Postoperative period after CABG of the heart

The heart muscle feeds on oxygen, which it receives from the coronary arteries that come to it. Due to the narrowing of these vessels, the heart experiences a shortage of it and the so-called coronary heart disease occurs. IHD is a chronic disease, the basis of which is a violation between the needs of the myocardium for oxygen and its amount delivered by the vessels of the heart. The most common cause of prolonged narrowing of the coronary arteries is atherosclerosis in their walls.

IHD is a whole group of diseases, which, at the moment, is one of the main causes of death in developed countries. Every year, about 2.5 million people die from its complications, of which about thirty percent are people of working age. But in recent years, significant progress has been made in its treatment. In addition to broad drug therapy (disaggregants, statins, sortans, b-blockers, etc.), surgical methods are now actively introduced in the Russian Federation. A real breakthrough earlier was coronary artery bypass grafting. CABG is still not only one of the most radical operations, but also one of the most proven, proven in clinical practice.

CABG: postoperative period

The first is the technique of the operation itself. Thus, it is believed that patients who have used their own artery have a lower risk of relapse than those who have used their own vein.

The second is the presence of concomitant diseases before surgery, complicating the course of rehabilitation. These can be diabetes mellitus and other endocrine diseases, hypertension, previous strokes and other neurological diseases.

The third is the interaction between the patient and the doctor in the postoperative period, aimed at preventing early complications of CABG and stopping the progression of atherosclerosis. Among the complications of bypass surgery, pulmonary embolism, deep vein thrombosis, atrial fibrillation, and, importantly, infections are more common.

Therefore, in order to quickly return the patient to his usual way of life, physical, medical and psychological rehabilitation is carried out, the main principle of which is the observance of stages. Most doctors agree that patients need to start moving after surgery as early as the first week. The main rehabilitation is about two months, including sanatorium treatment.

Physical rehabilitation: first week

During the first days after the operation, the patient is in the intensive care unit or intensive care unit, where he is assisted by anesthesiologists-resuscitators. The duration of the action of individual anesthetics is longer than the operation itself, so for some time the artificial lung ventilation apparatus (ALV) breathes for the patient. At this time, doctors use it to monitor indicators such as heart rate (HR), blood pressure, and record an electrocardiogram (ECG). A few hours later, the patient is removed from the ventilator and fully breathes on his own.

It is recommended that the patient lie on their side, changing sides every few hours. Already on the same day, it is allowed to sit down, the next - carefully get out of bed, do light exercises for the arms and legs. On the third day, the patient can walk along the corridor, but preferably with an escort. The recommended time for walking is from 11 am to 1 pm and from 5 to 7 pm. The pace of walking should be observed at the beginning of 60-70 steps per minute with a gradual increase, steps on the stairs should be at a speed of no faster than 60 steps per minute. During the first three days, there may be a slight increase in body temperature, which is a normal reaction of the body to the operation.

Also at this time, special attention should be paid to breathing exercises, doctors can prescribe aerotherapy and nebulizer inhalations with bronchodilators. If surgeons used their own vein as a biomaterial, and especially the great saphenous vein, then compression stockings will be needed. Such underwear made of elastic fabric will help relieve swelling on the lower leg. It is believed that it is necessary to wear it for about six weeks.

Physical rehabilitation: second-third week

The patient continues to engage in physical activity in a sparing mode. Of the local methods of treatment, physiotherapy is recommended: massage of the cervical-collar zone, magnetotherapy on the calf muscles, UHF on the chest and postoperative sutures and scars, aerophytotherapy. Laboratory indicators of the effectiveness of recovery at this time will be the level of troponin in the body, creatinophosphokinase (CPK), activated partial thromboplastin time (APTT), prothrombin and others.

Physical rehabilitation: from 21 days

Since that time, the nature of the patient's physical activity has changed. You can switch to low-intensity strength training, as well as interval training. For each patient, a separate training program is prescribed by an exercise therapy doctor or a certified trainer. It is necessary to focus not only on the level of fitness of the patient, but also on the condition of postoperative scars. It will be good to start doing health paths, jogging, swimming, walking. Of the sports disciplines, volleyball, basketball, tennis are not recommended for life.

Physiotherapy is supplemented with halotherapy, drug electrophoresis (with panangin, papaverine) on the neck-collar zone, electrostatic massage on the operation area. The duration of the course is just over a month.

For the prevention of postinfarction cardiosclerosis, it is necessary to repeat this course 1-2 times a year.

How to heal open wounds after CABG surgery?

The leading incision for CABG is made in the middle of the chest. The next one is done on the leg to take a vein (or veins) or on the forearm to take an artery. The first time after the operation, the sutures are treated with antiseptic solutions - chlorhexidine, hydrogen peroxide. By the beginning of the second week, the stitches can be removed, and by the end of it, this area can be washed with soap. Complete healing of the sternum occurs only after a few months, which at first causes pain in the operating area. On the lower extremities, burning pains may occur at the site of the taken vein. In the process of restoring blood circulation, they pass.

After discharge

A return to normal life is essential for successful rehabilitation, so the sooner the better. Among the recommendations:

– It is allowed to drive a car starting from the second month of rehabilitation

- Return to work is possible in a month and a half. If hard physical work - the term is negotiated individually with the doctor, if sedentary work - earlier.

- Restoration of sexual activity is also prescribed by a doctor.

Prevention of complications of coronary artery disease largely depends on lifestyle. Patients should give up smoking for life, control blood pressure (for this, doctors teach patients to measure it correctly), weight and diet.

Diet

No matter how well the operation goes, if the patient does not follow the diet, the disease will progress and lead to greater vascular occlusion. Not only the coronary artery, which is already affected, can become blocked further, but also the shunt, which can lead to death. To prevent this from happening, the patient should limit the intake of any fats in the diet. From food are recommended:

- lean red meat, turkey liver, chicken, rabbit

- any kind of fish and seafood

- wholemeal bread, whole grain bread

- low fat dairy products

- cold pressed olive oil

- boiled vegetables

- fruits of any kind

– lightly carbonated mineral water

General forecast

After CABG, the patient needs to tune in to a long-term intake of certain drugs - statins, antiplatelet agents, anticoagulants, b-blockers, and others. The rehabilitation of the patient does not end with one cardiosurgical and cardiological department. It is advisable to go to a cardio-rheumatological sanatorium every year (the average stay is a month). Also, based on data from recent world studies, it follows that the average duration of patients after CABG is 17-18 years.

Rehabilitation after CABG: video exercises