Coronary artery bypass grafting is an effective treatment for angina pectoris in coronary artery disease. When the coronary artery lesion is poorly treated with medication or interventional therapy and recurrent angina pectoris occurs, coronary artery bypass grafting should be considered. Coronary angiography shows multiple lesions in the coronary arteries, with stenosis greater than 70% and the risk of myocardial infarction, which are indications for coronary artery bypass surgery. Bypass surgery is performed by using the patient’s saphenous vein and internal mammary artery as bridge tubes and sewing one end to the distal end of the coronary artery stenosis and the other end to the aorta, so that the ischemic myocardium can be well supplied with blood. Since the “bridge” used is the patient’s own blood vessel, there is no rejection, and it has a long-term patency rate, and after 10 years, 90% of the bridge is free of stenosis. Therefore, some people call “bypass” as the radical surgery for coronary heart disease, and the cost is much lower. After the operation, the vast majority of patients are back to work and their quality of life is significantly improved.
Many patients think that the heart vessel has been bypassed, so they can be like normal people and do not need to take medicine. In fact, the bridge vessel is different from the healthy vessel, it is only relatively smooth, using artery (such as radial artery, internal mammary artery) as the bypass vessel, the 5-year smoothness rate is 90%, using vein (such as saphenous vein), the 5-year smoothness rate is 80%, and the smoothness rate is not only related to the anastomosis technology, bridge vessel quality, but also related to the patient’s concomitant diseases. Therefore, patients should still take medication on time after surgery and actively treat the primary factors causing coronary artery disease.
After coronary artery bypass grafting, the blood supply to the heart is well improved. The next most important treatment is to participate in cardiac rehabilitation program, regular review, control the risk factors of coronary artery disease, learn good lifestyle and diet, and master the correct exercise methods to maintain coronary artery patency, improve and enhance heart function, and reduce the recurrence of coronary restenosis.
First of all, diet is a correctable risk factor, therefore, patients after coronary artery bypass grafting should pay attention to the diet.
(1) Pay attention to the supplement of high-quality protein. Ensure 1 egg, 50g of lean meat, 50g of fish and moderate amount of soy products every day.
(2) Low-fat diet. Dietary intake of animal fat should be limited, cooking, more vegetable oil, cholesterol is limited to less than 300 mg per day. Fat-lowering foods are preferred to soybean products. Black fungus has the effect of anti-platelet coagulation, lowering blood lipids and stopping blood cholesterol deposition. Capsicum, oats and barley are good for lowering blood lipids, lowering blood cholesterol and reversing fatty liver. High blood lipids cause patients’ blood to be sticky, form arterial plaques and cause atherosclerosis, so the intake of fat and cholesterol should be strictly controlled. Try not to use fatty meat, animal oil, chocolate and other foods, and use vegetable oil. Eat more fish, which contains unsaturated fatty acids and has the effect of preventing atherosclerosis. In addition, snapper, garlic, kelp, fresh milk and red pepper can lower cholesterol, while animal offal, brain, egg yolk and fish roe should be consumed sparingly, which have high cholesterol content.
(3) Vitamins and fiber. Fruits and vegetables are rich in vitamins, potassium and magnesium, which can maintain the nutrition of the heart muscle and lipid metabolism, and vitamins can reduce the absorption of cholesterol in the intestine, which is beneficial to the prevention of coronary heart disease, and can also prevent and control constipation. The main sources of dietary fiber are coarse grains, celery, bean sprouts, strawberries, pineapple, rice bran, etc.
(4) low-sodium diet. Low sodium diet should eat less salt or smoked food; canned food are to eat less.
(5) Other diet should be a small number of meals, avoid overfull, do not drink strong tea, coffee containing drinks. Avoid eating flatulent foods such as raw radish and dried beans, so as not to affect the heart activity with intestinal flatulence. In terms of alcohol consumption, a small amount of alcohol can appropriately increase blood circulation, which is conducive to the smooth flow of bridge vessels, and those who do not drink alcohol before surgery may not need to drink alcohol.
