虚拟现实技术支持下分级运动康复与认知功能训练对慢性心力衰竭并认知障碍患者的影响研究
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摘要
背景目前对于慢性心力衰竭(CHF)患者认知障碍的防治手段仍处于传统康复训练阶段,因此临床需不断引入新技术的支持,以改善CHF并认知障碍患者预后。目的探讨虚拟现实(VR)技术支持下分级运动康复与认知功能训练对慢性心力衰竭并认知障碍患者的影响。方法选取2017年2月—2018年5月唐山市人民医院康复科收治的CHF并认知障碍患者90例,采用随机数字表法分为对照组和研究组,每组45例。对照组患者进行传统分级运动康复与认知功能训练,研究组患者在VR技术支持下进行分级运动康复与认知功能训练;两组患者均连续干预8周。比较两组患者干预前及干预8周后心功能指标〔左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)〕、简易智能精神状态检查量表(MMSE)评分、蒙特利尔认知功能评估量表(MoCA)评分、6分钟步行距离、改良Barthel指数(mBI)评分,并观察两组患者干预期间不良事件发生情况。结果干预前两组患者LVEF、LVESD、LVEDD比较,差异无统计学意义(P>0.05);干预8周后研究组患者LVEF高于对照组,LVESD、LVEDD短于对照组(P<0.05)。两组患者干预前MMSE评分、MoCA评分、6分钟步行距离、mBI评分比较,差异无统计学意义(P>0.05);研究组患者干预8周后MMSE评分、MoCA评分、mBI评分高于对照组,6分钟步行距离长于对照组(P<0.05)。两组患者干预期间均未发生不良事件。结论 VR技术支持下进行分级运动康复与认知功能训练有利于更好地改善CHF并认知障碍患者心功能及认知功能,提高患者运动耐力及日常活动能力,且安全性较高。
Background Means of prevention and treatment for cognitive disorder in chronic heart failure(CHF patients is still stay in the stage of traditional rehabilitation training,thus we should introduce latest technical support to improve the prognosis of CHF patients complicated with cognitive disorder. Objective To investigate the impact of graded exercise rehabilitation and cognitive function training supported by virtual reality(VR)technology on effect in CHF patients complicated with cognitive disorder. Methods From February 2017 to May 2018,90 CHF patients complicated with cognitive disorder were selected in the Rehabilitation Department,the People's Hospital of Tangshan,and they were divided into control group and study group according to random number table method,each with 45 cases. Patients in control group received traditional graded exercise rehabilitation and conventional cognitive function training,while patients in study group received graded exercise rehabilitation and cognitive function training supported by VR technology;both groups continuously intervened for 8 weeks. Index of cardiac function(including LVEF,LVESD and LVEDD),MMSE score,MoCA score,distance of 6-minute walking test,mBI score before intervention and 8 weeks after intervention were compared between the two groups,and incidence of complications/adverse events was observed during intervention. Results No statistically significant difference of LVEF,LVESD or LVEDD was found between the two groups before intervention(P>0.05);8 weeks after intervention,LVEF in study group was statistically significantly higher than that in control group,meanwhile LVESD and LVEDD in study group were statistically significantly shorter than those in control group(P<0.05). No statistically significant difference of MMSE score,MoCA score,distance of 6-minute walking test or mBI score was found between the two groups before intervention(P>0.05);8 weeks after intervention,MMSE score,MoCA score and mBI score in study group were statistically significantly higher than those in control group,meanwhile distance of 6-minute walking test in study group was statistically significantly longer than that in control group(P<0.05). No one in the two groups occurred any complications/adverse events. Conclusion Graded exercise rehabilitation and cognitive function training supported by VR technology are helpful to more effectively improve cardiac function,cognitive function,exercise tolerance and daily living activity in CHF patients complicated with cognitive disorder,with relatively high safety.
