急性冠脉综合征患者心脏康复护理研究进展
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摘要
综述国内外急性冠脉综合征(Acute coronary syndromes,ACS)患者心脏康复(Cardiac Rehabilitation,CR)的研究进展,概述了ACS、CR的概念和CR的核心要素及护理模式,重点对比了各模式之间的优缺点。本文从评估,风险分层,康复设施,运动强度、频率、类型等方面详细介绍了如何在低资源环境下开展CR护理。介绍了目前ACS患者CR护理的应用效果,指出我国CR护理的现存问题及在未来工作中应关注的内容,以促进ACS患者CR护理的科学化和规范化。
This article reviews the research progress of Cardiac Rehabilitation(CR) in patients with acute coronary syndromes(ACS)at home and abroad,summarizes the concept of ACS and CR,the core elements and the nursing model of CR,focusing on comparing the merits and demerits of each model. Also,this paper details how to conduct CR care in a low-resource environment from the aspects of assessment,risk stratification,rehabilitation facilities,and the intensity,frequency and type of exercise. Meanwhile,this article introduces the application effect of CR nursing in patients with ACS,points out the existing problems of CR nursing in China and what should be noticed during work,thereby promoting the scientific and standardized CR nursing for ACS patients.
This article reviews the research progress of Cardiac Rehabilitation(CR) in patients with acute coronary syndromes(ACS)at home and abroad,summarizes the concept of ACS and CR,the core elements and the nursing model of CR,focusing on comparing the merits and demerits of each model. Also,this paper details how to conduct CR care in a low-resource environment from the aspects of assessment,risk stratification,rehabilitation facilities,and the intensity,frequency and type of exercise. Meanwhile,this article introduces the application effect of CR nursing in patients with ACS,points out the existing problems of CR nursing in China and what should be noticed during work,thereby promoting the scientific and standardized CR nursing for ACS patients.
引文
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[5]尤黎明,吴瑛.内科护理学[M].北京:人民卫生出版社,2014:203-204.
[6]AMSTERDAM EA,WENGER NK,BRINDIS RG,et al.2014 AHA/ACCGuideline for the Management of Patients with Non-ST-Elevation A-cute Coronary Syndromes:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines[J].J Am Coll Cardiol,2014,64(24):e139-e228.
[7]PRICE KJ,GORDON BA,BIRD SR,et al.A review of guidelines for cardiac rehabilitation exercise programmes:Is there an international consensus?[J].Eur J Prev Cardiol,2016,23(16):1715-1733.
[8]N ETWORK SIG.Cardiac rehabilitation.A national clinical guideline[Z/OL].(2017-08-29)[2018-12-03].http://www.sign.ac.uk.
[9]SANDESARA PB,LAMBERT CT,GORDON NF,et al.Cardiac Rehabilitation and Risk Reduction:Time to“Rebrand and Reinvigorate”[J].J Am Coll Cardiol,2015,65(4):389-395.
[10]刘霞,许之民,陈绣.国内外心脏康复模式的研究进展[J].国际心血管病杂志,2018,45(3):157-159.
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[12]王婷,陆萍静,柳晓,等.冠心病患者心脏康复护理研究进展[J].护理学杂志,2015,30(21):106-109.
[13]VARNFIELD M,KARUNANITHI M,LEE CK,et al.Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients:results from a randomised controlled trial[J].Heart,2014,100(22):1770-1779.
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[15]MADDISON JRNG.Telehealth exercise-based cardiac rehabilitation:a systematic review and meta-analysis[J].Heart,2016,102(18):1449-1455.
[16]ORGANIZATION WH.Global action plan for the prevention and control of noncommunicable diseases 2013-2020[R/OL].(2015-01-08)[2018-12-03].https://www.who.int/nmh/events/ncd_action_plan/en/.
[17]ANDERSON L,OLDRIDGE N,THOMPSON D R,et al.Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease:Cochrane Systematic Review and Meta-Analysis[J].J Am Coll Cardiol,2016,67(1):1-12.
[18]TURK-ADAWI K,SARRAFZADEGAN N,GRACE SL.Global availability of cardiac rehabilitation[J].Nat Rev Cardiol,2014,11(10):586-596.
[19]GRACE SL,TURK-ADAWI KI,CONTRACTOR A,et al.Cardiac rehabilitation delivery model for low-resource settings[J].Heart,2016,102(18):1449-1455.
[20]中华医学会老年医学分会,75岁及以上稳定性冠心病患者运动康复中国专家共识写作组.75岁及以上稳定性冠心病患者运动康复中国专家共识[J].中国综合临床,2018,34(2):97-104.
[21]BRUNO PAVY AMIBB.French Society of Cardiology guidelines for cardiac rehabilitation in adults[J].Arch Cardiovasc Dis,2012,105(5):309-328.
