摘要
目的探讨综合心脏康复在经皮冠状动脉介入治疗(PCI)术后急性冠状动脉综合征(ACS)患者中的完成情况及疗效。方法采用回顾性研究方法,连续入选首都医科大学附属北京友谊医院心脏康复数据库中2017年5月至2018年12月在首都医科大学附属北京友谊医院心血管中心行PCI术的ACS患者。这些患者接受急诊或者择期PCI术,生命体征平稳后予以急性期联合恢复期心脏康复干预,在干预前后评估患者的超声心动图、血生化、心肺运动负荷试验、6分钟步行试验、平衡功能及柔韧性并进行比较。结果通过检索数据库,符合入选标准的恢复期心脏康复复诊人数为42例,其中16例完成了3个月的门诊心脏康复干预,26例中途脱落,完成率为38. 10%。通过3个月的综合心脏康复干预,ACS患者的左室射血分数和室壁运动异常有改善的趋势,但干预前后的差异无统计学意义(P> 0. 05)。总胆固醇和低密度脂蛋白胆固醇在3个月心脏康复干预后显著下降(4. 34±0. 90 mmol/L vs. 2. 97±0. 41 mmol/L,2. 54±0. 67 mmol/L vs. 1. 52±0. 30 mmol/L),白蛋白显著上升(39. 27±2. 90 g/L vs. 45. 20±0. 95 g/L),差异具有统计学意义(P <0. 05)。3个月综合心脏康复干预明显改善了ACS患者的心肺耐力,患者的峰值公斤耗氧量、峰值代谢当量、峰值负荷占预计值的百分比、6分钟步行距离均较干预前显著增加[(20. 30±2. 69) ml·kg-1·min-1vs.(22. 20±3. 97)ml·kg^-1·min^-1,(5. 79±0. 77) m vs.(6. 32±1. 15) m,75. 50%±11. 58%vs. 85. 94%±12. 64%,430. 00(372. 50,490.00) m vs. 585. 00(526. 50,601. 50) m],差异具有统计学意义(P <0. 05)。此外,ACS患者干预后的平衡功能较干预前明显改善(P <0. 05),但柔韧性改善不明显(P> 0. 05)。结论急性期联合恢复期综合心脏康复干预可以有效、安全地提高PCI术后ACS患者的心肺耐力和平衡能力。
Objective To explore the completion rate and efficacy of comprehensive cardiac rehabilitation in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Methods A retrospective study was conducted in selection of patients in the Cardiac Rehabilitation Database with acute coronary syndrome (ACS) underwent percutaneous coronary intervention in Cardiology Center of this hospital, during May 2017 to December 2018. These patients underwent emergent or elective PCI. After vital signs were stabled, they received comprehensive acute period and outpatient period cardiac rehabilitation intervention. Before and after the intervention, echocardiography, blood biochemical examination, cardiopulmonary exercise test, 6-min walking test, balance function and flexibility were evaluated and compared. Results By searching the database, 42 patients met the selection criteria for cardiac rehabilitation in outpatient period, 16 cases had completed three months of outpatient cardiac rehabilitation intervention, 26 cases were dropped out, and the completion rate was 38.10%. After 3 months of comprehensive cardiac rehabilitation intervention, left ventricular ejection fraction and wall motion abnormality of ACS patients tended to be improved, but there was no significant difference before and after intervention (P 0.05). Total cholesterol and low density lipoprotein cholesterol decreased significantly (4.34±0.90 mmol/L vs. 2.97±0.41 mmol/L, 2.54±0.67 mmol/L vs. 1.52±0.30 mmol/L, P 0.05) and albumin increased significantly after 3 months of cardiac rehabilitation intervention (39.27±2.90 g/L vs. 45.20±0.95 g/L, P 0.05). The three-months comprehensive cardiac rehabilitation intervention significantly improved the cardiopulmonary fitness of ACS patients. The peak/kg oxygen consumption, peak metabolic equivalent of energy (METs), peak load per predictive value and 6-min walking distance of ACS patients were significantly increased compared with those before intervention [(20.30±2.69) ml·kg ^-1 ·min ^-1 vs.(22.20±3.97) ml·kg ^-1 ·min^-1 ,(5.79±0.77) m vs.(6.32±1.15) m, 75.50%±11.58% vs. 85.94%±12.64%, 430.00 (372.50, 490.00) m vs. 585.00 (526.50, 601.50) m, P <0.05]. In addition, the balance function of ACS patients after intervention was significantly improved ( P <0.05), but the improvement of flexibility was not significant ( P >0.05). Conclusion Acute period combined with outpatient period comprehensive cardiac rehabilitation intervention can effectively and safely improve the cardiopulmonary fitness and balance of ACS patients undergoing PCI.
作者
桂沛君
吴坚
张勃
韩淑霞
吴春薇
高翔宇
李卫萍
谢瑛
GUI Pei-jun;WU Jian;ZHANG Bo(Department of Rehabilitation Medicine,Capital Medical University Affiliated Beijing Friendship Hospital,Beijing 100050,China;Department of Cardiology,Capital Medical University Affiliated Beijing Friendship Hospital,Beijing 100050,China.)
出处
《临床和实验医学杂志》
2019年第18期1959-1964,共6页
Journal of Clinical and Experimental Medicine
基金
北京市卫生系统高层次卫生技术人才培养项目资助(编号:2015-3-004)
“友谊种子计划”人才项目(编号:YYZZ2017A29)
关键词
急性冠状动脉综合征
经皮冠状动脉介入治疗
综合心脏康复
疗效
心肺功能
Acute coronary syndrome
Percutaneous coronary intervention
Comprehensive cardiac rehabilitation
Efficacy
Cardiopulmonary fitness
