基于合理行动理论的心脏康复教育模式对经皮冠状动脉介入治疗患者运动康复及心血管病危险因素的影响

Education Model of Cardiac Rehabilitation Based on Theory of Reasoned Action on Exercise Rehabilitation and Cardiovascular Risk Factors for Patients after Percutaneous Coronary Intervention

背景《中国心血管病报告2017》显示,我国心血管病现患病人数2.9亿。心脏康复的益处已在国际上达成共识。我国心脏康复工作目前处于起步阶段,如何在现有条件下提高我国心血管病患者心脏康复参与度和依从性,是目前亟须解决的首要问题。目的探讨基于合理行动理论的心脏康复教育模式对经皮冠状动脉介入治疗(PCI)术后患者运动康复和心血管病危险因素的影响。方法采用便利抽样法,选取2017年3—12月在河南科技大学第一附属医院行PCI术后出院冠心病患者85例为研究对象。采用简单随机分组法,将患者分为干预组43例,对照组42例。干预组实施了心脏康复门诊护士主导的为期12周的心脏康复教育模式,对照组实施传统教育。比较两组干预前后6 min步行距离(6MWD)、日常运动锻炼依从性及心血管病危险因素。结果干预12周后,67例(78.8%)患者完成随访,干预组34例,对照组33例。干预后干预组患者6MWD较对照组增长(P<0.05);干预组患者干预后6MWD较干预前增长(P<0.05)。干预组患者干预后体质指数(BMI)、舒张压、低密度脂蛋白胆固醇(LDL-C)水平较干预前降低(P<0.05)。干预后干预组患者戒烟、限酒达标率高于对照组(P<0.05)。对照组患者干预后服药依从性达标率较干预前降低(P<0.05);干预组患者干预前与干预后服药依从性达标率比较,差异无统计学意义(P>0.05);干预组患者干预后合理膳食、戒烟、限酒达标率较干预前升高(P<0.05)。结论基于合理行动理论的心脏康复教育模式促进了PCI术后患者的运动康复,改善了患者心血管病危险因素。

Background According to Report on Cardiovascular Diseases in China 2017,there are 290 million Chinese people suffering from cardiovascular diseases.The benefits of cardiac rehabilitation are recognized internationally.Currently,cardiac rehabilitation in China is at the initial stage.How to improve the participation and compliance to cardiac rehabilitation under existing national conditions in China is the primary problem that needs to be solved urgently.Objective To explore the effects of an education model of cardiac rehabilitation based on theory of reasoned action on exercise rehabilitation and cardiovascular risk factors for patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods A total of 85 patients with coronary heart disease(CHD)who were discharged after PCI in the First Affiliated Hospital of Henan University of Science and Technology from March to December 2017 were selected as study objects by convenient sampling method.Of these,43 were assigned to the intervention group and 42 were assigned to the control group by simple randomization.Patients in the intervention group received a 12-week education of cardiac rehabilitation led by an outpatient nurse,while the control group received the routine health education.The 6-minute walk distance(6MWD),exercise compliance and cardiovascular risk factors were compared between the two groups before and after intervention.Results Twelve weeks after the intervention,67 patients(78.8%)were followed up,with 34 in the intervention group and 33 in the control group.Compared with the control group,the 6MWD in the intervention group was longer than that of the control group after intervention(P<0.05).In the intervention group,6MWD was prolonged after intervention(P<0.05).Body mass index(BMI),diastolic pressure and low density lipoprotein cholesterol(LDL-C)level of patients in the intervention group were lower than those before intervention(P<0.05).The rate of smoking cessation and alcohol restriction in the intervention group was higher than that in the control group(P<0.05).The drug compliance rate of patients in the control group decreased after intervention(P<0.05);there was no significant difference between drug compliance rate of patients in the intervention group before and after intervention(P>0.05).Compliance rate of reasonable diets,smoking cessation and alcohol restriction in the intervention group increased after intervention(P<0.05).Conclusion Education model of cardiac rehabilitation based on theory of reasoned action promoted the exercise rehabilitation and improved risk factors of cardiovascular diseases of patients after PCI.