Skip to main content Skip to main navigation menu Skip to site footer
Articles
VIEWS: 212
Published: 2019-07-30

Intervensi Rehabilitasi Jantung Fase I pada Pasien yang Menjalani Operasi Bedah Pintas Koroner (BPK): Literatur Review

cardiac rehabilitation phase I coronary artery bypass grafting early ambulation early mobilization

Abstract

Pasien yang menjalani operasi Bedah Pintas Koroner (BPK) atau coronary artery bypass grafting (CABG) memiliki risiko terjadinya komplikasi pasca operasi yang berakibat pada hari rawat yang lama bahkan kematian. Intervensi berupa rehabilitasi jantung fase I diperlukan untuk membantu mempercepat proses pemulihan pasca operasi serta mencegah terjadinya komplikasi pasca operasi BPK. Meskipun penelitian terkait rehabilitasi jantung sudah banyak dilakukan, namun perlu dilakukan telaah lebih lanjut dari artikel penelitian mengenai intervensi yang dapat dilakukan dalam program rehabilitasi jantung yang aman dan mudah dilakukan pada pasien pasca operasi BPK. Tujuan penelitian ini adalah untuk melihat intervensi yang aman dan efektif dilakukan dalam rehabilitasi jantung fase I pada pasien yang menjalani operasi BPK. Studi literatur ini dibuat dengan melakukan analisis terhadap atikel-artikel ilmiah minimal penelitian retrospektif yang dipublikasi tahun 2008 sampai 2018 dan berbahasa Inggris. Data didapat dari database meliputi Google Scholar, PubMed, DOAJ, dan Proquest dengan kata kunci cardiac rehabilitation phase I, coronary artery bypass grafting, early ambulation, early mobilization, education pre operative, dan physical exercise. Hasil studi literatur ini didapatkan 13 artikel yang sesuai dengan kriteria inklusi dan eksklusi. Hasil telaah ditemukan bahwa pelaksanaan rehabilitasi jantung fase I pada pasien yang menjalani operasi BPK dimulai dari fase praoperasi dan dilanjutkan pasca operasi sampai pasien akan pulang. Intervensi rehabilitasi jantung fase I, baik pre maupun pasca operasi, terdiri dari edukasi dan konseling, latihan/ aktivitas fisik, latihan bernapas, latihan batuk efektif, inspiratory muscle training, fisioterapi dada, dan respiratory muscle stretch gymnastics. Oleh karena itu, hasil telaah literatur ini dapat menjadi dasar dalam menentukan standar prosedur operasional terhadap pelaksanaan rehabilitasi jantung fase I untuk rumah sakit yang menyediakan pelayanan operasi BPK.

Abstract

Cardiac Rehabilitation Phase I in Patient Undergoing Coronary Artery Bypass Grafting Surgery. A patient undergoing coronary artery bypass grafting CABG surgery has a risk of post operative complication, which can cause prolonged length of stay and even mortality. The patient necessarily needs to do intervention cardiac rehabilitation phase I to help the recovery process after surgery and prevent post operative complications. The articles related to cardiac rehabilitation have been carried out. However, it is necessary to review research articles about the effective and safe intervention of cardiac rehabilitation phase I for patients undergoing CABG surgery. The aim of this study was to explore the effective and safe intervention of cardiac rehabilitation phase I. This literature review was conducted by analyzing articles including randomized control trial until retrospective design which published between 2008 until 2018 with English language articles. Data was searched through Google Scholar, PubMed, DOAJ, and Proquest. The keyword was early ambulation, coronary artery bypass grafting, preoperative education, physical exercise, early mobilization, and cardiac rehabilitation phase I or inpatient cardiac rehabilitation. The finding in this literature review was 13 articles corresponding with the inclusion and exclusion criteria. The result of this study found that the intervention in cardiac rehabilitation phase I in patient who undergoing coronary artery bypass grafting surgery was started from preoperative and continued postoperative phases until the patient will leave the hospital. Interventions in cardiac rehabilitation phase I consisted of education and counseling, physical exercise/ activity, breathing exercises, effective cough exercises, inspiratory muscle training, chest physiotherapy, and respiratory muscle stretch gymnastics. Therefore, the result of this literature review can be the basis to determine standard operational procedure for the implementation of the cardiac rehabilitation phase I for the hospitals that provide CABG surgery.

