Fizik tedavi ve rehabilitasyon servisinde yatan hastalarda kardiyak ritim ve etkileyen faktörler
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Dosyalar
Tarih
2022
Yazarlar
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Fizik tedavi ve rehabilitasyon (FTR) kliniğinde yatan hastalar genellikle kronik nöromuskuloskeletal sistem rahatsızlığına sahip olan ve yaşlı, kardiyovasküler olay yaşanma olasılığı yüksek olan kişilerdir. Egzersiz ve yüksek kardiyovasküler fitnessın aritmiyi azalttığına dair çok sayıda kanıta rağmen egzersizle indüklenen aritmilere dair de çalışmalar mevcuttur. Çalışmamızda herhangi bir nöromüsküloskeletal hastalık nedeniyle FTR kliniğinde yatarak tedavi görmesi kararlaştırılan hastaların yatış yapılan gün ve yatıştan üç hafta sonra yapılacak 24 saatlik ritim holter takibi ile kardiyak ritimlerinin değerlendirilmesi ve iki ölçüm arasında anlamlı değişiklik gözlenirse bu sonuç üzerine etkili olabilecek faktörlerin belirlenmesi amaçlanmıştır. Çalışmaya FTR servisinde yatan toplam 41’i kadın ve 22’si erkek olmak üzere 63 gönüllü hasta katıldı ve ilgili değerlendirmeleri yapıldı. Hastaların demografik özellikleri, mevcut komorbiditeleri ve aldıkları medikal tedaviler not edildi. ACC/AHA kılavuzu doğrultusunda hastaların 10 yıllık kardiyovasküler olay yaşama olasılıklarına karşı risk hesaplamaları yapıldı. Egzersiz seansları egzersiz tipi ve uygulanma saati, fizik tedavi ajanları da uygulanma saati olarak not edildi. VEV sayısına dayalı Lown sınıflandırması esas alınarak gönüllü hastalar ilk ve ikinci ölçüm sonuçlarına göre ilgili risk grubu açısından değerlendirildi. Egzersiz saatlerindeki en yüksek kalp hızları tespit edildi, isitirahat kalp hızları ile arasındaki farklar saptandı ve bu farklar egzersiz tipleri ile ilişkilendirildi. Maksimal kalp hızlarının %77’si esas alınarak bu sınır kalp hızı değerini aşan egzersiz grupları tipleri ile beraber saptandı. İlk ve ikinci değerlendirmelerde yapılan iki ölçüm arasında kalp hızları, SVT sayısı, VEV sayısı ve sinüs duraklaması sayısı açısından anlamlı bir farklılık saptanmadı. İlk değerlendirmede Lown sınıflandırmasına göre hastaların %20.6’sı yüksek riskli saptandı. İki ölçüm arasında Lown sınıflandırmasına göre evrelendirme açısından anlamlı bir farklılık saptanmadı. Egzersiz uygulamaları sırasında sınır kabul edilen maksimal kalp hızı değerinin %77’sini aşan toplam 6 hasta saptandı. Sonuç olarak FTR servisinde yatan hastaların 24 saatlik holter incelemeleri aritmi açısından belirli bir risk düzeyine işaret etmekle beraber uygulanan tedavi programlarının bu risk düzeyini arttırdığına veya azalttığına dair bir kanıt bulunamamıştır.
Patients hospitalized in physical therapy and rehabilitation clinics are generally elderly people who have chronic neuromusculoskeletal system disorders and are more likely to experience cardiovascular events. Despite ample evidence that exercise and high cardiovascular fitness reduce arrhythmias, there are also studies of exercise-induced arrhythmias. In our study, it was aimed to evaluate the cardiac rhythms of patients who were decided to receive inpatient treatment in the physical therapy and rehabilitation clinic due to any neuromusculoskeletal disease with 24-hour rhythm Holter follow-up on the day of hospitalization and three weeks after hospitalization, and to determine the factors that may affect this result if a significant change is observed between the two measurements. A total of 63 volunteer patients, 41 women and 22 men, who were hospitalized in the physical therapy and rehabilitation service, participated in the study and their related evaluations were made. The demographic characteristics of the patients, their current comorbidities and the medical treatments they received were noted. In accordance with the ACC/AHA guidelines, risk calculations were made against the probability of patients experiencing a 10-year cardiovascular event. Exercise sessions were noted as exercise type and application time, and physical therapy agents as application hours. Based on the Lown classification based on VPB number, volunteer patients were evaluated in terms of the relevant risk group according to the results of the first and second measurement. Peak heart rates during exercise hours were determined, differences with resting heart rates were determined and these differences were associated with exercise types. Based on 77% of the maximal heart rates, it was determined together with the types of exercise groups that exceeded this limit heart rate value. There was no significant difference between the two measurements made in the first and second evaluations in terms of heart rates, number of SVT, number of VPB and number of sinus pauses. In the initial evaluation, 20.6% of the patients were found to be at high risk according to the Lown classification. There was no significant difference between the two measurements in terms of staging according to Lown classification. A total of 6 patients who exceeded 77% of the maximal heart rate value, which was accepted as the limit, were detected during exercise applications. As a result, although 24-hour Holter examinations of patients hospitalized in the physical therapy and rehabilitation service point to a certain risk level for arrhythmia, there was no evidence that the treatment programs applied increased or decreased this risk level.
Patients hospitalized in physical therapy and rehabilitation clinics are generally elderly people who have chronic neuromusculoskeletal system disorders and are more likely to experience cardiovascular events. Despite ample evidence that exercise and high cardiovascular fitness reduce arrhythmias, there are also studies of exercise-induced arrhythmias. In our study, it was aimed to evaluate the cardiac rhythms of patients who were decided to receive inpatient treatment in the physical therapy and rehabilitation clinic due to any neuromusculoskeletal disease with 24-hour rhythm Holter follow-up on the day of hospitalization and three weeks after hospitalization, and to determine the factors that may affect this result if a significant change is observed between the two measurements. A total of 63 volunteer patients, 41 women and 22 men, who were hospitalized in the physical therapy and rehabilitation service, participated in the study and their related evaluations were made. The demographic characteristics of the patients, their current comorbidities and the medical treatments they received were noted. In accordance with the ACC/AHA guidelines, risk calculations were made against the probability of patients experiencing a 10-year cardiovascular event. Exercise sessions were noted as exercise type and application time, and physical therapy agents as application hours. Based on the Lown classification based on VPB number, volunteer patients were evaluated in terms of the relevant risk group according to the results of the first and second measurement. Peak heart rates during exercise hours were determined, differences with resting heart rates were determined and these differences were associated with exercise types. Based on 77% of the maximal heart rates, it was determined together with the types of exercise groups that exceeded this limit heart rate value. There was no significant difference between the two measurements made in the first and second evaluations in terms of heart rates, number of SVT, number of VPB and number of sinus pauses. In the initial evaluation, 20.6% of the patients were found to be at high risk according to the Lown classification. There was no significant difference between the two measurements in terms of staging according to Lown classification. A total of 6 patients who exceeded 77% of the maximal heart rate value, which was accepted as the limit, were detected during exercise applications. As a result, although 24-hour Holter examinations of patients hospitalized in the physical therapy and rehabilitation service point to a certain risk level for arrhythmia, there was no evidence that the treatment programs applied increased or decreased this risk level.
Açıklama
Anahtar Kelimeler
Nöromuskuloskeletal, Egzersiz, Ritim, Neuromusculoskeletal, Exercise, Rhythm
