基于移动医疗的经导管主动脉瓣置换术患者居家心脏康复依从性效果研究

doi:10.3761/j.issn.0254-1769.2025.17.006

摘要/Abstract

摘要：

目的构建基于移动医疗的经导管主动脉瓣置换术（transcatheter aortic valve replacement，TAVR）患者居家心脏康复方案并验证其效果。方法基于最佳证据总结，以行为改变轮为框架，邀请相关领域的15名专家开展德尔菲专家函询，构建居家心脏康复方案并开发干预系统。便利选取2024年1—3月浙江省某三级甲等综合医院的72例患者作为研究对象，于2024年6—8月实施干预。采用随机数字表法分为试验组和对照组，每组各36例。试验组在常规护理的基础上实施基于移动医疗的居家心脏康复方案，对照组接受常规护理。干预12周后比较两组结局指标的差异。结果 2轮德尔菲专家函询的专家权威系数均为0.95，肯德尔和谐系数分别为0.591、0.414（P<0.001）。方案终稿包含一级指标6个、二级指标14个、三级指标25个。共有70例患者完成干预，试验组和对照组各35例。干预前，两组居家心脏康复运动依从性、衰弱和日常生活活动能力比较，差异均无统计学意义（P>0.05）。干预12周后，试验组居家心脏康复运动依从性高于对照组（Z=-7.203，P<0.001）。结论基于移动医疗的TAVR患者居家康复方案科学、可行，可有效改善TAVR患者的居家心脏康复运动依从性。未来，可在临床应用中不断优化康复方案的内容及干预系统，以改善患者预后。

关键词: 经导管主动脉瓣置换术, 心脏康复, 护理, 居家, 行为改变轮

Abstract:

Objective To construct a home cardiac rehabilitation program based on mobile healthcare for patients undergoing transcatheter aortic valve replacement（TAVR） and validate its application effectiveness. Methods Based on the best evidence summary，using the Behavior Change Wheel as a framework，15 experts from relevant fields were invited for the Delphi expert consultation to construct a home-based cardiac rehabilitation program and develop an intervention system. Using convenience sampling method，72 patients from a tertiary hospital in Zhejiang Province from January to March 2024 were selected as research subjects，and the intervention was implemented from June to August 2024. They were randomly divided into an experimental group and a control group using a random number table method，with 36 cases in each group. The experimental group received a home rehabilitation program based on mobile healthcare on the basis of routine care，while the control group received routine care. The differences in outcome indicators were compared between 2 groups of patients after 12 weeks of intervention. Results The expert authority coefficients for the 2 rounds of Delphi expert inquiry were 0.95，and Kendall’s W were 0.591 and 0.414，respectively（P<0.001）. The final draft of the intervention plan includes 6 primary indicators，14 secondary indicators，and 25 tertiary indicators. A total of 70 patients completed the intervention，with 35 in the experimental group and 35 in the control group. Before intervention，there was no statistically significant difference in home cardiac rehabilitation exercise compliance，frailty，and activities of daily living ability between the 2 groups（P>0.05）. After 12 weeks of intervention，the scores of the home-based cardiac rehabilitation exercise adherence scale in the experimental group improved compared to the control group（Z=-7.203，P<0.001）. Conclusion The home rehabilitation program for TAVR patients based on mobile healthcare is scientific and feasible，and can effectively improve patients’ exercise compliance with home cardiac rehabilitation. In the future，the rehabilitation program and the system can be continuously optimized in the clinical application to improve patient prognosis.

Key words: Transcatheter Aortic Valve Replacement, Cardiac Rehabilitation, Nursing Care, Home, Behavior Change Wheel

贾盈盈, 王雅, 王红幸, 宋剑平. 基于移动医疗的经导管主动脉瓣置换术患者居家心脏康复依从性效果研究[J]. 中华护理杂志, 2025, 60(17): 2079-2086.

JIA Yingying, WANG Ya, WANG Hongxing, SONG Jianping. Study on the effect of home-based cardiac rehabilitation adherence in patients undergoing transcatheter aortic valve replacement based on mobile healthcare[J]. Chinese Journal of Nursing, 2025, 60(17): 2079-2086.

