摘要
目的我国冠心病PCI术后康复仍处于起步阶段,心脏康复参与率十分低下。混合性家庭康复模式或能成为解决以上问题方法之一。本研究探讨混合性康复模式的有效性、可行性及探讨6min步行实验(6MWT)在混合性康复模式中的应用。方法38例人选患者分为标准康复组(20例)和混合性康复组(18例).比较两组康复前后体质量指数(BMI)、甲状腺功能、血脂、心脏超声等相关指标及院内7d、院外8周康复后心肺运动实验、6min步行距离(6MWD)等相关参数。结果标准康复组和混合康复组康复后BMI较康复前明显降低[标准康复组:(25.99±3.36)kg/m=vs.(23.04±3.72)kg/m2,P〈0.05;混合康复组:(24.84±2.70)kg/m2 vs.(22.88±2.56)kg/m2,P〈0.05]。两组低密度脂蛋白(LDL)康复后较康复前降低,差异有统计学意义[标准康复组:(3.40±1.38)mg/dl vs.(2.04±0.73)mg/dl,P〈0.01];混合康复组:(3.40±1.01)mg/dl vs.(2.114-0.37)mg/dl,P〈0.01]。两组组内比较院外康复8周后心肺运动实验无氧阈值(AT),最大摄氧量(VO_2max),代谢当量(MET)和6MWD较康复7d后增加,差异有统计学意义[标准康复组:(12.37±1.53)mL/(kg·min)vs.(14.77±1.57)mL/(kg·min),(17.87±1.66)mL/(kg·min)vs.(20.73±2.14)mL/(kg·min),(5.02±O.36)vs.(6.09±0.53),(500±53.36)m vs.(582.5±57.6)m,P〈0.01;混合康复组:(12.56±1.11)mL/(kg·min)vs.(14.30±1.23)mL/(kg·min),(17.28±1.38)mL/(kg·min)vs.(20.02±1.37)mL/(kg·min),(5.07±0.47)vs.(5.94±0.46),(511.4±50.96)m vs.(590.3±56.1)m,P〈0.01]。两组间院内康复7d后及院外8周后各参数比较均差异无统计学意义(P〉0.05)。结论院外康复8周后,混合性康复组和标准康复组患者的心肺运动实验及6min步行实验结果均较前改善明显,两组间差异无统计学意义。混合性康复模式能够达到院内标准康复相当的效果,极大地增加了心脏康复的患者参与数量和提高了心脏康复的依从性。6MWT经济易行,对混合性康复的康复效果有着较好的评价。混合性康复模式和6MWT为急性心肌梗死患者的心脏康复在我国更好地开展和普及提供了更多的可能。
Objective To study the effects of binary cardiac rehabilitation (CR) composed of hospital-based and home-based CR in patients after acute myocardial infarction (AMI) evaluated by six-minute walking distance (6MWD). Methods A total of 38 post-MI patients were divided into two groups, namely conventional CR group (n=20) and binary CR group (n=18). In the first seven days, CR training was carried out in all 38 patients in our hospital, and then 20 patients were kept at CR training in the hospital (hospital-based CR group), whereas the remaining 18 patients (binary CR group) got tele-monitored walking training at home for eight weeks (binary model). Before discharge from hospital based CR or after 8 weeks CR at home, all patients received Cardiopulmonary Exercise Testing and Six-minute Walk Test, and the data of patients' body mass index (BMI), thyroid function, serum lipid metabolism and echocardiography were collected before and after CR. Results After CR, BMI and low density lipoprotein (LDL) decrease in both groups compared with those before CR[hospital-based group: BMI, (25.99±3.36)kg/m2 vs. (23.04±3.72) kg/m2,P〈0.05; LDL, (3.40±1.38) mg/dl vs. (2.04±0.73)mg/ dl, P〈0.01; binary group: BMI, (24.84±2.70) kg/m2 vs. (22.88±2.56) kg/m2, P〈0.05; LDL, (3.40±1.01) mg/dl vs. (92.11±0.37) mg/dl, P〈0.01]. After 8 weeks CR at home or hospital based CR until discharge, the anaerobic threshold (AT), maximum rate of oxygen consumption (VO_2max), metabolic equivalent (MET) and 6MWD improved significantly in both groups compared with those at 7 days after CR in hospital [Hospital-based group: AT, (12.37±1.53) mL/(kg · min) vs. (14.77±1.57) mL/(kg · min); VO_2max (17.87±1.66 mL/(kg · min) vs. (20.73±2.14) mL/(kg · min); MET (5.02±0.36) vs. (6.09±0.53); 6MWD (500±53.36) m vs. (582.5±57.6) m, P〈0.01; Binary group: AT, (12.56±1.11) mL/(kg.min) vs. (14.30±1.23) mL/(kg· min); VO_2ma’, (17.28±1.38) mL/(kg · min) vs. (20.02±1.37) mL/(kg · min); MET, (5.07±0.47) vs. (5.94±0.46); 6MWD, (511.4±50.96) m vs. (590.3±56.1)m, P〈0.01]. There was no significant difference in CR effects observed between two groups (P〉0.05). Conelusions In post-MI patients, a binary model of CR training improved physical capacity and was a similarly effective form of CR as a entirely hospital- based approach. A home-based tele-monitored program facilitated patients' adherence to CR. The 6 minute walk experiment is economical and good evaluation on the CR effect of binary cardiac rehabilitation.
作者
车晓汝
钱琳艳
庞洁
李厥宝
王慧
戴允兰
钱展红
仇雅菊
王静
胡雪烈
车贤达
Che Xiaoru;Qian Linyan;Pang Jie;Li Juebao;Wang Hui;Dai Yunlan;Qian Zhanhong;Qiu Yaju;Wang Jing;Hu Xuelie;Che Xianda(Department of Cardiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2018年第6期657-662,共6页
Chinese Journal of Emergency Medicine
关键词
心脏康复
急性心肌梗死
6分钟步行实验
家庭监护训练
Cardiac rehabilitation
Acute myocardial infarction
Six-minute walk test
Home-based tele-monitored training