摘要
目的探讨基于目标控制的心脏康复模式对行经皮冠状动脉介入术(PCI)治疗的冠状动脉粥样硬化性心脏病(CAHD)患者心脏储备功能及运动能力的影响。方法选择2017年2月至2019年3月于郑州市第七人民医院心血管内科行PCI治疗的96例CAHD患者为研究对象,采用简单随机数字表法将患者分为对照组及观察组,每组48例。对照组剔除随访资料不全4例,最终纳入44例;观察组纳入48例。对照组患者PCI术后给予传统心脏康复模式管理,观察者患者PCI术后给予基于目标控制的心脏康复模式管理。分别于干预前及干预24周后,应用心脏超声心动图检测2组患者左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)等心功能指标,采用CAHD自我管理行为量表(CSMS)评估2组患者自我管理能力;分别于出院时及干预24周后,采用6 min步行试验(6MWT)评估2组患者运动能力,根据美国胸科协会/美国胸科医师协会制定的心肺运动试验指南完成心肺运动试验并记录峰值摄氧量(VO_(2)peak)、峰值摄氧量占预计值的百分比(VO_(2)peak%)、二氧化碳通气当量(VE/VCO_(2))等心脏储备功能指标,记录PCI术后24周内2组患者恶性心律失常、心绞痛、心力衰竭等心血管不良事件发生情况。比较2组患者心功能指标、自我管理能力、运动能力、心脏储备功能指标及心血管不良事件发生情况。结果干预前,观察组与对照组患者不良嗜好、症状、情绪认知、疾病知识、日常生活、急救、治疗依从性评分比较差异无统计学意义(P<0.05)。2组患者干预24周后不良嗜好、症状、情绪认知、疾病知识、日常生活、急救、治疗依从性评分均显著高于干预前(P<0.05);干预24周后,观察组患者不良嗜好、症状、情绪认知、疾病知识、日常生活、急救、治疗依从性各维度评分显著高于对照组(P<0.05)。干预前,观察组与对照组患者LVEDV、LVESV、LVEF比较差异无统计学意义(P>0.05)。2组患者干预24周后LVEF显著高于干预前(P<0.05),LVEDV、LVESV与干预前比较差异无统计学意义(P>0.05)。干预24周后,观察组患者LVEF显著高于对照组(P<0.05),观察组与对照组患者LVEDV、LVESV比较差异无统计学意义(P>0.05)。出院时,观察组与对照组患者6MWT比较差异无统计学意义(P>0.05);2组患者干预24周后6MWT显著高于出院时(P<0.05);干预24周后,观察组患者6MWT显著高于对照组(P<0.05)。出院时,观察组与对照组患者VO_(2)peak、VO_(2)peak%、VE/VCO_(2)比较差异无统计学意义(P>0.05)。2组患者干预24周后VO_(2)peak、VO_(2)peak%显著高于出院时(P<0.05),VE/VCO_(2)与出院时比较差异无统计学意义(P>0.05)。干预24周后,观察组患者VO_(2)peak、VO_(2)peak%显著高于对照组(P<0.05),观察组与对照组患者VE/VCO_(2)比较差异无统计学意义(P>0.05)。对照组患者发生恶性心律失3例,心绞痛常2例,心力衰竭2例,心血管不良事件总发生率为15.91%(7/44);观察组患者仅发生恶性心律失1例,心血管不良事件总发生率为2.08%(1/48);观察组患者心血管不良事件总发生率显著低于对照组(χ^(2)=3.923,P<0.05)。结论基于目标控制的心脏康复管理模式可显著提高PCI术后CAHD患者心功能,有效改善心脏储备功能及运动能力,减少心血管不良事件,对PCI术后CAHD患者康复有显著效果。
Objective To explore the effect of target control-based cardiac rehabilitation model on cardiac reserve function and exercise capacity of patients with coronary atherosclerotic heart disease(CAHD)treated by percutaneous coronary intervention(PCI).Methods A total of 96 patients with CAHD who underwent PCI in Department of Cardiovascular Medicine of the 7 th People′s Hospital of Zhengzhou from February 2017 to March 2029 were selected as the study subjects,and the patients were divided into control group and observation group by using the simple random number table method,with 48 cases in each group.In the control group,4 cases with incomplete follow-up data were eliminated,thus finally there were 44 cases in the control group;there were 48 cases in the observation group.The patients in the control group were given traditional cardiac rehabilitation model management after PCI,and the patients in the observation group adopted target control-based cardiac rehabilitation model management after PCI.Before intervention and after 24 weeks of intervention,cardiac echocardiography was used to detect the cardiac function indicators including the left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)and left ventricular ejection fraction(LVEF)of patients in the two groups.CAHD Self-Management Scale(CSMS)was applied to evaluate the self-management ability of patients in the two groups.Cardiopulmonary exercise test was completed according to the guidelines for cardiopulmonary exercise test developed by the American Thoracic Society/American College of Clinical Pharmacology,and the cardiac reserve function indicators including the peak oxygen uptake(VO_(2)peak),percentage of peak oxygen uptake in predicted value(VO_(2)peak%)and ventilatory equivalent for carbon dioxide(VE/VCO_(2))were recorded.The occurrence of adverse cardiovascular events including the malignant arrhythmia,angina pectoris and heart failure were recorded in the two groups within 24 weeks after PCI.The cardiac function indicators,self-management ability,exercise capacity,cardiac reserve function indicators and occurrence of cardiovascular adverse events were compared between the two groups.Results Before intervention,there were no significant differences