渐进式上肢运动康复在心脏起搏器植入患者中的应用研究

doi:10.3761/j.issn.0254-1769.2025.19.006

摘要/Abstract

摘要：

目的探讨基于多过程行动控制框架构建的渐进式上肢运动康复方案对永久性心脏起搏器植入（permanent pacemaker implantation，PPI）患者上肢功能、康复依从性及生活质量的干预效果。方法采用便利抽样法，选取2024年3—8月130例拟行PPI患者为研究对象，其中2024年6—8月收治的65例为试验组，2024年3—5月收治的65例为对照组。试验组在常规护理基础上应用渐进式上肢运动康复方案进行干预，对照组接受常规护理，干预时间为3个月。比较两组主要结局指标肩关节疼痛与功能障碍指数、握力和次要结局指标起搏器患者生存质量、并发症发生率、住院时长的差异。结果 122例患者完成研究，其中试验组62例，对照组60例。重复测量方差分析显示，肩关节疼痛与功能障碍指数总分及其疼痛、功能障碍维度得分，起搏器患者生存质量的躯体功能、心理功能维度得分和总分均存在时间与组间的交互效应（P<0.001）。简单效应分析表明，试验组术后1个月握力优于对照组，术后1、3个月肩关节疼痛与功能障碍指数各维度得分及总分均低于对照组，术后1个月起搏器患者生存质量总分及各维度得分均高于对照组（P<0.05）。两组并发症发生率和住院时长比较，差异无统计学意义（P>0.05）。结论构建的渐进式上肢运动康复方案能有效解决PPI患者康复依从性低的问题，改善其上肢功能与生活质量，且安全性良好，为PPI患者提供了切实可行且安全有效的康复新路径。

关键词: 起搏器植入, 上肢运动, 多过程行动控制框架, 依从性, 康复护理

Abstract:

Objective To investigate the intervention effects of a progressive upper limb exercise rehabilitation program based on the multi-process action control theory on upper limb function，rehabilitation compliance，and quality of life in patients with permanent pacemaker implantation（PPI）. Methods A total of 130 patients scheduled for PPI from March to August 2024 were selected using a convenience sampling method. Among them，65 patients admitted from June to August were assigned to the experimental group， and 65 patients admitted from March to May formed the control group. The experimental group received the progressive upper limb exercise program in addition to routine care，while the control group received routine care only. The intervention lasted for 3 months. The differences were compared between the 2 groups in terms of primary outcome measures，including the Shoulder Pain and Disability Index（SPADI） and grip strength. The secondary outcome measures were the Quality of Life Instrument for Chinese Patients with Pacemaker（QLICPP），hospital stay and incidence of complications. Results A total of 122 patients（62 in the experimental group and 60 in the control group） completed this study. Repeated-measures analysis of variance showed significant interaction effects between time and group for the total SPADI score and its pain and disability dimensions，as well as for the physical function，psychological function，and total score of QLICPP（P<0.001）. Simple effects analysis indicated that the experimental group had better grip strength than the control group at 1 month postoperatively，and lower SPADI scores and total score than the control group at 1 and 3 months postoperatively. At 1 month postoperatively，the total QLICPP score and each dimension of the experimental group were higher than those of the control group（P<0.05）. There were no significant differences between the 2 groups in the incidence of complications and length of hospital stay（P>0.05）. Conclusion The progressive upper limb exercise rehabilitation program developed in this study effectively addressed the issue of low rehabilitation compliance in PPI patients，improved their upper limb function and quality of life，and it was safe. It provides a feasible and effective new pathway for the rehabilitation of PPI patients.

Key words: Pacemaker Implantation, Upper Limb Exercise, Multi-Process Action Control Framework, Compliance, Rehabilitation Nursing

冯佳, 郑琳琳, 邵翠梅, 郑苏炜, 姚晓芳, 彭丹, 宋剑平. 渐进式上肢运动康复在心脏起搏器植入患者中的应用研究[J]. 中华护理杂志, 2025, 60(19): 2340-2347.

FENG Jia, ZHENG Linlin, SHAO Cuimei, ZHENG Suwei, YAO Xiaofang, PENG Dan, SONG Jianping. Application of progressive upper limb exercise rehabilitation in patients with permanent pacemaker implantation[J]. Chinese Journal of Nursing, 2025, 60(19): 2340-2347.

图/表 5

表1 心脏起搏器植入患者渐进式上肢运动康复方案

Table 1 Progressive upper limb exercise rehabilitation program for patients after pacemaker implantation

表2 两组一般资料的比较[例（百分比，%）]

Table 2 Comparison of general information of the 2 groups of patients[cases（percentage，%）]

表3 两组握力的重复测量方差分析（kg，$\bar{x}\pm s$）

Table 3 Repeated-measures ANOVA of grip strength in 2 groups of patients（kg，$\bar{x}\pm s$）

表4 两组肩关节疼痛与功能障碍指数评分的重复测量方差分析（分，$\bar{x}\pm s$）

Table 4 Repeated-measures ANOVA of Shoulder Pain and Disability Index scores in 2 groups of patients（分，$\bar{x}\pm s$）

表5 两组起搏器患者生存质量评分的重复测量方差分析（分，$\bar{x}\pm s$）

Table 5 Repeated-measures ANOVA of Quality of Life Instrument for Chinese Patients with Pacemaker scores between the 2 groups（分，$\bar{x}\pm s$）

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