远程心电监测在冠心病合并慢性心力衰竭患者心脏康复中的应用价值

Therapeutic value of remote ECG monitoring in cardiac rehabilitation in CHD+CHF patients

目的:评估远程心电监测在冠心病(CHD)合并慢性心力衰竭(CHF)患者在心脏康复中的应用价值。方法:选择300例CHD合并CHF患者,随机分为常规康复训练组(150例,在常规治疗的基础上于家中或社区实施康复训练)和心电监测康复组(150例,在常规康复训练组的基础上根据心脏远程监护指导康复),治疗24周。比较两组心律失常和心肌缺血检出率,治疗前后血浆脑钠肽(BNP)、醛固酮(ALD)水平、6min步行距离(6MWD)、左室射血分数(LVEF)、生活质量评分以及心功能改善情况。结果:随访24周,与常规康复训练组比较,心电监测康复组心律失常(18.7%比42.0%)、无症状心肌缺血(22.7%比65.3%)、胸闷气急症状(28.0%比56.7%)检出率以及心功能改善总有效率(58.6%比79.5%)均显著提高(P均=0.001);血浆BNP[(322.9±46.4)pg/ml比(273.8±40.9)pg/ml]及ALD[(116.1±13.1)pg/ml比(85.3±12.9)pg/ml]水平显著下降,LVEF[(49.2±5.0)%比(51.0±4.6)%]、6MWD[(287.0±29.7)m比(337.7±45.3)m]均显著增加,生活质量显著提高(量表评分显著降低)[(75.6±13.0)分比(63.4±11.3)分],再入院率显著降低(24.7%比12.7%),P均<0.01。结论:心脏远程监护指导CHD合并CHF患者的心脏康复训练,能够显著增加CHD合并CHF患者运动量,减少再入院率,提高生活质量。

Objective:To assess clinical application value of remote ECG monitoring in guidance of cardiac rehabilitation(CR)in patients with coronary heart disease(CHD)complicated chronic heart failure(CHF).Methods:A total of 300 CHD+CHF patients were randomly divided into routine rehabilitation training group(n=150,received rehabilitation training at home or in community based on routine therapy)and ECG monitoring rehabilitation training group(received CR according to remote ECG monitoring based on routine rehabilitation training group),both groups were treated for 24 weeks.Detection rates of arrhythmias and myocardial ischemia,plasma levels of BNP,aldosterone(ALD),6min walking distance(6MWD),LVEF,quality of life(QOL)score and cardiac function improvement before and after treatment were compared between two groups.Results:Compared with routine rehabilitation training group after 24-week follow-up,there were significant rise in detection rates of arrhythmia(18.7%vs.42.0%),asymptomatic myocardial ischemia(22.7%vs.65.3%),chest tightness and shortness of breath(28.0%vs.56.7%),and total effective rate of cardiac function improvement(58.6%vs.79.5%),P=0.001 all;significant reductions in plasma levels of BNP[(322.9±46.4)pg/ml vs.(273.8±40.9)pg/ml]and ALD[(116.1±13.1)pg/ml vs.(85.3±12.9)pg/ml],significant rise in LVEF[(49.2±5.0)%vs.(51.0±4.6)%],6MWD[(287.0±29.7)m vs.(337.7±45.3)m]and QOL(significant reduction in scale score[(75.6±13.0)scores vs.(63.4±11.3)scores]),and significant reduction in rehospitalization rate(24.7%vs.12.7%)in ECG monitoring rehabilitation training group,P<0.01 all.Conclusion:Cardiac remote monitoring-guided cardiac rehabilitation training can significantly improve exercise amount and quality of life in CHD complicated CHF patients.