改良早期心脏康复方案在经皮冠状动脉介入术后患者中的应用

doi:10.3761/j.issn.0254-1769.2020.09.009

摘要/Abstract

摘要：

目的探讨改良早期心脏康复方案在急性心肌梗死行经皮冠状动脉介入术患者中的应用效果。方法纳入冠心病监护病房112例急性ST段抬高型心肌梗死行经皮冠状动脉介入术后的患者,随机分为试验组和对照组,每组各56例。试验组给予改良早期心脏康复方案进行锻炼,对照组给予早期心脏康复方案进行锻炼。比较两组干预前及干预后第7天的日常生活能力、左心室射血分数、冠心病监护病房住院天数及不良事件发生率。结果干预7d后,试验组的日常生活能力、左心室射血分数高于对照组,试验组的住院天数少于对照组,差异均有统计学意义（P<0.01）;试验组和对照组均无不良事件发生。结论改良早期心脏康复方案安全、有效,可促进急性心肌梗死行冠状动脉介入治疗术后患者的康复,增加左心室射血分数,提高患者日常自理能力并缩短住院时间,提高患者生活质量。

关键词: 心肌梗死, 经皮冠状动脉介入, 早期康复, 护理

Abstract:

Objective To evaluate the application and effects of a modified version of early cardiac rehabilitation program in patients with acute ST-segment elevation myocardial infarction treated by Percutaneous Coronary Intervention（PCI）.Methods Totally 112 patients with acute ST-segment elevation myocardial infarction undergoing PCI enrolled in Coronary Care Unit（CCU） were randomized into a control group and an experimental group with 56 cases in each group. The experimental group was given a modified version of the early cardiac rehabilitation program,while the control group received routine exercise training. The Activity of Daily Living Scale（ADL）,left ventricular ejection fraction（LVEF）,the length of hospital stay and the incidence of adverse events were compared in both groups before the intervention and at 7th day after the intervention,and the satisfaction of patients was investigated through interviews.Results After a week of interventions,results of ADL and LVEF in the experimental group was significantly higher than those in the control group. The length of hospital stay in the experimental group was shorter than that in the control group. The differences of 3 statistical results were statistically significant（P<0.01）. No adverse events occurred in both groups. Participants in the experimental group claimed that the modified rehabilitation program could be used to help them recover their self-care ability and rebuild their confidence to return to life according to patients own conditions as soon as possible,and all of them could cooperate actively.Conclusion The modified version of the early cardiac rehabilitation program is safe and effective that can be used to accelerate the rehabilitation of patients with acute myocardial infarction after PCI,increase LVEF,improve the daily self-care ability of patients,shorten the length of hospitalization,and improve the quality of life of patients.

Key words: Myocardial Infarction, Percutaneous Coronary Intervention, Early Recovery, Nursing Care

冯舒爽,华俊,魏睿宏,张耀峰,林雍容,林映,杨雪慧,林冰栒,袁永红,王伟,刘慧. 改良早期心脏康复方案在经皮冠状动脉介入术后患者中的应用[J]. 中华护理杂志, 2020, 55(9): 1330-1334.

FENG Shushuang,HUA Jun,WEI Ruihong,ZHANG Yaofeng,LIN Yongrong,LIN Ying,YANG Xuehui,LIN Bingxun,YUAN Yonghong,WANG Wei,LIU Hui. Application of a modified version of early cardiac rehabilitation program in patients with acute ST-segment elevation myocardial infarction treated by percutaneous coronary intervention[J]. Chinese Journal of Nursing, 2020, 55(9): 1330-1334.