[22]G B.Borg’s perceived exertion and pain scales[J].Champaign:Illinois Human Kinetics,1998,22(7):102-106.
[23]王玲,李建国.急性心肌梗死患者早期康复治疗的研究进展[J].中国临床医生杂志,2007,35(8):27-29.
[24]刘佳妮.心脏康复指导对接受介入治疗ACS患者生活质量影响的研究[D].沈阳:中国医科大学,2016.
[25]ANDERSON L,TAYLOR RS.Cardiac rehabilitation for people with heart disease:an overview of Cochrane systematic reviews[J].Int J Cardio,2014,177(2):348-361.
[26]KIM C,KIM DY,DONG WL.The Impact of Early Regular Cardiac Rehabilitation Program on Myocardial Function after Acute Myocardial Infarction[J].Ann Rehabil Med,2011,35(4):535-540.
[27]李桂香,沙丽曼,王雅慧,等.针药结合运动疗法及护理干预在冠心病患者中的应用[J].中国疗养医学,2018,27(1):27-30.
[28]边汝涛,李薇羽.五禽戏在心脏康复中的应用[J].中国中医药现代远程教育,2018,16(8):59-60.
[29]朱银娇,李陆振,邓燕用,等.八段锦结合心脏康复七步法在心脏术后病人Ⅰ期心脏康复的效果观察[J].全科护理,2018,16(12):1479-1481.
[30]胡大一.从中国心脏康复实践看“颠覆”医疗[J].慢性病学杂志,2015,16(2):119-121.
[31]THOMAS RJ,KING M,LUI K,et al.AACVPR/ACCF/AHA 2010 Update:Performance Measures on Cardiac Rehabilitation for Referral to Cardiac Rehabilitation/Secondary Prevention Services:Endorsed by the American College of Chest Physicians,the American College of Sports Medicine,the American P[J].J Am Coll Cardiol,2010,56(14):1159-1167.
[32]叶超毅,叶鹏,PETERS AE,等.急性心肌梗死后心脏康复训练的趋势和预测因素[J].中华高血压杂志,2018,26(1):4.
[33]CORTES-BERGODERI M,LOPEZ-JIMENEZ F,HERDY AH,et al.Av ailability and characteristics of cardiovascular rehabilitation programs in South America[J].J Cardiopulm Rehabil Prev,2013,33(1):33-41.
[34]马欣蕾,温澄非.心脏康复的SWOT分析[J].解放军护理杂志,2017,34(17):43-45.
[35]吴思亮,彭筱平.西医为体中医为用做好心脏康复[J].中医药导报,2015,21(13):108-109.
[36]于美丽,陈可冀,徐浩.心脏康复的未来:全程管理、多位一体、中西医结合[J].中国中西医结合杂志,2018,38(5):604-607.
[2]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2017》概要[J].中国循环杂志,2018,33(1):1-8.
[3]杨丽娟,隋捷,刘晓波,等.急性冠脉综合征患者的护理干预及健康管理[J].护理实践与研究,2013,10(12):39-41.
[4]OLDRIDGE N.Exercise-based cardiac rehabilitation in patients with coronary heart disease:meta-analysis outcomes revisited[J].Future Cardiol,2012,8(5):729-751.
[5]尤黎明,吴瑛.内科护理学[M].北京:人民卫生出版社,2014:203-204.
[6]AMSTERDAM EA,WENGER NK,BRINDIS RG,et al.2014 AHA/ACCGuideline for the Management of Patients with Non-ST-Elevation A-cute Coronary Syndromes:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines[J].J Am Coll Cardiol,2014,64(24):e139-e228.
[7]PRICE KJ,GORDON BA,BIRD SR,et al.A review of guidelines for cardiac rehabilitation exercise programmes:Is there an international consensus?[J].Eur J Prev Cardiol,2016,23(16):1715-1733.
[8]N ETWORK SIG.Cardiac rehabilitation.A national clinical guideline[Z/OL].(2017-08-29)[2018-12-03].http://www.sign.ac.uk.
[9]SANDESARA PB,LAMBERT CT,GORDON NF,et al.Cardiac Rehabilitation and Risk Reduction:Time to“Rebrand and Reinvigorate”[J].J Am Coll Cardiol,2015,65(4):389-395.
[10]刘霞,许之民,陈绣.国内外心脏康复模式的研究进展[J].国际心血管病杂志,2018,45(3):157-159.
[11]KINSARA AJ.Do We Need Cardiac Rehabilitation in Heart Failure[J].J Coll Physicians Surg Pak,2018,28(1):61-62.