(6) Avoid eating foods that excite the nervous system, such as wine, strong tea, coffee, etc. Smoking is extremely harmful to the heart because (1) cigarettes contain tar, nicotine and carbon monoxide, which are extremely harmful to the human body. ② When the concentration of carbon monoxide hemoglobin in the blood is too high, it can cause a decrease in blood oxygen concentration, insufficient oxygen supply to the tissues, edema of the inner walls of the arteries, endothelial damage, lipid infiltration into the walls of the blood vessels and accelerate the formation of atherosclerosis. In patients with coronary heart disease, smoking can accelerate the progression of the disease and cause heart attacks. Heavy smoking can induce serious arrhythmias such as ventricular fibrillation, which becomes one of the causes of sudden death.
Secondly, rehabilitation exercise after coronary artery bypass grafting is also extremely necessary. Exercise prescription must be made, because the preoperative symptoms of coronary artery bypass graft patients are different, and their respective cardiac function levels are different, so there must be individual guidance of rehabilitation exercise and strengthening of their own moderate and appropriate exercise after surgery. Any exercise prescription should be based on disease diagnosis, health status, functional status of cardiovascular and exercise organs, age, gender, exercise history and exercise preferences. The appropriate exercise method and amount of exercise should be selected according to the recovery from coronary artery bypass grafting and the presence of complications.
In conclusion, the rehabilitation exercise prescription should be individualized. Exercise prescription is also called training exercise program. Exercise prescriptions must be developed for post-coronary artery bypass grafting patients and should be carefully tailored, as should medication prescriptions. The exercise prescription includes the type of exercise, intensity, duration, frequency and rate of progression. In addition, home exercise should be reinforced after discharge from the hospital.
Appropriate postoperative exercise is beneficial for bridging the blood vessels, increasing myocardial blood volume, and improving myocardial blood supply and reserve capacity. Appropriate exercise can also reduce patients’ depressive symptoms and maintain a good mood. Patients should choose exercise according to their actual situation, aerobic exercise is appropriate, such as jogging, walking, tai chi, cycling, etc., the time is generally 20-30min, after the activity to increase the heart rate of 10%-20% of the original heart rate is appropriate. After the operation, you should go to the hospital regularly for review, which includes heart sound auscultation, chest X-ray, electrocardiogram and vascular ultrasound. If there are palpitations, syncope and other indications of maladjustment, you should go to the hospital immediately.
(1) Type of exercise: The purpose of rehabilitation exercise is to obtain and maintain the ability to perform normal physical activity. Whether this can be achieved depends on several basic factors, which include cardiopulmonary tolerance, structure of the body (fat as a percentage of body weight), muscle strength and endurance, and flexibility of the joints. The most important thing for coronary artery bypass graft patients after surgery is to increase cardiopulmonary tolerance. Aerobic endurance activities improve cardiopulmonary tolerance and are divided into two groups.
The first group: physical activity is characterized by little exercise intensity and little change in heart rate, such as walking, jogging, climbing stairs, riding an exercise bike, doing various types of health exercises with various apparatus training, relics playing taijiquan, dancing taiji sword, etc.
The second group: physical activity is characterized by sustained exercise intensity and not easy to maintain physical activity, such as dance, games, ball games and other activities.
(2) Exercise intensity: Exercise intensity refers to the amount of exercise within a certain period of time. Improving the endurance of the cardiovascular system requires a certain intensity of exercise. Exercise intensity requires proper monitoring to determine appropriateness, and it is the most difficult part of designing an exercise prescription. In medical rehabilitation, exercise intensity can be determined based on metabolic indicators expressed in terms of heart rate, maximum oxygen uptake, and level of self-conscious fatigue. Of these metrics, maximal oxygen uptake is the most difficult to implement. The relationship between heart rate and exercise intensity is linear and proportional. However, coronary artery bypass graft patients have to take medications for quite a long time after surgery, such as calcium antagonists that have an effect on heart rate and do not objectively reflect exercise intensity. We suggest that patients after coronary artery bypass grafting should apply talking exercise level to grasp the intensity of exercise.
Talking exercise level: the exercise intensity that talks while exercising without obvious shortness of breath is the appropriate exercise intensity to produce training. If you can sing during exercise, it means that the exercise intensity is not large enough.