Keywords: cardiac rehabilitation phase I, coronary artery bypass grafting, early ambulation, early mobilization.

References

  1. Akhtar, S.A., Ahmed, F., Grover, S., & Srivastava, S. (2015). Effect of respiratory muscle stretch gymnastics on pain, chest expansion, pulmonary functions and functional capacity in phase 1 post-operative CABG patients. Journal of Cardiology & Current Research, 2 (6), 1–5. https://doi.org/10.15406/jccr.2015.02.00084.
  2. Alexander, J.H., & Smith, P.K. (2016). Coronary artery bypass grafting. New England Journal of Medicine, 374 (20), 1954–1964. https://doi.org/10.1056/NEJMra1406944.
  3. Alkouri, O.A. (2016). Predictors of pulmonary complications among Jordanian post coronary artery bypass graft surgery patients.Research Journal of Biological Sciences, 11 (1), 43–48.
  4. Almashrafi, A., Elmontsri, M., & Aylin, P. (2016). Systematic review of factors influencing length of stay in ICU after adult cardiac surgery. BMC Health Services Research, 16 (1), 1–12. https://doi.org/10.1186/s12913-016-1591-3.
  5. American Heart Association. (2012). What Is Coronary Bypass Surgery? Retrieved from http://www.heart.org/HEARTORG/Conditions/What-Is-Coronary-Bypass-Surgery_UCM_309003_Article.jsp.
  6. Borzou, S.R., Amiri, S., Salavati, M., Soltanian, R., & Safarpoor, G. (2018). Effects of the first phase of cardiac rehabilitation training on self-efficacy among patients undergoing coronary artery bypass graft surgery. The Journal of Tehran University Heart Center, 13 (3), 126–131.
  7. Cassina, T., Putzu, A., Santambrogio, L., Villa, M., & Licker, M.J. (2016). Hemodynamic challenge to early mobilization after cardiac surgery : A pilot study. Annals of cardiac anaesthesia, 19 (3), 425.–432. https://doi.org/10.4103/0971-9784.185524.
  8. Contractor, A.S. (2011). Cardiac rehabilitation after myocardial infarction. Journal of the Association of Physicians of India, 59, 51–55.
  9. Depkes RI. (2006). Pharmaceutical care untuk pasien penyakit jantung koroner. Retrieved from https://binfar.depkes.go.id/bmsimages/1361351516.pdf.
  10. Dong, Z., Yu, B., Zhang, Q., Pei, H., Xing, J., Fang, W., ... Song, Z. (2016). Early rehabilitation therapy is beneficial for patients with prolonged mechanical ventilation after coronary artery bypass surgery. International Heart Journal, 57 (2), 241–246. https://doi.org/10.1536/ihj.15-316.
  11. Heart Foundation. (2011). Heart valve surgery. Retrieved from https://www.heartfoundation.org.au/images/uploads/publications/CON-083.v4_Heart_valve_surgery_2011-web.pdf.
  12. Ghashghaei, F.E., Sadeghi, M., Marandi, S.M.., & Ghashghaei, S.E. (2012). Exercise-based cardiac rehabilitation improves hemodynamic responses after coronary artery bypass graft surgery. ARYA Atherosclerosis, 7 (4), 151–156.
  13. Herdy, A.H., Marcchi, P.L., Vila, A., Tavares, C., Collaço, J., Niebauer, J., & Ribeiro, J.P. (2008). Pre-and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery: A randomized
  14. controlled trial. American journal of physical medicine & rehabilitation, 87 (9), 714–719. doi: 10.1097/PHM.0b013e3181839152.
  15. Kementerian Kesehatan RI. (2017). Penyakit Jantung Penyebab Kematian Tertinggi, Kemenkes Ingatkan CERDIK. Retrieved from http://www.depkes.go.id/article/view/17073100005/penyakit-jantung-penyebab-kematian-tertinggi-kemenkes-ingatkan-cerdik-.html
