心脏康复综合管理对经皮冠状动脉介入治疗术后患者生命质量的影响

Effect of comprehensive management of cardiac rehabilitation on quality of life of patients after percutaneous coronaryintervention

目的 探讨心脏康复综合管理对经皮冠状动脉介入治疗（PCI）术后患者生命质量的影响.方法 选取60例PCI术后患者采用便利抽样法随机分为康复组与对照组各30例.对照组接受常规PCI术后治疗与护理,康复组在此基础上接受心脏康复综合管理,包括运动指导、双心管理、营养干预、建立随访系统等.观察PCI术后6个月时,2组患者医院焦虑抑郁量表（HADS）评分、6分钟步行距离（6MWD）、冠心病危险因素控制水平及西雅图心绞痛评分（SAQ评分）情况.结果患者PCI术后6个月时,康复组HADS评分焦虑状态率、抑郁状态率、焦虑合并抑郁状态率分别为10.0%（3/30）、10.0%（3/30）、0,对照组分别为33.3%（10/30）、36.7%（11/30）、13.3%（4/30）,2组比较差异有统计学意义（χ^2=4.504、5.963、1.071,均P〈0.05）;康复组6MWD（451±48）m,对照组6MWD（402±42）m,2组比较差异有统计学意义（t=6.155,P=0.022）;2组冠心病危险因素控制水平比较,总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白、体质量指数、收缩压、舒张压差异有统计学意义（t=-2.927~5.981,P〈0.01或0.05）,康复组SAQ评分中躯体活动受限程度、心绞痛稳定状态、心绞痛发作情况、治疗满意程度、疾病认知程度5项得分分别为（73.79±6.04）、（80.35±7.63）、（75.31±8.11）、（80.23±5.44）、（76.59±14.29）分,对照组分别为（53.19±5.13）、（65.87±18.85）、（64.41±6.31）、（70.49±8.01）、（45.83±8.65）分,2组比较差异有统计学意义（t=-21.630~18.959,均P〈0.01）.结论 心脏康复综合管理减轻了PCI术后患者的焦虑抑郁状态,降低了冠心病危险因素水平,明显提高患者的运动能力及生命质量.

Objective To explore the effect of comprehensive management of cardiac rehabilitation on the quality of life of patients after percutaneous coronary intervention（PCI）. Methods A total of 60 patients with PCI were randomly divided into the rehabilitation group and the control group with 30 cases each by convenience sampling method. The control group received routine treatment and nursing care of postoperative PCI, and the rehabilitation group received cardiac rehabilitation management on the basis of the control group, including training guidance, management of double heart psychological intervention, nutritional intervention diet guidance, evidence-based medicine, and set up system etc. The Hospital Anxiety and Depression Scale（HADS） score, 6 minutes walking distance （6MWD）, coronary heart disease risk factors and Seattle Angina Score （SAQ score） were observed at 6 months after PCI. Results HADS score anxiety rate, depression rate, anxiety and depressive state at 6 months after PCI was 10.0%（3/30）, 10.0%（3/30）, 0 respectively in the rehabilitation group, and 33.3%（10/30）, 36.7%（11/30）, 13.3%（4/30） in the control group respectively, and there was significant difference between 2 groups （χ^2=4.504, 5.963, 1.071. all P〈0.05）. 6MWD was （451 ± 48） m in the rehabilitation group and （402 ± 42） m in the control group, and there was significant difference between 2 groups （t=6.155, P=0.022）. Compared two groups of coronary heart disease risk factors control level： there was significant difference in total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, glycosylated hemoglobin, body mass index, systolic pressure, diastolic pressure（t=-2.927-5.981, P〈0.01 or 0.05）. SAQ score in physical limitation, angina stability , angina pectoris, treatment satisfaction, disease awareness scores were （73.79 ± 6.04）, （80.35 ± 7.63）, （75.31 ± 8.11）, （80.23 ± 5.44）, （76.59 ± 14.29） points in the rehabilitation group, and （53.19 ± 5.13）, （65.87 ± 18.85）, （64.41 ± 6.31）, （70.49 ± 8.01）, （45.83 ± 8.65） points in the control group, there were significant differences between 2 groups （t=-21.630-18.959, all P〈0.01）. Conclusions The comprehensive management of cardiac rehabilitation alleviates the anxiety and depression of patients after PCI, reduces the risk factors of coronary heart disease, and improves the exercise ability and quality of life.