in the adverse habits,symptoms,emotional cognition,disease knowledge,daily life,first aid and treatment compliance scores of patients between the control group and observation group(P>0.05).After 24 weeks of intervention,the adverse habits,symptoms,emotional cognition,disease knowledge,daily life,first aid and treatment compliance scores of patients in the two groups were significantly higher than those before intervention(P<0.05);the adverse habits,symptoms,emotional cognition,disease knowledge,daily life,first aid and treatment compliance scores of patients in observation group were significantly higher than those in the control group(P<0.05).Before intervention,there were no significant differences in the LVEF,LVEDV and LVESV of patients between the control group and observation group(P>0.05).After 24 weeks of intervention,the LVEF of patients was significantly higher than that before intervention in the two groups(P<0.05).There were no significant differences in the LVEDV and LVESV of patients after 24 weeks of intervention compared with those of before intervention in the two groups(P>0.05).After 24 weeks of intervention,the LVEF of patients in the observation group was significantly higher than that in the control group(P<0.05),there were no significant differences in the LVEDV and LVESV of patients between the control group and observation group(P>0.05).Before intervention,there was no significant difference in the 6MWT of patients between the control group and observation group(P>0.05).The 6MWT of patients after 24 weeks of intervention was significantly higher than that at discharge in the two groups(P<0.05).After 24 weeks of intervention,the 6MWT of patients in the observation group was significantly higher than that in the control group(P<0.05).Before intervention,there was no significant difference in the VO_(2)peak,VO_(2)peak%and VE/VCO_(2) of patients between the control group and observation group(P>0.05).The VO_(2)peak and VO_(2)peak%of patients after 24 weeks of intervention were significantly higher than those at discharge in the two groups(P<0.05).There was no statistical significance in the VE/VCO_(2) of patients after 24 weeks of intervention compared to that at discharge in the two groups(P>0.05).After 24 weeks of intervention,the VO_(2)peak and VO_(2)peak%of patients in the observation group were significantly higher than those in the control group(P<0.05),there was no significant difference in VE/VCO_(2) of patients between the control group and observation group(P>0.05).In the control group,there were 3 cases of malignant arrhythmia,2 cases of angina pectoris and 2 cases of heart failure,the total incidence of adverse cardiovascular events was 15.91%(7/44).In the observation group,there was only 1 case of malignant arrhythmia,the total incidence of adverse cardiovascular events was 2.08%(1/48).The total incidence of adverse cardiovascular events in the observation group was significantly lower than that in the control group(χ^(2)=3.923,P<0.05).Conclusion Target control-based cardiac rehabilitation management model for patients with CAHD after PCI can significantly enhance cardiac function,effectively improve cardiac reserve function and exercise capacity,and reduce adverse cardiovascular events.It has a significant effect on the rehabilitation of patients with CAHD after PCI.
作者
赵华
霍仙娜
ZHAO Hua;HUO Xianna(CCU of Department of Cardiovascular Medicine,the 7 th People′s Hospital of Zhengzhou,Zhengzhou 450000,Henan Province,China)
出处
《新乡医学院学报》
CAS
2021年第8期775-780,共6页
Journal of Xinxiang Medical University
基金
2018年河南省医学科技攻关计划项目(编号:2018020865)。
关键词
冠状动脉粥样硬化性心脏病
心脏康复
目标控制
心脏储备功能
运动能力
coronary atherosclerotic heart disease
cardiac rehabilitation
target control
cardiac reserve function
exercise capacity
