery in two shifts, morning and evening. After the first measurement, the intervention was performed and pain intensity, hemodynamic indicators immediately and 15 minutes after the intervention and arterial oxygen saturation, pulmonary complications after interventions and duration Hospital stay was measured on the day of discharge after the intervention was measured Data analysis was done using SPSS version 24 software. Quantitative data were compared using one-way ANOVA and qualitative data were compared between groups using Chi-Square Test and Fisher Exact Test. TUKY test was used to compare study variables between groups. The significance level for the statistical tests used was P<0.05.
results: The results of the study showed that after the intervention, the hemodynamic indices in the two groups receiving progressive early movement and early movement with breathing exercises compared to the control group In some items, such as pulse number and diastolic blood pressure, there was a statistically significant difference (P<0.05), but there was no statistically significant difference in the cases of diastolic blood pressure, pulse pressure, and mean arterial blood pressure(P>0/05). Also, after the intervention, the intensity of pain in the two groups receiving early movement and breathing exercises compared to the control group had no statistically significant difference (p=0.65), but the second intervention group was better than the first intervention group and the control group Pain was reduced (p=0.002) Also, In terms of the mean percentage of arterial oxygen saturation, there was a statistically significant difference in the group receiving early movement and breathing exercises and the group receiving early movement in comparison with the group receiving routine care (p=0.001).
There was no statistically significant difference regarding the length of stay in the hospital between the study groups. (p=0.55), no postoperative complications (pulmonary complications and deep vein thrombosis) were observed after the intervention.
Discussion and conclusion: Based on the findings of this study, the hemodynamic indices in the patients of the second intervention group (early movement with breathing exercise) are higher compared to the first intervention group (progressive early movement) and the control group (routine movement). Was. Also, the amount of pain in the patients of the second intervention group (early movement with breathing exercise) was less than the patients of the first intervention group and the control group. The level of arterial oxygen saturation in the second intervention group (early movement with breathing exercises) was higher than the other two groups. Therefore, early movement with more emphasis on pulmonary exercises and combining with movement exercises can be used as an effective method by nurses in the standard care of the intensive care unit to reduce postoperative complications and improve clinical outcomes. It is recommended to conduct multicenter clinical trial studies with more participants in this field.