图/表 3

表1 居家心脏康复方案

Table 1 Home cardiac rehabilitation program for TAVR patients

表2 两组一般资料的比较

Table 2 Comparison of general information of 2 groups

表3 两组干预前后衰弱、日常生活活动能力的比较（分，$\bar{x}±s$）

Table 3 Comparison of frailty and activities of daily living in the 2 groups before and after intervention（score，$\bar{x}±s$）

参考文献 27

[1]	Abawi M, Pagnesi M, Agostoni P, et al. Postoperative delirium in individuals undergoing transcatheter aortic valve replacement:a systematic review and meta-analysis[J]. J Am Geriatr Soc, 2018, 66(12):2417-2424.
[2]	Oz A, Tsoumas I, Lampropoulos K, et al. Cardiac rehabilitation after TAVI:a systematic review and meta-analysis[J]. Curr Probl Cardiol, 2023, 48(3):101531.
[3]	贾盈盈, 宋剑平, 程继芳, 等. 机器学习在经导管主动脉瓣置换术患者术后精准护理中的应用进展[J]. 中国护理管理, 2024, 24(4):621-625.
	Jia YY, Song JP, Cheng JF, et al. Application progress on machine learning for prognostic precision care of patients undergoing transcatheter aortic valve replacement[J]. Chin Nurs Manag, 2024, 24(4):621-625.
[4]	葛焰, 陈忠兰, 赵振刚, 等. 《经导管主动脉瓣置换术围术期护理中国专家共识》解读[J]. 华西医学, 2024, 39(11):1699-1703.
	Ge Y, Chen ZL, Zhao ZG, et al. Interpretation of Chinese expert consensus on perioperative nursing of transcatheter aortic valve replacement[J]. West China Med J, 2024, 39(11):1699-1703.
[5]	Howard T, Majmundar M, Sarin S, et al. Predictors of major adverse cardiovascular events in patients with moderate aortic stenosis:implications for aortic valve replacement[J]. Circ Cardiovasc Imaging, 2023, 16(7):557-565.
[6]	谢慕蓉, 许海燕, 吴永健. 经导管主动脉瓣置换术后患者心脏康复研究进展[J]. 中国循环杂志, 2022, 37(4):444-448.
	Xie MR, Xu HY, Wu YJ. Research progress on cardiac rehabilitation of patients after transcatheter aortic valve replacement surgery[J]. Chin Circ J, 2022, 37(4):444-448.
[7]	Makita S, Yasu T, Akashi YJ, et al. JCS/JACR 2021 guideline on rehabilitation in patients with cardiovascular disease[J]. Circ J, 2022, 87(1):155-235. DOI PMID
[8]	Golbus JR, Lopez-Jimenez F, Barac A, et al. Digital technologies in cardiac rehabilitation:a science advisory from the American Heart Association[J]. Circulation, 2023, 148(1):95-107.
[9]	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):563-569. 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):563-569.
[10]	刘莉, 张艳, 田雨同, 等. 行为改变轮理论在护理领域中的应用进展[J]. 中华护理教育, 2023, 20(9):1132-1138.
	Liu L, Zhang Y, Tian YT, et al. Research progress on behaviour change wheel theory in nursing[J]. Chin J Nurs Educ, 2023, 20(9):1132-1138.
[11]	贾盈盈, 宋剑平, 张倩, 等. 经导管主动脉瓣置换术患者居家心脏康复的最佳证据总结[J]. 中华急危重症护理杂志, 2024, 5(3):214-221.
	Jia YY, Song JP, Zhang Q, et al. Summary of the best evidence for home cardiac rehabilitation in patients undergoing transcatheter aortic valve replacement surgery[J]. Chin J Emerg Crit Care Nurs, 2024, 5(3):214-221.
[12]	Braun V, Clarke V. Using thematic analysis in psychology[J]. Qual Res in Psychol, 2006, 3(2):77-101.
[13]	林榕, 颜缘娇, 晁玥畦, 等. 独立式移动医疗应用程序可用性问卷的汉化及信效度检验[J]. 护理学杂志, 2023, 38(10):107-111.
	Lin R, Yan YJ, Chao YQ, et al. Validity and reliability of the Chinese version of the Standalone mHealth Apps Usability Questionnaire for Standalone mHealth Apps-Patient Version in older adults[J]. J Nurs Sci, 2023, 38(10):107-111.
