慢性心力衰竭患者运动处方最佳证据的应用

doi:10.3761/j.issn.0254-1769.2024.14.005

摘要/Abstract

摘要：

目的将慢性心力衰竭患者运动处方的最佳证据应用于临床实践并评价其效果。方法总结慢性心力衰竭患者运动处方最佳证据，制订循证实践方案，于2022年8月—10月，在浙江省某三级甲等综合医院心内科开展循证实践，比较最佳证据应用前后，护士运动处方知信行水平，审查指标执行率以及患者住院天数、运动耐力、日常生活能力和握力的差异。结果最佳证据应用后，护士运动处方知信行调查问卷知识、态度、行为维度得分分别为（9.34±0.98）、（63.29±1.37）、（25.49±1.51）分，与证据应用前比较，差异具有统计学意义（P<0.05）；最佳证据应用后，16个审查指标执行率较证据应用前提升（P<0.001）；证据应用组患者住院天数较基线审查组缩短（Z=-2.610，P<0.001）；干预后，证据应用组患者运动耐力、日常生活能力和握力与基线审查组比较，差异具有统计学意义（P<0.05）。结论慢性心力衰竭患者运动处方最佳证据的应用，可提高护士运动处方知信行水平，规范护士运动处方执行依从性，减少患者住院天数，提高患者运动耐力、日常生活能力和握力。

关键词: 慢性心力衰竭, 运动处方, 循证护理学, 最佳证据

Abstract:

Objective To investigate the best evidence application of exercise prescription in patients with chronic heart failure in clinical practice and evaluate its effectiveness. Methods The best evidence of exercise prescription for patients with chronic heart failure was summarized，and the evidence-based practice plan was developed，and it was implemented in the cardiology department of a tertiary hospital in Zhejiang Province from August to October，2022. Nurses’ exercise prescription knowledge-attitude-practice level，implementation rate of review indicators，the length of hospital stay，exercise endurance，daily living ability and grip strength of both groups before and after the intervention were compared. Results After the application of the best evidence，the score of knowledge dimension was（9.34±0.98） points；the score of attitude dimension was（63.29±1.37） points；the score of practice dimension was（25.49±1.51） points，which were statistically significant compared with the scores before the application of evidence（P<0.05）. After the application of the best evidence，the implementation rate of 16 review indicators was higher than that before the application of evidence（P<0.001）. The length of hospital stay in the evidence application group was shorter than that in the baseline examination group（Z=-2.610，P<0.001）. After intervention，the exercise endurance，daily living ability and grip strength of patients in the evidence application group were improved compared with the baseline review group，and the difference was statistically significant（P<0.05）. Conclusion After the application of the best evidence of exercise prescription in patients with chronic heart failure，it can improve the level of knowledge，attitude and practice of nurses on exercise prescription，standardize the compliance of nurses’ exercise prescription，reduce the number of days in the hospital，and improve patients’ exercise endurance，daily living ability and grip strength.

Key words: Chronic Heart Failure, Exercise Prescription, Evidence-Based Nursing, Best Evidence

周莉莉, 郭鸽, 李梅, 邵翠梅, 毛越, 朱蓓蓓, 冯佳, 陈海莲, 宋剑平. 慢性心力衰竭患者运动处方最佳证据的应用[J]. 中华护理杂志, 2024, 59(14): 1698-1705.

ZHOU Lili, GUO Ge, LI Mei, SHAO Cuimei, MAO Yue, ZHU Beibei, FENG Jia, CHEN Hailian, SONG Jianping. Best evidence application of exercise prescriptions for patients with chronic heart failure[J]. Chinese Journal of Nursing, 2024, 59(14): 1698-1705.

图/表 5

表1 慢性心力衰竭患者运动处方最佳证据及审查指标

Table 1 Best evidence and review indicators for exercise prescription in patients with chronic heart failure

表2 两组一般资料的比较

Table 2 Comparison of general information between the 2 groups

表3 证据应用前后护士运动处方的知信行得分比较（n=108，分，$\bar{x}±s$）

Table 3 Comparison of KAP scores of nurses on exercise prescription before and after application of evidence（n=108，score，$\bar{x}±s$）

表4 证据应用前后护士对审查指标执行情况的比较

Table 4 Comparison of implementation of review indicators by nurses before and after evidence application

表5 两组运动耐力、日常生活能力和握力评分的比较（$\bar{x}±s$）

Table 5 Comparison of exercise endurance, daily living ability and grip strength scores in the 2 groups（$\bar{x}±s$）

