基于医联体模式下的运动康复对慢性心力衰竭患者的影响

Influence of exercise rehabilitation based on medical treatment combination model on patients with chronic heart failure

目的:研究基于医联体模式下的运动康复对慢性心力衰竭(CHF)患者的影响。方法:于我院治疗的110例CHF患者被随机均分为常规护理组与运动康复组(常规护理组基础上接受基于医联体模式下的运动康复治疗),两组均干预12周。比较两组干预前后峰值摄氧量(Peak VO_(2))、峰值功率(Peak WR)、无氧阈值(AT)、Peak VO_(2)与心率比值(Peak VO_(2)/HR)、明尼苏达心衰生活质量量表(MLHFQ)评分、6min步行距离(6MWD)及主要不良心血管事件(MACE)发生率。结果:干预期间,两组各有3例失访。与常规护理组比较,干预后,运动康复组Peak VO_(2)[(13.92±0.88)ml·min^(-1)·kg^(-1)比(16.00±0.84)ml·min^(-1)·kg^(-1)]、Peak VO_(2)/HR[(8.92±0.81)ml/beat比(9.83±0.79)ml/beat]、AT[(684.10±74.11)ml/min比(827.38±98.56)ml/min]、6MWD[(470.12±42.76)m比(502.21±26.54)m]均显著升高,Peak WR[(79.85±6.10)W比(72.65±5.48)W]、MLHFQ评分[(49.17±3.96)分比(36.38±3.57)分]均显著降低(P均=0.001)。运动康复组MACE发生率显著低于常规护理组(0.36%比15.38%,P=0.046)。结论:基于医联体模式下的运动康复可显著改善慢性心力衰竭患者心肺功能及运动耐力,降低心血管不良事件发生率,改善短期生活质量。

Objective:To study influence of exercise rehabilitation based on medical treatment combination model on patients with chronic heart failure(CHF).Methods:A total of 110 CHF patients treated in our hospital were randomly and equally divided into routine nursing group and exercise rehabilitation group(received exercise rehabilitation on the basis of medical treatment combination model based on routine nursing group).Both groups were intervened for 12 weeks.Peak oxygen uptake(Peak VO_(2)),Peak work rate(Peak WR),anaerobic threshold(AT),ratio of peak VO_(2) to heart rate(Peak VO_(2)/HR),score of Minnesota living with heart failure questionnaire(MLHFQ)and 6min walking distance(6MWD)before and after intervention and incidence rate of major adverse cardiovascular events(MACE)were compared between two groups.Results:There were three cases lost during intervention in each group.Compared with routine nursing group,after intervention,there were significant rise in Peak VO_(2)[(13.92±0.88)ml·min^(-1)·kg^(-1) vs.(16.00±0.84)ml·min^(-1)·kg^(-1)],Peak VO_(2)/HR[(8.92±0.81)ml/beat vs.(9.83±0.79)ml/beat],AT[(684.10±74.11)ml/min vs.(827.38±98.56)ml/min]and 6MWD[(470.12±42.76)m vs.(502.21±26.54)m],and significant reductions in Peak WR[(79.85±6.10)W vs.(72.65±5.48)W]and MLHFQ score[(49.17±3.96)scores vs.(36.38±3.57)scores]in exercise rehabilitation group(P=0.001 all).Incidence rate of MACE in exercise rehabilitation group was significantly lower than that of routine nursing group(0.36%vs.15.38%,P=0.046).Conclusion:Exercise rehabilitation based on medical treatment combination model can significantly improve cardiopulmonary function and exercise endurance,reduce incidence rate of adverse cardiovascular events and improve short-term quality of life in patients with chronic heart failure.