(3) Movement duration: It is the time required for one rehabilitation training. It can be divided into three stages: adaptive activities, cardiorespiratory endurance training and relaxation activities. The time required for each of the three phases is: 5-10 minutes; 20-30 minutes; and 5-10 minutes. Adaptive activities include flexion and extension of joints, slowly increasing the volume of exercise, etc.. It can avoid sudden high-intensity exercise together with myocardial ischemia and prevent muscle and joint injury. For patients with poor health status after coronary artery bypass grafting, the adaptive activity should be extended appropriately. Cardiorespiratory endurance training exercise is high intensity and should not exceed 10-15 minutes for patients who first participate in the exercise. Relaxation exercises are designed to reduce the discomfort after exercise. At the beginning of and during relaxation exercise, the heart rate should return to normal soon. If the heart rate recovers slowly during relaxation exercise, the intensity of exercise should be reduced appropriately according to the situation.
(4) Exercise frequency: For the exercise of patients after U-artery bypass surgery, we recommend intermittent exercise in the beginning stage. Intermittent exercise is alternating exercise and rest, but its accumulated exercise time should not be at least lower than the prescribed continuous exercise time, and the ratio of exercise to rest time is 1:1.
The advantages of intermittent exercise for patients with coronary artery disease are.
1) Patients achieve a higher intensity of exercise with less fatigue because, unlike continuous exercise, the accumulation of lactic acid is reduced during the rest period.
2) More stimulation of the heart training, mainly because of the ability to repeat the political see heart beat volume, venous return and intracardiac pressure. Frequency of exercise refers to the number of rehabilitation exercises per week. To achieve the desired effect of rehabilitation exercise, patients should exercise no less than three times per week, and the time between each exercise session should not exceed 2 days. Patients who participate in exercise three times per week can have some degree of improvement in cardiopulmonary tolerance after 2-3 weeks, and usually have significant improvement after 6-8 weeks. At the same time, we emphasize that coronary artery bypass graft patients must exercise consistently in order to maintain the exercise effect. If the frequency of exercise is reduced to 1 time per week, half of the acquired cardiorespiratory fitness will be lost within 10 weeks. If the activity is stopped completely, the patient will lose all the acquired cardiorespiratory tolerance within 5 weeks.
3) Rate of progression of the exercise program: The progression of the exercise program depends on the individual’s maximum physical capacity, health status, age and goals. Exercise is prescribed for cardiorespiratory tolerance in three phases, i.e., initiation phase, improvement phase and maintenance phase.
Patients can go home and be active if they have no palpitations, shortness of breath, chest pain and angina at rest, no heart failure, heart rate below 110-120 beats/min, no serious arrhythmias, no myocardial ischemic changes on ECG, and ST-segment downshift less than 0.1 mV. In the initial stage, the daily activity should be continued at the later stage of hospitalization, and later on, the patient can take care of his own life and do general household chores, such as sweeping the floor, scrubbing the floor, buying vegetables, cooking, washing dishes, etc. He can also participate in some relaxing recreational activities, such as watching TV, but should avoid overexertion, tension and excitement. Six months after heart surgery, patients can return to work and gradually resume their original physical activities. To reduce risk factors and prevent recurrence is the purpose of long-term rehabilitation treatment, and appropriate indoor and outdoor activities can be carried out according to the physical condition.
(1)Walking: pay attention to control the speed, distance and time when walking, the amount of exercise should be small at the beginning and gradually increase, outdoor walking should be accompanied by family members.
(2) playing taijiquan: taijiquan movements stretch natural, rigid and flexible, moving in the quiet, more suitable for coronary heart disease patients rehabilitation exercise, generally choose to simplify taijiquan, the amount of exercise should be small at the beginning, gradually increase the range of action, extend the time.
(3) massage: massage can make the muscles relax, blood circulation accelerated, regulate the function of the central nervous system, relieve mental tension.
(4) Natural therapy: During the stabilization period, you can go for a walk in the forest, high mountains and seaside, one is to exercise the limbs, the other is to breathe fresh air, which is conducive to improving the function of the central nervous system and respiratory system.