图/表 4

图1 早期心脏康复方案

图2 改良早期心脏康复方案运动流程注：1 mmHg=0.133 kPa。

表1 两组一般资料的比较(n=112)

表2 两组干预1周后日常生活能力、住院时间和左心室射血分数评分的比较($\bar{x}±s$)

参考文献 21

[1]	中华医学会心血管病学分会介入心脏病学组, 中国医师协会心血管内科医师分会血栓防治专业委员会, 中华心血管病杂志编辑委员会. 中国经皮冠状动脉介入治疗指南(2016)[J]. 中华心血管病杂志, 2016,44(5):382-400.
[2]	牛亚芊芊, 郭丹杰, 金宗学 , 等. 急性期接受经皮冠状动脉介入治疗的心肌梗死患者运动耐量影响因素[J]. 中华内科杂志, 2019
	58(10):763-769.
[3]	张博, 潘晓芳, 孙飞一, 等. 运动负荷超声心动图联合运动心电图对经皮冠状动脉介入治疗后冠状动脉严重病变的诊断价值[J]. 中国循环杂志, 2019,34(9):872-876.
[4]	Du X, Patel A, Anderson CS, et al. Epidemiology of cardiovascular disease in China and opportunities for improvement:JACC international[J]. J Am Coll Cardiol, 2019,73(24):3135-3147. DOI URL PMID
[5]	张瑞岩, 高炜. 急性ST段抬高型心肌梗死诊断和治疗指南(2019)[J]. 中华心血管病杂志, 2019,47(10):766-783.
[6]	Guazzi M, Arena R, Halle M, et al. 2016 focused update:clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations[J]. Circulation, 2016,133(24):e694-e711. DOI URL PMID
[7]	陈纪言, 陈韵岱, 韩雅玲, 等. 经皮冠状动脉介入治疗术后运动康复专家共识[J]. 中国介入心脏病学杂志, 2016,24(7):361-369.
[8]	国家心血管病中心《中西医结合Ⅰ期心脏康复专家共识》专家委员会. 中西医结合Ⅰ期心脏康复共识[J]. 中华高血压杂志, 2017,25(12):1140-1148.
[9]	冯舒爽, 魏睿宏, 王冰冰, 等. 经皮冠状动脉介入治疗患者信息需求的质性研究[J]. 国际医药卫生导报, 2018,24(15):2368-2372.
[10]	王冰冰, 冯舒爽, 郑奇贤, 等. 分段式强化用药教育法在PCI术后患者中的应用[J]. 中华现代护理杂志, 2019,26(24):3151-3156.
[11]	冯舒爽. 经皮冠状动脉介入治疗术前宣教视频的开发及初步应用[D]. 汕头:汕头大学, 2018.
[12]	潘世琴, 王丽, 王玉宇. 危重症患者肌力评定方法的研究进展[J]. 中国康复理论与实践, 2019,25(9):1052-1056.
[13]	赵志勇, 王惠琴, 吴清美, 等. 延续照护在急诊经皮冠状动脉介入术后患者居家康复中的效果研究[J]. 中华护理杂志, 2019,54(3):428-433.
[14]	许彩会. 老年人功能性体适能城乡比较研究[D]. 南京:南京师范大学, 2018.
[15]	邹艳辉, 段红梅, 陈芳, 等. Orem自理理论的康复护理指导对脑梗死偏瘫患者日常自理能力和焦虑情绪的影响[J]. 中外医学研究, 2019,17(30):115-117.
[16]	何成雨, 甘秀妮, 崔念奇, 等. 心脏康复训练对冠心病病人康复效果的Meta分析[J]. 护理研究, 2018,32(15):2369-2379.
[17]	魏丽丽, 韩斌如. 以护士为主导的早期活动方案在机械通气患者中的应用研究[J]. 中华护理杂志, 2019,54(12):1765-1770.
[18]	段一超, 黄晏, 苏新, 等. 运动与心脏康复[J]. 实用心电学杂志, 2019,28(4):285-288.
[19]	顾淑芳, 于艳艳, 张丽敏. 急性心肌梗死患者行冠状动脉介入术后即刻康复训练的效果研究[J]. 中华护理杂志, 2018,53(2):173-178.
[20]	渠林楠, 崔玉芳, 虞彬. 早期康复对经桡动脉行急诊PCI的急性心梗患者左室射血分数及运动耐量的影响[J]. 实用临床医药杂志, 2017,21(8):5-7.
[21]	梅小琴. 早期康复运动指导对急性心梗PCI术后患者的影响[J]. 当代护士(下旬刊), 2019(11):32-33.