基于区域协同救治理念的心脏康复在ST段抬高型心肌梗死患者中的应用效果

Application Effect of Cardiac Rehabilitation Based on Regional Cooperative Treatment Concept in Patients with ST Segment Elevation Myocardial Infarction

目的探讨基于区域协同救治理念的心脏康复在ST段抬高型心肌梗死(STEMI)患者中的应用效果。方法本研究为队列研究,选取2019年1月—2022年1月在中国人民解放军南部战区总医院心血管内科接受急诊经皮冠状动脉介入治疗(PPCI)的STEMI患者117例为研究对象。依据来院方式不同,将患者分为干预组[来自网络医院(已建立基层版胸痛中心或胸痛单元的医院),56例]和对照组(自行来院和来自非网络医院,61例)。对照组患者住院期间接受院内心脏康复,出院后自行在家进行心脏康复训练,定期回院复诊;干预组患者住院期间接受院内心脏康复,病情稳定后反向转诊至网络医院,接受基于区域协同救治理念的心脏康复方案;两组均干预12个月。比较两组一般资料,入院时、术后6个月、术后12个月冠心病危险因素控制情况(包括血压、血糖、血脂达标和吸烟)、左心室射血分数(LVEF)、6 min步行距离、12条目简短生命质量量表(SF-12)评分,术后12个月主要不良心血管事件(MACE)发生情况。结果最终共92例患者完成本研究,其中对照组47例、干预组45例。干预组术后12个月血脂达标者占比高于对照组,吸烟者占比低于对照组(P<0.05)。干预方法与时间在LVEF、6 min步行距离、SF-12评分上存在交互作用(P<0.05);干预方法、时间在LVEF、6 min步行距离、SF-12评分上主效应显著(P<0.05)。干预组术后6个月6 min步行距离长于对照组,SF-12评分高于对照组(P<0.05);干预组术后12个月LVEF、SF-12评分高于对照组,6 min步行距离长于对照组(P<0.05);对照组、干预组术后6个月LVEF、SF-12评分分别高于本组入院时,6 min步行距离分别长于本组入院时(P<0.05);干预组术后12个月LVEF高于入院时、术后6个月(P<0.05);对照组、干预组术后12个月6 min步行距离分别长于本组入院时、术后6个月,SF-12评分分别高于本组入院时、术后6个月(P<0.05)。两组术后12个月MACE发生率比较,差异无统计学意义(P>0.05)。结论基于区域协同救治理念的心脏康复可帮助STEMI患者有效控制冠心病危险因素,改善患者心功能,提高生活质量,且安全性较好。

Objective To investigate application effect of cardiac rehabilitation based on regional cooperative treatment concept in patients with ST segment elevation myocardial infarction(STEMI).Methods In this cohort study,117 STEMI patients who received primary percutaneous coronary intervention(PPCI)in the Department of Cardiology,General Hospital of Southern Theater Command,PLA from January 2019 to January 2022 were selected as the study subjects.According to the way of admission,the patients were divided into intervention group[56 cases from network hospitals(hospitals that have established a grassroots version of chest pain center or chest pain unit)]and control group(61 cases from self-admission and non-network hospitals).Patients in control group received in-hospital cardiac rehabilitation during hospitalization,and after discharge,they underwent cardiac rehabilitation training at home and returned to the hospital for regular follow-up visits.During hospitalization,patients in the intervention group received in-hospital cardiac rehabilitation.After their condition stabilized,they were referred back to a network hospital and received a cardiac rehabilitation plan based on regional cooperative treatment concept.Both groups were intervened for 12 months.General data,the control condition of risk factors of coronary heart disease(including blood pressure,blood glucose,and blood lipid compliance and smoking),left ventricular ejection fraction(LVEF),6-min walking distance and 12-Items Short Form Health Survey(SF-12)score at admission,6 months and 12 months after PPCI,major adverse cardiovascular events(MACE)at 12 months after PPCI were compared between the two groups.Results A total of 92 patients completed the study,including 47 in the control group and 45 in the intervention group.The proportion of blood lipid compliant patients in the intervention group was higher than that in the control group at 12 months after PPCI,and the proportion of smokers was lower than that of the control group(P<0.05).There were interaction effects between intervention method and time on LVEF,6-min walking distance and SF-12 score(P<0.05).The main effects of intervention method and time on LVEF,6-min walking distance and SF-12 score were significant(P<0.05).The 6-min walking distance of the intervention group was longer than that of the control group at 6 months after PPCI,and the SF-12 score was higher than that of the control group(P<0.05).The LVEF and SF-12 score in the intervention group were higher than those in the control group at 12 months after PPCI,and the 6-min walking distance was longer than that in the control group(P<0.05).In the control group and the intervention group,the LVEF and SF-12 scores at 6 months after PPCI were higher than those at admission,the 6-min walking distance was longer than that at admission,respectively(P<0.05).The LVEF of the intervention group at 12 months after PPCI was higher than that at admission and 6 months after PPCI(P<0.05).In the control group and the intervention group,the 6-min walking distance at 12 months after PPCI was longer than that at admission and 6 months after PPCI,the SF-12 score was higher than that at admission and 6 months after PPCI,respectively(P<0.05).There was no significant difference in the incidence of MACE at 12 months after PPCI between the two groups(P>0.05).Conclusion The implementation of cardiac rehabilitation based on regional collaborative treatment concept can help STEMI patients effectively control the risk factors of coronary heart disease,improve the heart function and the quality of life of patients,and has good safety.