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中国人民解放军总医院老年心血管病研究所
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
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马晶,张瀛月,李海燕,戈程,徐勇,陈韵岱.融合心脏康复治疗对心肌梗死患者心肺运动功能和心理状态的影响[J].中华老年多器官疾病杂志,2019,18(10):721~725
融合心脏康复治疗对心肌梗死患者心肺运动功能和心理状态的影响
Effect of integrated cardiac rehabilitation on cardiopulmonary function and psychological status in myocardial infarction patients
投稿时间:2019-09-01  
DOI:10.11915/j.issn.1671-5403.2019.10.157
中文关键词:  融合心脏康复;心肌梗死;心肺运动功能;焦虑;抑郁
英文关键词:integrated cardiac rehabilitation; myocardial infarction; cardiopulmonary exercise testing; anxiety; depression This work was supported by the National Key R&D Program of China
基金项目:国家重点研发计划(2018YFC2000600)
作者单位E-mail
马晶 解放军总医院第一医学中心心血管内科,北京 100853  
张瀛月 解放军总医院第一医学中心心血管内科,北京 100853  
李海燕 解放军总医院第一医学中心心血管内科,北京 100853  
戈程 解放军总医院第一医学中心心血管内科,北京 100853  
徐勇 解放军总医院第一医学中心心血管内科,北京 100853  
陈韵岱 解放军总医院第一医学中心心血管内科,北京 100853 cyundai@vip.163.com 
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中文摘要:
      目的 探讨机构心脏康复联合居家康复的融合心脏康复模式对心肌梗死患者心肺功能和心理状态的影响。方法 纳入2017年7月至2018年3月转诊至解放军总医院第一医学中心心血管内科心脏康复中心治疗的3个月内曾患急性心肌梗死的患者84例。分为治疗组和对照组,每组42例。对照组患者于入组时进行1次健康宣教。治疗组患者采用融合心脏康复治疗:2次/周门诊运动治疗,持续18周,每次运动治疗结束后由医护人员进行15min健康宣教,并指导患者居家运动训练计划;18周后转入完全居家康复程序,继续治疗6周。对比2组患者治疗前后的体质量指数、腰臀比、心肺运动试验指标、广泛性焦虑量表(GAD-7)及患者健康问卷(PHQ-9)评分等指标。采用SPSS 19.0软件进行数据处理。依据数据类型,组间比较分别采用t检验或χ2检验。结果 组内比较:与治疗前相比,治疗后治疗组患者的腰臀比[(0.91±0.64)和(0.93±0.51)]、GAD-7评分[(2.60±3.02)和(4.69±4.61)]、PHQ-9评分[(4.14±2.54)和(6.26±3.51)]、二氧化碳通气当量斜率(VE/VCO2 slope)[(23.46±5.09)和(25.31±4.00)]均显著降低(P<0.05),而峰值千克摄氧量(Peak VO2/kg)[(23.43±5.88)和(20.70±4.13)ml/(min·kg)]、最大代谢当量(METmax)[(6.62±1.68)和(5.92±1.18)]、氧脉搏[(13.25±4.06)和(11.78±3.48)ml/beat]均显著升高(P<0.05)。组间比较:与对照组相比,治疗组患者治疗后的Peak VO2/kg[(23.43±5.88)和(19.48±4.47)ml/(min·kg)]、METmax[(6.62±1.68)和(5.66±1.25)]、氧脉搏[(13.25±4.06)和(11.76±0.70)ml/beat]均显著升高(P<0.05),而腰臀比[(0.91±0.64)和(0.94±0.44)]显著降低(P<0.05)。结论 融合心脏康复治疗可以提高心肌梗死患者的心肺运动功能,改善焦虑抑郁等精神障碍,值得临床推广。
英文摘要:
      Objective To explore the effect of integrated cardiac rehabilitation model (center- and home-based cardiac rehabilitation) on cardiopulmonary function and psychological status in patients with myocardial infarction. Methods A total of 84 cases of acute myocardial infarction within 3 months and referred to the Cardiovascular Rehabilitation Center of Chinese General Hospital of PLA from July 2017 to March 2018 were enrolled, and then randomized into treatment group and control group, with 42 patients in each group. The patients of the treatment group were treated with center-based exercise followed by health education of 15 min by medical staffs, twice a week for totally 18 weeks, and then home-based exercise for another 6 weeks. While, those in the control group were given health education for only once. Body mass index, waist-to-hip ratio, indices of cardiopulmonary exercise testing, and scores of generalized anxiety disorder (GAD-7) and patient health auestionnaire (PHQ-9) were compared before and after treatment between the 2 groups. SPSS statistics 19.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for different data types. Results After 24 weeks of integrated cardiac rehabilitation, the patients of the treatment group obtained significantly lower waist-to-hip ratio [(0.91±0.64) vs (0.93±0.51)], GAD-7 score [(2.60±3.02) vs (4.69±4.61)], PHQ-9 score [(4.14±2.54) vs (6.26±3.51)], and minute ventilation/carbon dioxide production (VE/VCO2) slope [(23.46±5.09) vs (25.31±4.00)], and obviously increased peak oxygen uptake per kilogram [Peak VO2/kg, (23.43±5.88) vs (20.70±4.13)ml/(min·kg)], maximal metabolism equivalents [METmax, (6.62±1.68) vs (5.92±1.18)], and oxygen pulse [(13.25±4.06) vs (11.78±3.48)ml/beat] (all P<0.05). What′s more, the Peak VO2/kg [(23.43±5.88) vs (19.48±4.47)ml/(min·kg)], METmax [(6.62±1.68) vs (5.66±1.25)], oxygen pulse [(13.25±4.06) vs (11.76±0.70)ml/beat] were notably higher, while the waist-to-hip ratio [(0.91±0.64) vs (0.94±0.44)] were obviously decreased in the treatment group than the control group (P<0.05). Conclusion Integrated cardiac rehabilitation can promote cardiopulmonary exercise function, improve mental disorders such as anxiety and depression, and is worthy of clinical promotion for myocardial infarction population.
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