不稳定型心绞痛患者行不完全血运重建术后心脏康复干预效果研究

The effects of cardiac rehabilitation interventions in patients with unstable angina pectoris after partial revascularization

目的探讨不稳定型心绞痛患者不完全血运重建术后心脏康复干预的疗效。方法收集2016年9月至2017年8月山西省心血管病医院收治的行不完全血运重建术的不稳定型心绞痛患者100例作为研究对象,随机分为常规治疗组(50例)和康复干预组(50例),随访过程中2例失访,3例要求终止随访。最终纳入患者95例,其中常规治疗组47例,康复干预组48例。常规治疗组予常规出院指导,康复干预组在常规治疗基础上实施心脏康复干预。心脏康复干预措施包括运动处方、药物处方、营养处方、心理处方和戒烟处方等措施。分析不稳定型心绞痛患者不完全血运重建术后心脏康复干预的疗效。结果术后12个月,康复干预组血压达标率(79.2%比57.4%,P=0.023)、血糖达标率(87.5%比66.0%,P=0.013)、体重指数达标率(77.1%比55.3%,P=0.025)、总胆固醇达标率(83.3%比53.2%,P=0.002)、三酰甘油达标率(75.0%比46.8%,P=0.005)、低密度脂蛋白胆固醇达标率(79.2%比51.1%,P=0.004)、高密度脂蛋白胆固醇达标率(70.8%比48.9%,P=0.029)、峰值摄氧量[(21.27±1.79)ml/(kg·min)比(17.58±2.36)ml/(kg·min),P<0.001]、无氧阈[(16.86±2.43)ml/(kg·min)比(13.26±2.59)ml/(kg·min),P<0.001]、躯体功能[(82.90±3.96)分比(71.04±3.73)分,P<0.001]、躯体角色[(83.04±8.05)分比(67.57±6.04)分,P<0.001]、躯体疼痛[(77.81±9.60)分比(69.74±9.30)分,P<0.001]、精神健康[(84.44±6.22)分比(70.02±5.38)分,P<0.001]、精力[(73.02±8.83)分比(62.00±6.31)分,P<0.001]、社会功能[(78.46±6.30)分比(69.94±5.21)分,P<0.001]、情感职能[(76.27±8.87)分比(65.23±8.74)分,P<0.001]、总体健康[(79.63±9.28)分比(69.06±5.94)分,P<0.001]均高于常规治疗组,而吸烟率(10.4%比40.4%,P=0.001)、主要不良心血管事件发生率(6.3%比23.4%,P=0.022)及再住院率(4.2%比21.3%,P=0.014)显著低于常规治疗组,差异均有统计学意义。结论心脏康复干预可显著提高不稳定型心绞痛患者不完全血运重建术后危险因素控制达标率、运动耐量、生活质量,减少临床事件发生,显著改善患者预后。

Objective To explore the eff ects of cardiac rehabilitation interventions (CRI) in patients with unstable angina pectoris (UAP) after partial revascularization (PR). Methods A total of 100 UAP patients who had undergone partial revascularization in the Shanxi Cardiovascular Hospital (SCH) from September 2016 to August 2017 were enrolled. They were randomly divided into two groups: the conventional treatment group (CTP)(n=50) and the rehabilitation intervention group (RTG)(n=50). Patients in the CTP group were given routine discharge guidance, while patients in the RTG group received CRI additional to conventional. CRI measures included exercise prescription, drug prescription, nutrition prescription, psychological prescription and smoking cessation guidance, etc. The eff ect of CRI during follow up was further studied. Results Ninety-fi ve patients(95%) had accomplished the 12-month follow up. Compared to the CTP group, patients in the RTG group had higher rates of successful risk factors control including blood pressure (79.2% vs. 57.4%, P=0.023), blood glucose (87.5% vs. 66.0%, P=0.013), BMI(77.1% vs.55.3%, P=0.025), total cholesterol (83.3% vs. 53.2%, P=0.002), TG (75.0% vs. 46.8%, P=0.005), LDL-C (79.2% vs. 51.1%, P=0.004) and HDL-C (70.8% vs. 48.9%, P=0.029). Exercise tolerance and life quality score(SF-36 scale) were both improved in the RTG group (all P<0.001). Smoking cessation (10.4% vs. 40.4%, P=0.001), MACE(6.3% vs. 23.4%, P=0.022) and rehospitalization rate (4.2% vs. 21.3%, P=0.014) were lower in the RTG group. Conclusions CRI significantly improvedthe rates of risk factors control, exercise tolerance, and life quality in unstable angina patients with partial revascularization. CRI reduced clinical events and improved clinical prognosis.