  16. Klopper, M., & Hanekom, S. (2014). The implementation of an intensity regulated exercise programme in coronary artery bypass graft surgery patients : A pilot randomised controlled trial. SA Heart, 11 (3), 136–142. https://doi.org/10.24170/11-3-1750.
  17. Leung, Y.W., Flora, D.B., Gravely, S., Irvine, J., Carney, R.M., & Grace, S.L. (2015). The impact of pre-morbid and post-morbid depression onset on mortality and cardiac morbidity among coronary heart disease patients: A meta-analysis. Psychosomatic Medicine, 74 (8), 786–801. https://doi.org/10.1097/PSY.0b013e31826ddbed.The
  18. Mendes, A., Simo, R.P., Souza, F.D.E., Costa, M., Bianca, C., Pantoni, F., ... Borghi-silva, A. (2010). Short-term supervised inpatient physiotherapy exercise protocol improves cardiac autonomic function after coronary artery bypass graft surgery–a randomised controlled trial. Disability and Rehabilitation, 32 (16), 1320–1327. https://doi.org/10.3109/09638280903483893.
  19. Moazzami, K., Dolmatova, E., Maher, J., Gerula, C., Sambol, J., Klapholz, M., & Waller, A. H. (2017). In-hospital outcomes and complications of coronary artery bypass grafting in the United States between 2008 and 2012. Journal of Cardiothoracic and Vascular Anesthesia, 31 (1), 19–25. https://doi.org/10.1053/j.jvca.2016.08.008.
  20. Modi, R., Bhise, A., & Patel, F. (2014). Effect of supervised moderate intensity exercise program in phase one cardiac rehabilitation of post operative CABG patients - a randomized controlled trail. International Journal of Physiotherapy, 1 (4), 215–219. https://doi.org/10.15621/ijphy/2014/v1i4/54561.
  21. Moradian, S.T., Najafloo, M., Mahmoudi, H., & Ghiasi, M.S. (2017). Early mobilization reduces the atelectasis and pleural effusion in patients undergoing coronary artery bypass graft surgery: A randomized clinical trial. Journal of Vascular Nursing, 35 (3), 141–145. https://doi.org/10.1016/j.jvn.2017.02.001.
  22. National Heart, Lung, and Blood Institute (NHLBI). (n.d.). Coronary Artery Bypass Grafting. Washington, US: the National Institutes of Health and the U.S. Department of Health and Human Services. Retrrieved from https://www.nhlbi.nih.gov/health-topics/coronary-artery-bypass-grafting.
  23. Nuraeni, A., Mirwanti, R., Anna, A., Prawesti, A., & Emaliyawati, E. (2016). Faktor yang memengaruhi kualitas hidup pasien dengan penyakit jantung koroner factors influenced the quality of life among patients diagnosed with coronary heart disease. Jurnal Keperawatan Padjadjaran, 4 (2), 107–116. Retrieved from http://jkp.fkep.unpad.ac.id/index.php/jkp/article/view/231/123.
  24. Parvand, M., Goosheh, B., & Sarmadi, A.R. (2016). Effect of cardiac rehabilitation on heart rate and functional capacity in patients after myocardial infarction. Iranian Rehabilitation Journal, 14 (3), 157–162. https://doi.org/10.18869/nrip.irj.14.3.157.
  25. Petrucci, L., Ramella, F.C., Ricotti, S., Carlisi, E., Di Natali, G., Messina, S., ... Dalla Toffola, E. (2013). Early rehabilitative treatment in aortocoronary bypass surgery. Giornale Italiano Di Medicina Del Lavoro Ed Ergonomia, 35 (2), 125–128.
