胸痛中心建设背景下心脏康复运动评估的现状

Current situation of cardiac rehabilitation and exercise evaluation under the background of the construction of chest pain center

目的调查我国胸痛中心开展心脏康复运动评估的现状。方法纳入2015年12月至2022年5月中国心血管健康联盟系统中申请或获批成立的心脏康复中心进行问卷调查,收集心脏康复和运动评估开展情况等信息,进行统计分析。结果参与调研单位791家,其中,已启动心脏康复流程的中心682家(86.2%),心脏康复中心建设或认证单位611家(77.2%),其人员组成及硬件设施相对完善。已开展心脏康复的682家中心,采用心肺运动试验(CPET),564家(82.7%)及6 min步行试验540家(79.2%)等评估方式,相比之下平板运动试验采用率较少429家(62.9%)。本研究纳入的心脏康复中心建设或认证单位(611家)开展CPET(85.3%比60.6%)、平板运动试验(65.6%比39.4%)、6 min步行试验(84.6%比32.4%)的比例均较未认证单位(71家)高,差异均有统计学意义(均P<0.001)。多因素Logistic分析显示心脏康复中心建设或认证单位开展CPET和6 min步行试验的情况优于未认证单位,差异均有统计学意义(均P<0.001)。各中心运动评估记录内容相对规范,但缺乏标准化的记录方案,仍有不少核心CPET指标未能得到记录。且运动评估的开展情况欠缺规范性,实施CPET的心脏康复中心里仍有166家(29.4%)未建立数据库。结论目前我国各级医疗机构已逐步开展心脏康复及运动评估,但在运动评估的开展率和规范性等方面仍需要进一步完善。

Objective To investigate the current status of cardiac rehabilitation exercise evaluation in medical centers in China.Methods Cardiac rehabilitation centers were investigated by questionnaires.These centers applied for or had been certified in the Chinese Cardiovascular Health Alliance system.The information of cardiac rehabilitation and exercise evaluation were collected and statistically analyzed.Results There were 791 participating centers,of which 611(77.2%)cardiac rehabilitation centers had been certified(77.2%).The human resources and hardware facilities were relatively sufficient.Cardiopulmonary exercise testing(CPET)and 6-minute walking test were mostly used for evaluation.In contrast,treadmill exercise testing was less frequently adopted.The proportion of cardiac rehabilitation center construction or certification units(611)included in this study conducting CPET(85.3%vs.60.6%),treadmill exercise test(65.6%vs.39.4%),and 6-minute walking test(84.6%vs.32.4%)was higher than that of non certification units(71),and the differences were statistically significant(all P<0.001).Multivariate regression analysis showed that cardiac rehabilitation centers carried out CPET and 6-minute walking test better than non certified-centers(both P<0.001).The content of exercise evaluation records in each center was relatively standardized,but there was a lack of standardized recording protocol,and many core CPET indicators still failed to be recorded.The exercise evaluation program was not standardized.29.4%of cardiac rehabilitation centers performing CPET had not established a database.Conclusions Cardiac rehabilitation and exercise evaluation had been gradually performed in medical institutions in China,but the implementation rate and standardization of exercise evaluation still needed to be improved.