冠心病患者社区运动康复训练的可行性及效果分析
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摘要
目的:在冠心病患者中开展基于社区的运动康复训练项目,考察其可行性并评估其在改善患者运动能力和生活质量等方面的效果。方法:将研究对象随机分为心脏康复组和常规管理组。在心脏康复组开展运动训练,并用6 min步行实验和简明生活质量评估量表测评两组患者基线、6个月时的运动能力和生活质量。结果:心脏康复组患者参与率为66.3%,退出率为6.2%。相比较于基线水平,心脏康复组患者运动能力明显提升(t=5.64,P=0.001),身体状况(t=6.43,P=0.001)和心理状况(t=4.61,P=0.001)明显改善。同期常规管理组则未发现明显变化。两组患者服药依从性明显提高,每日吸烟量均明显减少。结论:基于社区的运动康复训练能有效提升CHD患者运动能力和生活质量,是适应我国当前卫生服务体系和适合我国人群特点的康复管理模式。
Objective:To implement a community-based cardiac rehabilitation(CR) program in patients with coronary heart disease,and assess its effects in improving patients' exercise capacity and quality of life.Methods:Patients were randomly allocated into cardiac rehabilitation(CR) group and usual group.Variables like exercise capacity and quality of life were assessed through 6 minutes walk test(6 MWT) and quality of life(QOL) at baseline as well as 6 months.Results:The participation rate in CR group was 66.3% and the withdraw rate was 6.2%.Compared to that at baseline,patients in CR group achieved a significant improvement in exercise capacity(t=5.64,P<0.01),mental component score(t=6.43,P<0.01) and physical component score(t=4.61,P<0.01).However,no obvious change was observed in usual group.The compliance of the two groups was significantly improved,and the daily smoking volume was significantly reduced.Conclusion:Community based sports rehabilitation training can effectively improve the exercise ability and quality of life of CHD patients,and it is a rehabilitation management mode that adapts to the current health service system and the characteristics of Chinese population.
Objective:To implement a community-based cardiac rehabilitation(CR) program in patients with coronary heart disease,and assess its effects in improving patients' exercise capacity and quality of life.Methods:Patients were randomly allocated into cardiac rehabilitation(CR) group and usual group.Variables like exercise capacity and quality of life were assessed through 6 minutes walk test(6 MWT) and quality of life(QOL) at baseline as well as 6 months.Results:The participation rate in CR group was 66.3% and the withdraw rate was 6.2%.Compared to that at baseline,patients in CR group achieved a significant improvement in exercise capacity(t=5.64,P<0.01),mental component score(t=6.43,P<0.01) and physical component score(t=4.61,P<0.01).However,no obvious change was observed in usual group.The compliance of the two groups was significantly improved,and the daily smoking volume was significantly reduced.Conclusion:Community based sports rehabilitation training can effectively improve the exercise ability and quality of life of CHD patients,and it is a rehabilitation management mode that adapts to the current health service system and the characteristics of Chinese population.
引文
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[14] 陈娓,李予文,娄百玉,等.冠心病介入治疗患者情绪障碍及心理干预研究 [J].中华行为医学与脑科学杂志,2004,13(2):163-164.
[2] 胡东生,顾东风.中国1980-2010年心血管疾病流行病学研究回顾 [J].中华流行病学杂志,2011,32(11):1059-1064.
[3] 刘江生.解读与评论2010年欧洲心血管预防和康复协会心脏康复分会关于二级预防中心脏康复的意见 [J].心血管康复医学杂志,2014,23(6):591-596.
[4] Kerrigan DJ,Williams CT,Ehrman JK,et al.Cardiac rehabilitation improves functional capacity and patient-reported health status in patients with continuous-flow left ventricular assist devices:the Rehab-VAD randomized controlled trial [J].JACC Heart Fail,2014,2(6):653-659.
[5] Rotterdam J,Hensley M,Hazelton M.A Comparative Effectiveness Review:Responsiveness of Patient outcome Measures in cardiac and pulmonary rehabiltation[J].J Cardiopulm Rehabil Prev,2019,39(2):73-84.
[6] 田朝伟,徐如芹,王丽,等.指导家庭运动对冠状动脉支架植入术后患者Ⅲ期心脏康复的影响 [J].广东医学,2016,37(16):2402-2405.
[7] Pack QR,Squires RW,Lopezjmenez F,et al.Participation Rates,Process Monitoring,and Quality Improvement Among Cardiac Rehabilitation Programs in the United States:A National Survey[J].Journal of Cardiopulmonary Rehabilitation & Prevention,2015,35(3):173.
[8] Williamson TM,Rouleau CR,Aggarwal SG,et al.Bridging the intention-behavior gap for cardiac rehabilitation participation:the role of perceived barriers[J].Disabil Rehabil,2018,Doi:10.1080/09638288.2018.1524519.
[9] Jin H,Wei Q,Chen L,et al.Obstacles and alternative options for cardiac rehabilitation in Nanjing,China:an exploratory study [J].BMC Cardiovasc Disord,2014,14(1):20.
[10] Fletcher GF,Ades PA,Kligfield P,et al.Exercise standards for testing and training:a scientific statement from the American Heart Association [J].Circulation,2013,128(8):873-934.
[11] Bjarnason-Wehrens B,Mcgee H,Zwisler AD,et al.Cardiac rehabilitation in Europe:results from the European Cardiac Rehabilitation Inventory Survey[J].Eur J Cardiovasc Prev Rehabil,2010,17(4):410-418.
[12] Soroush A,Heydarpour B,Komasi S,et al.Barriers for the referral to outpatient cardiac rehabilitation:A predictive model including actual and perceived risk factors and perceived control [J].Ann Card Anaesth,2018,21(3):249-254.
[13] 李艳鑫,王宪沛,方慧玲,等.有序化心理干预在住院冠心病患者焦虑状态中的应用研究 [J].中国继续医学教育,2016,8(6):261-263.
[14] 陈娓,李予文,娄百玉,等.冠心病介入治疗患者情绪障碍及心理干预研究 [J].中华行为医学与脑科学杂志,2004,13(2):163-164.