Background Means of prevention and treatment for cognitive disorder in chronic heart failure(CHF patients is still stay in the stage of traditional rehabilitation training,thus we should introduce latest technical support to improve the prognosis of CHF patients complicated with cognitive disorder. Objective To investigate the impact of graded exercise rehabilitation and cognitive function training supported by virtual reality(VR)technology on effect in CHF patients complicated with cognitive disorder. Methods From February 2017 to May 2018,90 CHF patients complicated with cognitive disorder were selected in the Rehabilitation Department,the People's Hospital of Tangshan,and they were divided into control group and study group according to random number table method,each with 45 cases. Patients in control group received traditional graded exercise rehabilitation and conventional cognitive function training,while patients in study group received graded exercise rehabilitation and cognitive function training supported by VR technology;both groups continuously intervened for 8 weeks. Index of cardiac function(including LVEF,LVESD and LVEDD),MMSE score,MoCA score,distance of 6-minute walking test,mBI score before intervention and 8 weeks after intervention were compared between the two groups,and incidence of complications/adverse events was observed during intervention. Results No statistically significant difference of LVEF,LVESD or LVEDD was found between the two groups before intervention(P>0.05);8 weeks after intervention,LVEF in study group was statistically significantly higher than that in control group,meanwhile LVESD and LVEDD in study group were statistically significantly shorter than those in control group(P<0.05). No statistically significant difference of MMSE score,MoCA score,distance of 6-minute walking test or mBI score was found between the two groups before intervention(P>0.05);8 weeks after intervention,MMSE score,MoCA score and mBI score in study group were statistically significantly higher than those in control group,meanwhile distance of 6-minute walking test in study group was statistically significantly longer than that in control group(P<0.05). No one in the two groups occurred any complications/adverse events. Conclusion Graded exercise rehabilitation and cognitive function training supported by VR technology are helpful to more effectively improve cardiac function,cognitive function,exercise tolerance and daily living activity in CHF patients complicated with cognitive disorder,with relatively high safety.
引文
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[9]郑刚.运动对心力衰竭与死亡危险影响研究的最新进展[J].中华老年心脑血管病杂志,2018,20(8):875-878.DOI:10.3969/j.issn.1009-0126.2018.08.024.
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[14]中国康复医学会心血管病专业委员会,中国老年学学会心脑血管病专业委员会.慢性稳定性心力衰竭运动康复中国专家共识[J].中华心血管病杂志,2014,42(9):714-720.DOI:10.3760/cma.j.issn.0253-3758.2014.02.004.
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[16]REEVES G R,WHELLAN D J,PATEL M J,et a1.Comparison of Frequency of Frailty and Severely Impaired Physical Function in Patients≥60 Years Hospitalized With Acute Decompensated Heart Failure Versus Chronic Stable Heart Failure With Reduced and Preserved Left Ventricular Ejection Fraction[J].Am J Cardiol,2016,117(12):1953-1958.DOI:10.1016/j.amjcard.2016.03.046.
[17]周国庆,严斌,孙芳,等.慢性心力衰竭对老年人认知功能纵向变化速度的影响[J].中华老年心脑血管病杂志,2013,15(7):681-683.DOI:10.3969/j.issn.1009-0126.2013.07.004.
[18]金艾香,陈肖敏,章小飞,等.基于奥马哈系统的乳腺癌患者康复管理虚拟现实技术平台构建与应用[J].中国全科医学,2018,21(24):2987-2992.DOI:10.12114/j.issn.1007-9572.2018.00.026.
[19]宋金花,朱其秀,李培媛,等.虚拟现实技术对非痴呆型血管性认知障碍患者认知功能、日常生活活动能力以及P300的影响[J].中华物理医学与康复杂志,2018,40(3):195-197.DOI:10.3760/cma.j.issn.0254-1424.2018.03.008.
[20]李雅楠,左国坤,崔志琴,等.虚拟现实技术在康复训练中的应用进展[J].中国康复医学杂志,2017,32(9):1091-1094.DOI:10.3969/j.issn.1001-1242.2017.09.028.
[21]顾亚伟,陈昶.虚拟现实技术进展及在医学领域中的应用与展望[J].中华胸心血管外科杂志,2017,33(10):635-640.DOI:10.3760/cma.j.issn.1001-4497.2017.10.022.
[2]杨郑,孙颖,崔怡宁,等.老年慢性心力衰竭认知功能情况分析[J].中华老年多器官疾病杂志,2018,17(3):178-182.DOI:10.11915/j.issn.1671-5403.2018.03.039.
[3]臧鸿斌,李晓东.慢性心力衰竭与认知功能障碍关系的研究进展[J].中国心血管病研究,2017,15(8):673-676.DOI:10.3969/j.issn.1672-5301.2017.08.001.
[4]牛伟华,杨慧锋.慢性心力衰竭患者认知障碍及影响因素的研究进展[J].中华老年心脑血管病杂志,2018,20(3):323-325.DOI:10.3969/j.issn.1009-0126.2018.03.029.