参考文献 20

[1]	Uchmanowicz I, Kunierz M, Wleklik M, et al. Frailty syndrome and rehospitalizations in elderly heart failure patients[J]. Aging Clin Exp Res, 2018, 30(6):617-623. DOI PMID
[2]	中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10):760-789.
	Heart Failure Group of Chinese Society of Cardiology, Chinese Heart Failure Association of Chinese Medical Doctor Association, Editorial Board of Chinese Journal of Cardiology. China guidelines for diagnosis and treatment of heart failure 2018[J]. Chin J Cardiol, 2018, 46(10):760-789.
[3]	Ezekowitz JA, O’Meara E, McDonald MA, et al. 2017 comprehensive update of the Canadian cardiovascular society guidelines for the management of heart failure[J]. Can J Cardiol, 2017, 33(11):1342-1433. DOI PMID
[4]	Atherton JJ, Sindone A, de Pasquale CG, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand:Australian clinical guidelines for the management of heart failure 2018[J]. Med J Aust, 2018, 209(8):363-369. PMID
[5]	Hansen D, Coninx K, Beckers P, et al. Appropriate exercise prescription in primary and secondary prevention of cardiovascular disease:why this skill remains to be improved among clinicians and healthcare professionals. A call for action from the EXPERT Network[J]. Eur J Prev Cardiol,2023:zwad232.
[6]	Dicenso A, Bayley L, Haynes RB. Accessing pre-appraised evidence:fine-tuning the 5S model into a 6S model[J]. Evid Based Nurs, 2009, 12(4):99-101. DOI PMID
[7]	Ballesta García I, Rubio Arias Já, Ramos Campo DJ, et al. High-intensity interval training dosage for heart failure and coronary artery disease cardiac rehabilitation. A systematic review and meta-analysis[J]. Rev Esp Cardiol(Engl Ed), 2019, 72(3):233-243.
[8]	Pattyn N, Beulque R, Cornelissen V. Aerobic interval vs. continuous training in patients with coronary artery disease or heart failure:an updated systematic review and meta-analysis with a focus on secondary outcomes[J]. Sports Med, 2018, 48(5):1189-1205. DOI PMID
[9]	Tucker WJ, Beaudry RI, Liang YY, et al. Meta-analysis of exercise training on left ventricular ejection fraction in heart failure with reduced ejection fraction:a 10-year update[J]. Prog Cardiovasc Dis, 2019, 62(2):163-171.
[10]	高敏, 孙国珍, 邢双双, 等. 慢性稳定期心力衰竭患者运动康复的最佳证据总结[J]. 护理学杂志, 2020, 35(4):10-15.
	Gao M, Sun GZ, Xing SS, et al. Summary of best evidence for exercise-based rehabilitation for heart failure[J]. J Nurs Sci, 2020, 35(4):10-15.
[11]	McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Eur Heart J, 2021, 42(36):3599-3726. DOI PMID
[12]	Shoemaker MJ, Dias KJ, Lefebvre KM, et al. Physical therapist clinical practice guideline for the management of individuals with heart failure[J]. Phys Ther, 2020, 100(1):14-43. DOI PMID
[13]	Lindström Egholm C, Rossau HK, Nilsen P, et al. Implementation of a politically initiated national clinical guideline for cardiac rehabilitation in hospitals and municipalities in Denmark[J]. Health Policy, 2018, 122(9):1043-1051. DOI PMID
[14]	中华医学会老年医学分会心血管疾病学组, 《老年慢性心力衰竭诊治中国专家共识》编写组. 老年人慢性心力衰竭诊治中国专家共识(2021)[J]. 中华老年医学杂志, 2021, 40(5):550-561.
	Cardiovascular Group,Geriatrics Branch,, Chinese Medical As-sociation, Editing Group of Chinese Expert Consensus on the Diagnosis and Treatment of Chronic Heart Failure in the El-derly. Chinese experts consensus on the diagnosis and treatment of chronic heart failure in the elderly(2021)[J]. Chin J Geriatr, 2021, 40(5):550-561.
[15]	中国康复医学会心血管病专业委员会, 中国老年学学会心脑血管病专业委员会. 慢性稳定性心力衰竭运动康复中国专家共识[J]. 中华心血管病杂志, 2014, 42(9):714-720.
	Cardiovascular Committee of Chinese Association of Rehabili-tation Medicine, Cardio-cerebrovascular Disease Professional Committee of Chinese Gerontology Society. China expert con-sensus on exercise rehabilitation of chronic stable heart fail-ure[J]. Chin J Cardiol, 2014, 42(9):714-720.
[16]	杜宜修, 吴芳琴, 卢晓英, 等. 多学科团队延续性护理模式在心房颤动患者中的应用研究[J]. 中华护理杂志, 2020, 55(7):969-974. DOI URL
	Du YX, Wu FQ, Lu XY, et al. The application effects of continuous nursing care in management of patients with atrial fibrillation by a nurse-led multidisciplinary team[J]. Chin J Nurs, 2020, 55(7):969-974. DOI URL
[17]	逯莹, 甘红艳, 杨玉金, 等. 下肢动脉硬化闭塞症患者静态行为现状及其影响因素研究[J]. 中华护理杂志, 2023, 58(6):714-720. DOI URL
	Lu Y, Gan HY, Yang YJ, et al. Study on sedentary behavior and its influencing factors in patients with arteriosclerosis obliterans[J]. Chin J Nurs, 2023, 58(6):714-720. DOI URL
[18]	张雅静, 张小兰, 马延爱, 等. Barthel指数量表应用于急性脑卒中患者生活能力测量的信度研究[J]. 中国护理管理, 2007, 7(5):30-32.
	Zhang YJ, Zhang XL, Ma YA, et al. Assessments of reliability of Barthel Index in patients after acute stroke[J]. Chin Nurs Manag, 2007, 7(5):30-32.
[19]	宋剑平, 卢芳燕, 吴小燕, 等. 肝切除术后患者早期活动的最佳证据应用[J]. 中华护理杂志, 2019, 54(8):1175-1179. DOI URL
	Song JP, Lu FY, Wu XY, et al. Implementation of best evidence on early mobilization among patients after liver resection[J]. Chin J Nurs, 2019, 54(8):1175-1179. DOI URL
[20]	毛越, 徐剑锋, 李梅, 等. 经导管主动脉瓣置换术患者Ⅰ期心脏康复的最佳证据应用[J]. 中华护理杂志, 2022, 57(5):563-568. DOI
	Mao Y, Xu JF, Li M, et al. Best evidence application of phase I cardiac rehabilitation in transcatheter aortic valve replacement patients[J]. Chin J Nurs, 2022, 57(5):563-568.