基于WHO-FICs构建个体化心脏康复治疗对老年冠心病慢性心力衰竭患者心肺功能和运动耐力的影响

Influence of individualized cardiac rehabilitation therapy based on WHO-FICs on cardiopulmonary function and exercise endurance of elderly patients with chronic heart failure

目的研究基于世界卫生组织国际分类家族(WHO-FICs)构建个体化心脏康复治疗对老年冠心病慢性心力衰竭患者心肺功能、运动耐力的影响。方法选择2020年5月至2023年5月昆明市第二人民医院收治的108例老年冠心病慢性心力衰竭患者,按随机数表法分组。对照组(54例)行常规康复训练,研究组(54例)在此基础上实施基于WHO-FICs构建的个体化心脏康复干预方案,两组均持续干预2个月。对比两组心肺功能、运动耐力、日常生活能力、生活质量、不良心血管事件。结果干预后,研究组右心室舒张末期内径(RVEDD)[(26.38±6.07)mm]、右心室前壁厚度(RVAWT)[(4.22±0.56)mm]、肺动脉收缩压(PASP)[(37.48±3.57)mmHg]均低于对照组[(29.26±4.49)mm、(5.89±0.47)mm、(42.36±3.49)mmHg],第1秒用力呼气容积(FEV1)[(3.01±0.46)L]、用力肺活量(FVC)[(3.35±0.29)L]、FEV1/FVC[(70.28±7.05)]及运动持续时间(ED)[(391.29±55.36)s]、峰值摄氧量(VO_(2)peak)[(20.21±4.36)ml·kg^(-1)·min^(-1)]、无氧阈(AT)[(13.09±1.22)ml·kg^(-1)·min^(-1)]、6 min步行试验(6MWT)[(375.19±40.26)m]均高于对照组[(2.56±0.23)L、(2.49±0.26)L、(65.46±7.39)、(357.54±55.72)s、(17.64±4.13)ml·kg^(-1)·min^(-1)、(11.24±1.36)ml·kg^(-1)·min^(-1)、(345.57±40.31)m](P<0.05);干预后,研究组日常生活活动能力量表(ADL)[(72.19±6.25)分]、堪萨斯城心肌病患者生活质量量表(KCCQ)评分[(74.08±5.11)分]高于对照组[(67.31±6.04)分、(65.29±5.03)分](P<0.05);干预期间,研究组不良心血管事件发生率低于对照组(3.70%VS 16.67%)(P<0.05)。结论基于WHO-FICs构建的个体化心脏康复干预方案可改善患者心肺功能、提高其运动耐力及日常生活能力,并能够改善患者生活质量、减少不良心血管事件发生。

Objective To study the effects of individual cardiac rehabilitation therapy based on WHO International Classification family(WHO-FICs)on cardiopulmonary function and exercise endurance of elderly patients with chronic heart failure.Method A total of 108 elderly patients with coronary heart disease and chronic heart failure admitted to the Second People’s Hospital of Kunming from May 2020 to May 2023 were selected and grouped according to the principle of randomized control.The control group(54 patients)underwent routine rehabilitation training,and on this basis,the study group(54 patients)performed an individualized cardiac rehabilitation intervention program based on the WHO-FICs.Both groups continued for 2 months.Comparing the two groups,cardiopulmonary function,exercise endurance,daily living capacity,quality of life,and adverse cardiovascular events.Results After intervention,the right ventricular end-diastolic diameter(RVEDD)[(26.38±6.07)mm],right ventricular anterior wall thickness(RVAWT)[(4.22±0.56)mm],pulmonary artery systolic pressure(PASP)[(37.48±3.57)mmHg]in the study group were lower than those in the control group[(29.26±4.49)mm,(5.89±0.47)mm,(42.36±3.49)mmHg],and the forced expiratory volume in 1 second(FEV1)[(3.01±0.46)L],forced vital capacity(FVC)[(3.35±0.29)L],FEV1/FVC[(70.28±7.05)],exercise duration(ED)[(391.29±55.36)s],peak oxygen uptake(VO_(2)peak)[(20.21±4.36)ml·kg^(-1)·min^(-1)],anaerobic threshold(AT)[(13.09±1.22)ml·kg^(-1)·min^(-1)],6 min walking test(6MWT)[(375.19±40.26)m]in the study group were higher than those in the control group[(2.56±0.23)L,(2.49±0.26)L,(65.46±7.39),(357.54±55.72)s,(17.64±4.13)ml·kg^(-1)·min^(-1),(11.24±1.36)ml·kg^(-1)·min^(-1),(345.57±40.31)m](P<0.05).After intervention,the scores of activities of daily living(ADL)and Kansas City Cardiomyopathy Quality of Life Questionnaire(KCCQ)in the study group were(72.19±6.25)and(74.08±5.11)higher than those in the control group[(67.31±6.04)and(65.29±5.03)](P<0.05),and the incidence of adverse cardiovascular events in the study group was lower than that in the control group(3.70%vs.16.67%)(P<0.05).Conclusion The individualized cardiac rehabilitation intervention program based on WHO-FICs can improve the cardiopulmonary function,exercise endurance and daily living ability of patients,improve the quality of life of patients and reduce the occurrence of adverse cardiovascular events.