1. Early postoperative period
(1) Wound: Coronary artery bypass grafting usually uses a median sternotomy incision, and the wound will usually continue from the upper sternum to the upper abdomen, about 30 cm. In addition, there will also be a wound to take the vascular material, and the saphenous vein is one of the most commonly used vascular materials for coronary artery bypass grafting, so the patient will usually have a wound to take the saphenous vein in the lower extremity after surgery. Due to the use of the saphenous vein, the venous return of the corresponding lower extremity will be affected and swelling of the foot will occur, which requires frequent elevation of the affected extremity to assist venous return. This swelling is usually recovered gradually, but the recovery time varies from person to person and may take up to six months or more. In addition, there may be numbness or other abnormal sensation around the wound or foot, which is due to the inevitable damage to the nerve when the saphenous vein is taken or the edema of the wound compressing the nerve, some of these abnormal sensations can be recovered, some cannot, but generally there is no major impact. Bai Zhenxiang, Department of Cardiothoracic Surgery, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
Forearm wound: relatively young patients and patients with insufficient saphenous vein material may take the radial artery vascular material, as long as the test is qualified, then with the consent of the patient, generally the left radial artery is taken for right-handed patients and the right radial artery is taken for left-handed patients, thus leaving a wound of about 25 cm in the corresponding forearm, after the surgery, abnormal sensation may occur around the wound, palm and fingers, and may also These are common complications and do not require special treatment if they do not have a major impact on function.
Drainage tube wounds: Above the abdomen, there are usually 2-3 wounds about 1 cm in size, which are the skin incisions through which the drainage tubes pass. The drainage tube is the tube that drains the blood exuding from the internal wound. Once the drainage is reduced to an appropriate level, the doctor will remove the drainage tube, leaving 2-3 wounds.
For all wounds, a slight redness and swelling is normal, and if the wound is oozing blood and fluid, then the physician needs to be notified promptly for treatment. Some patients may be at greater risk of poor wound healing than others due to underlying conditions (obesity, diabetes, secondary surgery, malnutrition, etc.) and may receive some physical therapy after surgery. For most patients, the stitches can be removed on the seventh postoperative day, but the removal of the stitches may be delayed in patients with the possibility of poor wound healing.
2) Pain
Postoperative pain is inevitable for a major surgery like coronary artery bypass grafting. Generally, within 3 days after surgery, the main pain sensation of the patient comes from the incision, and we can use some analgesic measures to solve such pain (such as analgesic pump, pain medication, etc.); 3-5 days after surgery, most patients will feel a deep dull pain on the left side of the sternum, which is usually caused by the tissue damage caused by taking the left internal mammary artery; after 5 days after surgery, there may also be This is often due to the opening of the rib cage for surgical exposure, and there is also muscle pain, which is caused by the special position during surgery. However, if there is pain similar to the chest pain before surgery, you need to tell your doctor immediately and have it checked and treated.
3) Coughing
Postoperative cough is a very common symptom, and there are usually dry cough and cough accompanied by white thin sputum, white mucous sputum, yellow sputum, etc. No matter what kind of cough you have, you need to report it to the doctor promptly. If the cough is accompanied by white thin sputum and will worsen when lying down, it is often a sign of excessive water intake and needs to be strictly controlled; if it is accompanied by yellow sputum, it is often a sign of infection; if it is a dry cough, it is usually an irritating cough, which is not a big problem and only needs symptomatic treatment.
4） Diet
In the early 3 days after coronary artery bypass grafting, the patient’s diet should be appropriately limited in fluid intake, encouraged to eat, strengthen nutrition, provide high protein and easy to digest food (chicken, fish, etc.), except for allergic factors, there is generally no contraindication. For the first 7 days after surgery, water intake and excretion usually need to be measured.
For diabetic patients, the diet can be not strictly controlled during this period, the doctor will strictly monitor the blood sugar and use medication to help you control it.
5) Activity
After surgery, early activity is encouraged to increase appetite, reduce the chance of lung infection, and speed recovery. Initially, you can sit on the edge of the bed with both lower limbs hanging down, then you can sit on a chair with armrests, and if your strength allows, you can walk slowly by the bedside under the supervision of your relatives, and finally you can increase the amount of activity according to the specific situation, and it is generally recommended to stay in bed as much as possible. Generally, patients can sit and stand at the bedside on the second day after surgery.
6) Bowel movement
It is still necessary to keep the bowels open, for urine and stool usually need to be measured in the first 7 days after surgery; for some patients with severe disease, preoperative training is required because of the possibility of needing to urinate and defecate in bed.
7) Sleep
Due to the influence of anesthesia and sedative drugs, postoperative patients usually have irregular sleep patterns in the recovery room, and need to be adjusted to normal sleep patterns as soon as possible, i.e., no sleep during the day as much as possible, and maintain normal sleep hours at night.
8) Physical therapy and physiotherapy
Physical therapy mainly refers to back patting and sputum production, which may cause pain to the wound, but it is necessary to keep the airway open and enhance oxygenation, so the patient’s cooperation is required.
Post-operative recovery
After coronary artery bypass grafting, there is a gradual recovery process for both heart function and general condition. There are some precautions to be observed during this period, which will help you recover as soon as possible and thus obtain satisfactory results from the surgery.
1) Diet
During the recovery period after undergoing coronary artery bypass grafting, it is usually necessary to increase the intake of calories, proteins and vitamins in order to promote a speedy recovery from the surgery. However, after this period, dietary treatment, i.e., control of hyperlipidemia, is a long-term task for patients with coronary artery disease. This is because coronary artery bypass surgery only treats myocardial ischemia caused by blocked coronary arteries, but not the cause of coronary heart disease. Therefore, in terms of diet, attention to control hyperlipidemia is one of the important measures to prevent and slow down reocclusion after coronary artery bypass grafting.
a) Main elements of dietary therapy: The main nutrients affecting total serum cholesterol are saturated fatty acids and dietary cholesterol as well as overweight and obesity due to imbalance between dietary intake and digestion. Therefore, the main elements of dietary therapy are to reduce the intake of saturated fatty acids and cholesterol as well as to control total calories and increase physical activity to achieve caloric balance.
b) Dietary treatment goal: to facilitate the reduction of risk factors for cardiovascular disease and increase protective factors. Since the diets of patients with hyperlipidemia are often unbalanced, the goal of dietary therapy is to set a limit on the nutrients in question, and the following goals are based on the diets of our population in the 1990s.
Dietary treatment goals for high serum cholesterol
Nutrients
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Total fat