[12]王婷,陆萍静,柳晓,等.冠心病患者心脏康复护理研究进展[J].护理学杂志,2015,30(21):106-109.
[13]VARNFIELD M,KARUNANITHI M,LEE CK,et al.Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients:results from a randomised controlled trial[J].Heart,2014,100(22):1770-1779.
[14]GANT RMJ C.Effects and costs of real-time cardiac telerehabilitation:randomised controlled non-inferiority trial[J/OL].Heart,2018:1-8.[2018-08].http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=30150328&query_hl=1.DOI:10.1136/heartjnl-2018-313189.
[15]MADDISON JRNG.Telehealth exercise-based cardiac rehabilitation:a systematic review and meta-analysis[J].Heart,2016,102(18):1449-1455.
[16]ORGANIZATION WH.Global action plan for the prevention and control of noncommunicable diseases 2013-2020[R/OL].(2015-01-08)[2018-12-03].https://www.who.int/nmh/events/ncd_action_plan/en/.
[17]ANDERSON L,OLDRIDGE N,THOMPSON D R,et al.Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease:Cochrane Systematic Review and Meta-Analysis[J].J Am Coll Cardiol,2016,67(1):1-12.
[18]TURK-ADAWI K,SARRAFZADEGAN N,GRACE SL.Global availability of cardiac rehabilitation[J].Nat Rev Cardiol,2014,11(10):586-596.
[19]GRACE SL,TURK-ADAWI KI,CONTRACTOR A,et al.Cardiac rehabilitation delivery model for low-resource settings[J].Heart,2016,102(18):1449-1455.
[20]中华医学会老年医学分会,75岁及以上稳定性冠心病患者运动康复中国专家共识写作组.75岁及以上稳定性冠心病患者运动康复中国专家共识[J].中国综合临床,2018,34(2):97-104.
[21]BRUNO PAVY AMIBB.French Society of Cardiology guidelines for cardiac rehabilitation in adults[J].Arch Cardiovasc Dis,2012,105(5):309-328.
[22]G B.Borg’s perceived exertion and pain scales[J].Champaign:Illinois Human Kinetics,1998,22(7):102-106.
[23]王玲,李建国.急性心肌梗死患者早期康复治疗的研究进展[J].中国临床医生杂志,2007,35(8):27-29.
[24]刘佳妮.心脏康复指导对接受介入治疗ACS患者生活质量影响的研究[D].沈阳:中国医科大学,2016.
[25]ANDERSON L,TAYLOR RS.Cardiac rehabilitation for people with heart disease:an overview of Cochrane systematic reviews[J].Int J Cardio,2014,177(2):348-361.
[26]KIM C,KIM DY,DONG WL.The Impact of Early Regular Cardiac Rehabilitation Program on Myocardial Function after Acute Myocardial Infarction[J].Ann Rehabil Med,2011,35(4):535-540.
[27]李桂香,沙丽曼,王雅慧,等.针药结合运动疗法及护理干预在冠心病患者中的应用[J].中国疗养医学,2018,27(1):27-30.
[28]边汝涛,李薇羽.五禽戏在心脏康复中的应用[J].中国中医药现代远程教育,2018,16(8):59-60.
[29]朱银娇,李陆振,邓燕用,等.八段锦结合心脏康复七步法在心脏术后病人Ⅰ期心脏康复的效果观察[J].全科护理,2018,16(12):1479-1481.
[30]胡大一.从中国心脏康复实践看“颠覆”医疗[J].慢性病学杂志,2015,16(2):119-121.
[31]THOMAS RJ,KING M,LUI K,et al.AACVPR/ACCF/AHA 2010 Update:Performance Measures on Cardiac Rehabilitation for Referral to Cardiac Rehabilitation/Secondary Prevention Services:Endorsed by the American College of Chest Physicians,the American College of Sports Medicine,the American P[J].J Am Coll Cardiol,2010,56(14):1159-1167.
[32]叶超毅,叶鹏,PETERS AE,等.急性心肌梗死后心脏康复训练的趋势和预测因素[J].中华高血压杂志,2018,26(1):4.
[33]CORTES-BERGODERI M,LOPEZ-JIMENEZ F,HERDY AH,et al.Av ailability and characteristics of cardiovascular rehabilitation programs in South America[J].J Cardiopulm Rehabil Prev,2013,33(1):33-41.
[34]马欣蕾,温澄非.心脏康复的SWOT分析[J].解放军护理杂志,2017,34(17):43-45.
[35]吴思亮,彭筱平.西医为体中医为用做好心脏康复[J].中医药导报,2015,21(13):108-109.
[36]于美丽,陈可冀,徐浩.心脏康复的未来:全程管理、多位一体、中西医结合[J].中国中西医结合杂志,2018,38(5):604-607.