住院期康复治疗对心脏外科手术后患者运动能力的影响

In-hospital cardiac rehabilitation improves exercise capacity after cardiac surgery

目的探讨住院期心脏康复对心脏外科手术后患者运动能力的影响。方法纳入符合标准的心脏瓣膜病和冠心病患者42例，按随机数字表法分成康复组（22例）和对照组（20例）。对照组在常规治疗的基础上，予以术前教育和术前呼吸指导；康复组在对照组的基础上，行住院期心脏康复治疗。2组干预前后均行2rain踏步试验（2-MST）及左室射血分数（LVEF）测定，观察2组患者的住院时间。出院1个月后电话随访，用退伍军人特定活动问卷（VSAQ）估测2组患者出院1个月后的运动能力。结果干预后，2组患者左室射血分数分别为（53．73±9．29）％和（56．25±11．01）％，组间差异无统计学意义（P〉0．05）。康复组出院时2min踏步次数[（79．41±10．99）次]明显高于对照组[（71．25±14．21）次]，差异有统计学意义（P〈0．05）；出院1个月后康复组的运动能力METs（5．77±1．46）也显著高于对照组（4．75±1．34）METs，组间差异有统计学意义（P〈0．05）。出院时2min踏步次数与人院时2min踏步次数呈正相关（r=0．869，P〈0．01），出院1个月后运动能力与人院时2min踏步次数呈正相关（r=0．752，P〈0．01）。康复组的住院时间[（15．59±3．08）d]较对照组显著缩短[（18．45±3．63）d]，差异有统计学意义（P〈0．01）。结论住院期心脏康复可以明显改善心脏外科手术后患者的运动能力，缩短住院时间；2rain踏步试验方法简单且实用，可用于心脏外科手术后患者早期运动能力评估。

Objective To explore the effect of an in-hospital cardiac rehabilitation program on exercise capacity after cardiac surgery. Methods Forty-two patients with valvular heart disease or coronary heart disease were recruited and randomly divided into a rehabilitation group （n = 22） and a control group （n = 20）. Both groups were given preoperative education and breathing guidance on the basis of eonvenfional clinical treatment, but the re- habilitation group was also provided with in-hospital cardiac rehabilitation after the operation. The two-minute step- ping test （2-MST） and the left ventrieular ejection fraction test （LVEF） were performed before and after the inter- vention for both groups. Their hospital stays were also compared. One month after discharge, the exercise capacity of both groups was followed-up by telephone using the Veterans-specific Activity Questionnaire （ VSAQ）. Results After the intervention, there was no significant difference in average LVEF between the two groups （53.73±9.29% and 56.25±11.01% respectively）. The average 2-MST stepping frequency of the rehabilitation group was signifi- cantly greater than the control group （79.41± 10.99 times and 71.25±14.21 times respectiveiy, P〈0.05）. One month after discharge, the exercise capacity of the rehabilitation group was also significantly higher than the control group for （5.77-＋ 1.46 METs versus 4.75± 1.34 METs, P〈0.05）. Stepping frequency at discharge and exercise ca- pacity at one month after discharge were both positively correlated to 2-MST stepping frequency at admission （r = 0.869, P〈0.01 ; r= 0.752, P〈0.01 ）. The average hospital stay of the rehabilitation group was significantly shorter （by about 3 days） than the control group （ 15.59-＋3.08 days versus 18.45±3.63 days, P〈0.01）. Conclusions In-hospital cardiac rehabilitation can significantly improve exercise capacity after cardiac surgery and reduce the length of hospital stays. The 2-minute step test is a simple and practical way to assess the exercise capacity of patients early after cardiac surgery.