  26. Santos, R.D., Ricci, A. ., Suster, A.B., Paisani, D.M., & Chiavegato, D.L. (2016). Effects of early mobilisation in patients after cardiac surgery: a systematic review. Physiotherapy (United Kingdom), 103 (1), 1–12. https://doi.org/10.1016/j.physio.2016.08.003.
  27. Savci, S., Degirmenci, B., Saglam, M., Arikan, H., Inal-Ince, D., Turan, H.N., & Demircin, M. (2011). Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: A randomized controlled trial. Scandinavian Cardiovascular Journal, 45(5), 286–293. https://doi.org/10.3109/14017431.2011.595820.
  28. Shakuri, S.K., Salekzamani, Y., Taghizadieh, A., Sabbagh-Jadid, H., Soleymani, J., Sahebi, L., & Sahebi, R. (2015). Effect of respiratory rehabilitation before open cardiac surgery on respiratory function: a randomized clinical trial. Journal of Cardiovascular and Thoracic Research, 7 (1), 13–17. https://doi.org/10.15171/jcvtr.2014.03.
  29. Soares, G., Ferreira, D., Gonçalves, M., Alves, T., David, F., Henriques, K., & Riani, L. (2011). Prevalence of major postoperative complications in cardiac surgery. International Journal of Cardiovascular Sciences, 24 (3), 139–146.
  30. Sobrinho, M.T., Guirado, G.N., & Silva, M.A.D.M. (2014). Preoperative therapy restores ventilatory parameters and reduces length of stay in patients undergoing myocardial revascularization. Brazilian Journal of Cardiovascular Surgery, 29(2), 221–228. https://doi.org/10.5935/1678-9741.20140021.
  31. Stein, R., Maia, C.P., Silveira, A.D., Chiappa, G.R., Myers, J., & Ribeiro, J.P. (2009). Inspiratory muscle strength as a determinant of functional capacity early after coronary artery bypass graft surgery. Archives of Physical Medicine and Rehabilitation, 90 (10), 1685–1691. https://doi.org/10.1016/j.apmr.2009.05.010.
  32. Tung, H.H., Shen, S.F., Shih, C.C., Chiu, K.M., Lee, J.Y., & Liu, C.Y. (2012). Effects of a preoperative individualized exercise program on selected recovery variables for cardiac surgery patients: a pilot study. Journal of the Saudi Heart Association, 24(3), 153–161. https://doi.org/10.1016/j.jsha.2012.03.002.
  33. Winkelmann, E.R., Dallazen, F., Beerbaum, A., Bronzatti, S., Lorenzoni, C.W., & Windmöller, P. (2015). Analysis of steps adapted protocol in cardiac rehabilitation in the hospital phase. Brazilian Journal of Cardiovascular Surgery, 30 (1), 40–48. https://doi.org/10.5935/1678-9741.20140048.
  34. World Health Organization. (2016). Cardiovascular Disease. Retrieved from https://www.who.int/cardiovascular_diseases/en/
  35. Yulianti, N.T., Kosasih, C.E., & Emaliyawati, E. (2012). Gambaran Kualitas Hidup Pasien Acute Coronary Syndrome Di Poliklinik Jantung Rumah Sakit Al Islam Bandung. Retrieved from http://journal.unpad.ac.id/ejournal/article/view/651
  36. Zhang, C.Y., Jiang, Y., Yin, Q.Y., Chen, F.J., Ma, L. Le, & Wang, L.X. (2012). Impact of nurse-initiated preoperative education on postoperative anxiety symptoms and complications after coronary artery bypass grafting. Journal of Cardiovascular Nursing, 27 (1), 84–88. https://doi.org/10.1097/JCN.0b013e3182189c4d.

How to Cite

Jurnal Keperawatan Indonesia. (2019). Intervensi Rehabilitasi Jantung Fase I pada Pasien yang Menjalani Operasi Bedah Pintas Koroner (BPK): Literatur Review. Jurnal Keperawatan Indonesia, 22(2), 110–121. https://doi.org/10.7454/jki.v22i2.726