It is worth pointing out that we should pay attention to the strict control of the start time of exercise, and only after the doctor’s examination to ensure that the condition is stable, then exercise. In addition, if dyspnea, chest tightness, chest pain occurs during exercise, you should immediately take medicine to relieve the symptoms and send to the hospital after stabilization.
In addition, attention to physical conditioning alone is not enough, the heart care is more important. Patients with coronary heart disease have a strong personality, so after surgery, they should pay attention to slowing down the pace of life and work, control their emotions, and do things according to their ability, and do not seek too much. Otherwise, it will aggravate the disease and cause a variety of diseases. For this reason, it is necessary to better strengthen psychological regulation and exercise: (1) improve the patient’s home environment
(1) Improve the patient’s home environment: the patient’s home environment should be sunny, appropriate temperature and humidity, quiet and comfortable, and avoid noisy sounds.
(2) To face the reality, objective understanding of their own ability, do not force to do what they can not do, to try to avoid or learn to adapt to unfavorable circumstances.
(3) learn to take time off from work, to ensure rest, not in a state of tension and busy all day, after work should be appropriate recreational activities to relieve the nervous system tension, can listen to music, chess, painting. Treat people with kindness, do not easily get emotionally involved, stay calm, and try to create a harmonious living and working environment for yourself.
(4) Be understanding, listen to persuasion, don’t be stubborn and overly insist on personal views and opinions. The 3 months after surgery is an important stage to overcome the trauma of surgery and physical recovery, so you should keep your spirit happy and relaxed.
(5) Observe regular sleep time: there is a biological clock in human body, if life is always irregular, then various diseases will come to your door. You can make a personal schedule, develop habits and form a routine. Before going to bed, the spirit should be relaxed, avoid tension, listen to some relaxing music, arrange a comfortable environment, such as a comfortable bed, appropriate light, suitable room temperature, etc..
After the physical and mental recuperation, some other areas related to the surgery are also worth noting.
Medication care.
Before discharge from the hospital, you should ask the doctor in charge about the specific plan of anticoagulation therapy, the name, dosage, time and precautions of the drugs taken, so that you can take the drugs strictly according to the doctor’s prescription after going home. Continue to take vasodilators according to the doctor’s prescription. You should not buy too much medication at a time. In summer, with high temperature, strong sunlight and high humidity, all medications should be stored in a low temperature, light-proof and dry environment to prevent deterioration.
Care of the incision.
You can take a bath when the incision heals well, but do not use irritating soap and do not rub the skin at the incision with force. When redness, swelling, swelling and painful sensation or oozing from the incision is noticed, the patient should go to the hospital as soon as possible to check for incision infection. Patients may feel discomfort at the incision site during the first few weeks at home, which may increase with sneezing, coughing, sudden position changes or prolonged inactivity. The discomfort usually improves significantly after 1-2 months, and after 6 months, the discomfort almost disappears. After coronary artery bypass grafting, there may be a long incision on the leg and you may feel a mild numbness on the skin on both sides of the incision, the incision will heal slowly and there will be some discomfort, which is normal. After the incision is healed, the tightness, edema and numbness will gradually disappear. After surgery, the leg should be tied with elastic bandage or wear elastic stockings to reduce lower limb edema. Do not sit on the edge of the bed with your legs down, as this may cause or aggravate the leg incision edema. To reduce the swelling of the lower extremities, the lower extremities should be elevated on a small stool when sitting. Note that whether sitting or lying down, do not cross your legs to avoid friction on the incision and affect its recovery.
Coronary artery bypass grafting is a major operation for the patient, taking a great risk, not only experiencing physical pain, but also a heavy mental burden, and many patients still have palpitations after the operation, going home is cautious, not leaving home, and too nervous. Patients should be guided to establish a healthy lifestyle after surgery, maintain a good state of mind, keep emotional stability, do not be overjoyed, guide patients to treat the disease with a positive and optimistic attitude, and family members should try to establish a good and relaxed living environment for patients, with a view to achieving the best recovery effect.