[14]	梁倩, 汪晓丽, 刘梦琪, 等. 多组分运动护理干预在老年慢性心力衰竭合并衰弱患者中的应用[J]. 中华护理杂志, 2023, 58(23):2821-2828. DOI
	Liang Q, Wang XL, Liu MQ, et al. Effects of multi-component exercise nursing intervention on frailty in elderly patients with chronic heart failure[J]. Chin J Nurs, 2023, 58(23):2821-2828. DOI
[15]	Gobbens RJJ, van Assen MALM, Luijkx KG, et al. The Tilburg Frailty Indicator:psychometric properties[J]. J Am Med Dir Assoc, 2010, 11(5):344-355.
[16]	奚兴, 郭桂芳, 孙静. 中文版Tilburg衰弱评估量表的信效度研究[J]. 护理学报, 2013, 20(16):1-5.
	Xi X, Guo GF, Sun J. Reliability and validity of Chinese version of Tilburg Frailty Indicator[J]. J Nurs(China), 2013, 20(16):1-5.
[17]	Yang Z, Sun YH, Wang H, et al. A scale for measuring home-based cardiac rehabilitation exercise adherence:a development and validation study[J]. BMC Nurs, 2023, 22(1):259.
[18]	Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation[J]. J Clin Epidemiol, 1989, 42(8):703-709. DOI PMID
[19]	Leung SOC, Chan CCH, Shah S. Development of a Chinese version of the Modified Barthel Index:validity and reliability[J]. Clin Rehabil, 2007, 21(10):912-922.
[20]	陈岩, 韦丽华, 钟美容, 等. 基于行为改变轮理论的线上线下居家康复方案在行PCI的老年冠心病患者中的应用效果[J]. 实用心脑肺血管病杂志, 2024, 32(1):114-118.
	Chen Y, Wei LH, Zhong MR, et al. Application effect of online and offline home rehabilitation programs based on behavior change wheel theory in elderly patients with coronary heart disease undergoing PCI[J]. Pract J Card Cereb Pneumal Vasc Dis, 2024, 32(1):114-118.
[21]	郭卫婷, 刘建萍, 张晓雪, 等. 远程心脏康复有效性及依从性的系统评价再评价[J]. 中华护理杂志, 2023, 58(4):426-433. DOI
	Guo WT, Liu JP, Zhang XX, et al. Effectiveness and compliance of remote cardiac rehabilitation:an overview of systematic reviews[J]. Chin J Nurs, 2023, 58(4):426-433.
[22]	Nelson RK, Solomon R, Hosmer E, et al. Cardiac rehabilitation utilization,barriers,and outcomes among patients with heart failure[J]. Heart Fail Rev, 2023, 28(6):1239-1249.
[23]	王思沛, 王研, 牛伟华, 等. 慢性心力衰竭患者躯体、认知、社会衰弱共存现状及影响因素研究[J]. 中华护理杂志, 2025, 60(3):311-318.
	Wang SP, Wang Y, Niu WH, et al. The current status and influencing factors of the coexistence of multiple frailty domains in patients with chronic heart failure[J]. Chin J Nurs, 2025, 60(3):311-318.
[24]	Nagatomi Y, Ide T, Higuchi T, et al. Home-based cardiac rehabilitation using information and communication technology for heart failure patients with frailty[J]. ESC Heart Fail, 2022, 9(4):2407-2418. DOI PMID
[25]	Ögmundsdóttir Michelsen H, Sjölin I, Bäck M, et al. Effect of a lifestyle-focused web-based application on risk factor management in patients who have had a myocardial infarction:randomized controlled trial[J]. J Med Internet Res, 2022, 24(3):e25224.
[26]	Thomas RJ. Cardiac rehabilitation-challenges,advances,and the road ahead[J]. N Engl J Med, 2024, 390(9):830-841.
[27]	Taylor RS, Sadler S, Dalal HM, et al. The cost effectiveness of REACH-HF and home-based cardiac rehabilitation compared with the usual medical care for heart failure with reduced ejection fraction:a decision model-based analysis[J]. Eur J Prev Cardiol, 2019, 26(12):1252-1261. DOI PMID