Impacto da mobilização precoce na modulação autonômica de indivíduos submetidos à angioplastia.

Abstract

BACKGROUND: Patients in the Intensive Care Unit (ICU) are frequently submitted to prolonged rest in the bed, which promotes several deleterious effects, including cardiac autonomic dysfunction. Physical therapy in phase I of cardiovascular rehabilitation, through early mobilization, can be started 12 hours after angioplasty, however, prolonged bed rest is common because of the fear of patient instability. Objectives: To evaluate the impact of early mobilization on the autonomic cardiac modulation of individuals submitted to angioplasty admitted to the ICU and to verify the behavior of the autonomic heart rate modulation during the exercises in these individuals. To characterize the cardiac autonomic modulation of infarcted or not, after an angioplasty procedure. Methods: Elective post-angioplasty individuals or AMI were divided into two groups: Control (GC, N = 16) and Early Mobilization (GMP = 16). The GMP was submitted to the protocol of early mobilization after angioplasty during the hospitalization period. Both groups were evaluated at the time of admission and high for cardiac autonomic modulation (Heart Rate Variability - HRV), and in the GMP, HRV was also verified at moments before, during and after exercise of the last attendance before discharge. The physiotherapeutic protocol for early mobilization was initiated 12-18 hours after an angioplasty procedure. For the evaluation of changes in continuous variables in relation to the baseline, the paired Student's t-test was used in the case of normal distribution variables or the Wilcoxon paired test if the distribution was non-normal. For comparison between groups, the Student t test for continuous variables with normal distribution and the Mann-Whitney U test for those with non-normal distribution. For the analysis of the moments (before x during x after exercise), repeated measurements of unidirectional analysis of variance (ANOVA1) were applied. The established level of significance was 5%. Results: Patients had a mean age of (61.29 ± 8.34) in the CG and (63.50 ± 9.64) in the GI, with no statistical difference in age (p = 0.43). When comparing the two groups, it was observed that the values of the linear and non-linear indices did not present a statistically significant difference in the admission, but at the high moment, the GMP presented a statistically significant increase of SDNN indices (p = 0.042), Triangular Index (p = 0.014), VLF (p = 0.004) and SD2 (p = 0.034). The VLF, Lmean, REC (%), DET, ShanEn, ApEn, and SampEn indices showed significant changes in the evaluation of the GMP during the last moments: before, during and after exercises, comparing the rest and exercise moments. Post-angioplasty patients had low HRV compared to healthy subjects. Conclusion: Early mobilization influences the autonomic modulation of individuals during the period of hospitalization after an angioplasty procedure. Post-angioplasty individuals have worse heart rate modulation compared to healthy subject.