[5]余彬,曾庆,黄国志.头戴式虚拟现实系统在运动康复治疗中的应用进展[J].中国康复医学杂志,2018,33(6):734-737.DOI:10.3969/j.issn.1001-1242.2018.06.025.
[6]胡丹丹,何俊,丁渝权,等.虚拟现实技术在老年慢性阻塞性肺疾病并轻度认知障碍患者肺康复训练中的应用效果[J].实用心脑肺血管病杂志,2018,26(6):85-88.DOI:10.3969/j.issn.1008-5971.2018.06.023.
[7]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.DOI:10.3760/cma.j.issn.0253-3758.201409.002.
[8]孙桂锋,刘宇,李艳,等.基层医院慢性心力衰竭治疗现状调查[J].中国全科医学,2018,21(11):1280-1284.DOI:10.3969/j.issn.1007-9572.2018.00.089.
[9]郑刚.运动对心力衰竭与死亡危险影响研究的最新进展[J].中华老年心脑血管病杂志,2018,20(8):875-878.DOI:10.3969/j.issn.1009-0126.2018.08.024.
[10]王楠,张双,刘永政,等.曲美他嗪联合运动康复对慢性心力衰竭患者心肾功能及甲状旁腺素的影响[J].实用心脑肺血管病杂志,2018,26(3):104-108.DOI:10.3969/j.issn.1008-5971.2018.03.030.
[11]KETEYIAN S J,KERRIQAN D J,LEWIS B,et al.Exercise training workloads in cardiac rehabilitation are associated with clinical outcomes in patients with heart failure[J].Am Heart J,2018,204:76-82.DOI:10.1016/j.ahj.2018.05.017.
[12]沈玉芹.心力衰竭患者的心脏康复[J].中国实用内科杂志,2017,37(7):599-601.DOI:10.19538/j.nk2017070106.
[13]NAKANISHI M,NAKAO K,KUMASAKA L,et a1.Improvement in exercise capacity by exercise training associated with favorable clinical outcomes in advanced heart failure with high B type natriuretic peptide level[J].Circ J,2017,81(9):1307-1314.DOI:10.1253/circj.CJ-16-1268.
[14]中国康复医学会心血管病专业委员会,中国老年学学会心脑血管病专业委员会.慢性稳定性心力衰竭运动康复中国专家共识[J].中华心血管病杂志,2014,42(9):714-720.DOI:10.3760/cma.j.issn.0253-3758.2014.02.004.
[15]DODSON J A,TRUONG T T,TOWLE V R,et a1.Cognitive impairment in older adults with heart failure:prevalence,documentation,and impact on outcomes[J].Am J Med,2013,126(2):120-126.DOI:10.1016/j.amjmed.2012.05.029.
[16]REEVES G R,WHELLAN D J,PATEL M J,et a1.Comparison of Frequency of Frailty and Severely Impaired Physical Function in Patients≥60 Years Hospitalized With Acute Decompensated Heart Failure Versus Chronic Stable Heart Failure With Reduced and Preserved Left Ventricular Ejection Fraction[J].Am J Cardiol,2016,117(12):1953-1958.DOI:10.1016/j.amjcard.2016.03.046.
[17]周国庆,严斌,孙芳,等.慢性心力衰竭对老年人认知功能纵向变化速度的影响[J].中华老年心脑血管病杂志,2013,15(7):681-683.DOI:10.3969/j.issn.1009-0126.2013.07.004.
[18]金艾香,陈肖敏,章小飞,等.基于奥马哈系统的乳腺癌患者康复管理虚拟现实技术平台构建与应用[J].中国全科医学,2018,21(24):2987-2992.DOI:10.12114/j.issn.1007-9572.2018.00.026.
[19]宋金花,朱其秀,李培媛,等.虚拟现实技术对非痴呆型血管性认知障碍患者认知功能、日常生活活动能力以及P300的影响[J].中华物理医学与康复杂志,2018,40(3):195-197.DOI:10.3760/cma.j.issn.0254-1424.2018.03.008.
[20]李雅楠,左国坤,崔志琴,等.虚拟现实技术在康复训练中的应用进展[J].中国康复医学杂志,2017,32(9):1091-1094.DOI:10.3969/j.issn.1001-1242.2017.09.028.
[21]顾亚伟,陈昶.虚拟现实技术进展及在医学领域中的应用与展望[J].中华胸心血管外科杂志,2017,33(10):635-640.DOI:10.3760/cma.j.issn.1001-4497.2017.10.022.