What rehabilitation activities should be performed early after bypass surgery

In recent years, it has been gradually recognized that scientific early postoperative rehabilitation exercises are helpful for smooth recovery after cardiac surgery, and are especially important for elderly patients. The purpose of rehabilitation exercises after coronary artery bypass grafting is to promote the recovery of cardiac function, prevent the occurrence of complications in various organs such as lung and digestive tract, and enable patients to return to normal life as soon as possible. Active rehabilitation exercises can dilate coronary arteries and increase blood supply to the heart muscle. Because accelerated blood flow can prevent stenosis and occlusion of coronary bridges to a certain extent, it improves circulatory function, promotes incision healing, improves renal perfusion and reduces water and sodium retention. Increased activity can promote the recovery of pulmonary function, prevent deep vein thrombosis, avoid postural hypotension which is easily caused by long-term bed rest, and also improve blood rheological status and reduce neurohumoral overreaction, etc. Early rehabilitation exercise after coronary artery bypass grafting also has certain potential dangers, especially for patients with low cardiac function, which may result in blood pressure drop, rapid heart rate, severe chest pain, dyspnea, vertigo, arrhythmia, etc. Clinical examples of atrial fibrillation that may be related to activity have occurred. Most of these adverse effects are caused by excessive exercise, so it is crucial to determine the individualized amount of exercise to achieve the best results with the least risk. However, in patients with coronary artery disease, it is almost impossible to determine the maximum cardiac functional capacity preoperatively by pedaling or planking, and even if it can be barely determined, it should not be used as a postoperative control standard because preoperative exercise tests may induce angina pectoris or even myocardial infarction, thus underestimating the function of the heart itself. Therefore, the maximum postoperative exercise volume should only be determined according to the patient’s prevailing cardiac functional status. The amount of exercise is determined by a combination of exercise intensity, duration and frequency. Patients are encouraged to perform a sub-polar amount of exercise, i.e., mainly endurance exercise. In fact, this sub-maximal amount is uncertain because the exercise tolerance is gradually increased with the gradual recovery of cardiac function and physical strength. Patients are required to gradually increase the amount of exercise to the extent that they can tolerate themselves, do not feel overly fatigued, do not have shortness of breath, and do not induce arrhythmia or severe chest pain. According to the literature, the rehabilitation process for one coronary artery bypass graft is 15-20 days, and for two or more bypass graft is 20-28 days before reaching the discharge standard. The postoperative rehabilitation can be carried out step by step in the following ways: 1. Perform blowing training The frequency is reduced compared with the preoperative period, about 3-4 times a day for 10-15 minutes each time. During this period, the patient should be encouraged to eat a high-protein, high-calorie diet to promote physical recovery and healing of the surgical incision so that the patient has sufficient physical strength and good physical condition to cooperate with the training. 2, out of bed activities 24-48 hours after surgery, as the patient’s physical strength allows, the nurse helps the patient to gradually move from sitting on the bed to sitting on the edge of the bed, until leaving the bed to walk a short distance indoors. 72 hours later, the activity increases and the patient can walk along the corridor of the ward, pay attention to the slow speed at the beginning, and gradually accelerate the walking speed as the physical strength and cardiac function improve. Three times a day, 200-400 meters each time. 3.Activate the upper limbs, including upper limb extension and flexion exercises, lifting and appropriate chest expansion exercises. If the surgical incision is not healed well, or the sternum is not fixed firmly, or there is a bone rubbing feeling when moving, then avoid doing chest expansion exercise. Upper limb exercises can reduce joint stiffness, prevent chest wall ankylosis and chest wall muscle atrophy, and reduce shoulder and back pain and chest compression. 4. Encourage patients to take care of themselves, including washing face, brushing teeth, eating and urinating and defecating by themselves, etc. These daily life movements can help patients restore limb coordination, increase the amount of exercise to a certain extent, and increase patients’ self-confidence.