急性ST段抬高心肌梗死患者经皮冠状动脉介入治疗术后康复治疗现状分析

Current status of rehabilitation for acute ST segment elevation myocardial infarction patients after percutaneous coronary intervention

目的回顾分析某市级三级甲等医院急性ST段抬高心肌梗死(STEMI)住院患者经皮冠状动脉介入治疗(PCI)术后开始康复治疗的时间变化趋势及影响因素。方法选择2017年1月至2019年12月在沈阳医学院附属第二医院确诊STEMI并进行PCI治疗的患者472例,分为康复组和非康复组。康复组为生命体征平稳后,在药物治疗基础上愿意接受急性期(院内)联合恢复期(坚持至出院后3个月)的综合心脏康复干预者。收集2组的一般资料、院前延误时间、生化指标、门球(D to B)时间、血管病变及PCI术中术后情况及心脏彩超。通过分析比较2组患者开始康复的时间、依从性、主要不良心脏事件,探讨这3年STEMI患者急诊PCI术后开始康复治疗的时间变化、完成综合康复治疗的比例及影响因素。结果2017年完成综合心脏康复干预比例和PCI后病情适合开始康复治疗的平均时间为17.1%、12.14 d,2018年为18.4%、10.56 d,2019年为29.9%、8.45 d,差异有统计学意义(P<0.05)。年龄、性别、高脂血症、文化程度、D to B时间、PCI术中心律失常是完成综合康复治疗的独立因素。结论目前仍需完善急救系统网络,继续加强胸痛中心建设,缩短院前延迟时间,加强对STEMI患者PCI后运动康复的宣教。PCI术后患者运动康复开始的时间越早越好。心脏康复能解决介入治疗的局限性,实现临床获益最大化。

Objective To retrospectively analyze the trends and influencing factors in initiating rehabilitation therapy after percutaneous coronary intervention(PCI)in hospitalized patients with acute ST segment elevation myocardial infarction(STEMI)in a Shenyang tertiary grade A hospital.Methods A total of 472 patients diagnosed with STEMI and subsequently treated with PCI in The Second Affiliated Hospital of Shenyang Medical College from January 2017 to December 2019 were divided into rehabilitation and non-rehabilitation groups.The rehabilitation group underwent comprehensive cardiac rehabilitation interventions and who were accept the acute phase(in hospital)and monitored during the recovery period(up to 3 months after discharge)for stable vital signs before initiating drug treatment.The general data of the two groups,including pre-hospital delay time,biochemical indicators,door to balloon(D-to-B)time,vascular lesions,and intraoperative and postoperative conditions of PCI surgery with cardiac color Doppler ultrasonography,were collected.The starting rehabilitation time,patient compliance,and major adverse cardiac events of the two groups were analyzed and compared,and the changes in STEMI patients’starting rehabilitation time after emergency PCI and the proportion of completed comprehensive rehabilitation therapies and its influencing factors within 3 years were discussed.Results The proportion of completed comprehensive cardiac rehabilitation therapies and the average post-PCI starting rehabilitation time were 17.1%and 12.14 days in 2017,18.4%and 10.56 days in 2018,and 29.9%and 8.45 days in 2019,with statistically significant differences(P<0.05).Age,sex,hyperlipidemia,educational level,D to B time,and arrhythmia during PCI were independent factors for completing of comprehensive rehabilitation therapies.Conclusion At present,it is still necessary to improve the first-aid network,continue the construction of chest pain centers,shorten the pre-hospital delay time,and educate STEMI patients regarding exercise rehabilitation after PCI.Earlier exercise rehabilitation after PCI leads to more improved outcomes.Cardiac rehabilitation can solve the limitations of interventional therapy,thereby maximizing clinical benefits.