【摘要】：目的明確早期心臟康復(fù)訓(xùn)練對急性心肌梗死(AMI)經(jīng)皮冠狀動脈介入治療(PCI)術(shù)后患者的臨床價值,進一步探索不同心臟康復(fù)模式對AMI患者預(yù)后的效果。方法選取2014年1月—2016年5月紹興市人民醫(yī)院接受PCI的AMI患者90例,采用隨機數(shù)字表法分為3組,傳統(tǒng)常規(guī)組(30例)、傳統(tǒng)強化組(30例)和新型優(yōu)化組(30例)。傳統(tǒng)常規(guī)組根據(jù)2006年頒布的中國PCI術(shù)后心臟康復(fù)程序中急癥PCI術(shù)后1周康復(fù)程序制定,以步行等簡單的方式作為主要運動形式;傳統(tǒng)強化組根據(jù)2006年頒布的中國PCI術(shù)后心臟康復(fù)程序中擇期PCI術(shù)后康復(fù)程序制定,基礎(chǔ)活動量和總活動量強于傳統(tǒng)常規(guī)組;新型優(yōu)化組在傳統(tǒng)常規(guī)康復(fù)模式基礎(chǔ)上,綜合荷蘭Avans大學(xué)、UMC St RAdboud醫(yī)學(xué)院及香港伊利沙伯醫(yī)院接受的最新心臟康復(fù)理念,為患者提供早期、個體化和精確定量的新型心臟康復(fù)方案。3組均為期6個月。各組患者分別于PCI術(shù)后即刻(康復(fù)前)和心臟康復(fù)干預(yù)6個月后(康復(fù)后)行心臟彩色多普勒檢查,測量左心室射血分數(shù)(LVEF)、左心室收縮末期容積(LVESV)、左心室舒張末期容積(LVEDV)、室壁運動積分指數(shù)(WMSI)。測定血清中腫瘤壞死因子α(TNF-α)、一氧化氮(NO)、內(nèi)皮素1(ET-1)、可溶性血管細胞黏附分子1(sVCAM-1)水平。觀察患者心臟康復(fù)干預(yù)期間惡性心律失常、心絞痛、心力衰竭、猝死發(fā)生情況。結(jié)果康復(fù)前3組患者LVEF、LVESV、LVEDV、WMSI、TNF-α、NO、ET-1、sVCAM-1水平比較,差異均無統(tǒng)計學(xué)意義(P0.05)�？祻�(fù)后傳統(tǒng)強化組WMSI低于傳統(tǒng)常規(guī)組,新型優(yōu)化組LVEF高于傳統(tǒng)常規(guī)組和傳統(tǒng)強化組、WMSI低于傳統(tǒng)常規(guī)組和傳統(tǒng)強化組(P0.05)。3組康復(fù)后LVEF較康復(fù)前升高(P0.05)�？祻�(fù)后傳統(tǒng)強化組TNF-α、ET-1、sVCAM-1水平低于傳統(tǒng)常規(guī)組,NO水平高于傳統(tǒng)常規(guī)組;新型優(yōu)化組TNF-α、ET-1、sVCAM-1水平低于傳統(tǒng)常規(guī)組和傳統(tǒng)強化組、NO水平高于傳統(tǒng)常規(guī)組和傳統(tǒng)強化組(P0.05)。3組康復(fù)后TNF-α、ET-1、sVCAM-1水平較康復(fù)前降低,NO水平較康復(fù)前升高(P0.05)。3組患者心臟康復(fù)干預(yù)期間惡性心律失常發(fā)生率比較,差異有統(tǒng)計學(xué)意義(P0.05);心絞痛、心力衰竭發(fā)生率比較,差異無統(tǒng)計學(xué)意義(P0.05)。3組患者均無猝死發(fā)生。結(jié)論早期心臟康復(fù)訓(xùn)練對AMI PCI術(shù)后患者的心功能及預(yù)后有明顯改善,新型康復(fù)模式有效實現(xiàn)康復(fù)模式的個體化、人性化,最大限度地保護AMI患者的心功能,切實改善AMI患者的預(yù)后。
[Abstract]:Objective to determine the clinical value of early cardiac rehabilitation training in patients with acute myocardial infarction (AMI) after (PCI) after percutaneous coronary intervention (PCI), and to explore the effect of different cardiac rehabilitation models on the prognosis of AMI patients. Methods from January 2014 to May 2016, 90 AMI patients received PCI in Shaoxing people's Hospital were randomly divided into three groups: conventional group (30 cases), traditional reinforcement group (30 cases) and new optimization group (30 cases). The traditional routine group according to the Chinese PCI postoperative cardiac rehabilitation procedures issued in 2006 emergency PCI 1 week rehabilitation procedures, such as walking as the main form of exercise; The traditional reinforcement group was established according to the selective PCI rehabilitation procedure of the Chinese PCI postoperative cardiac rehabilitation procedure promulgated in 2006. The basic activity and total activity of the traditional group were higher than those of the traditional routine group, and the new optimized group was based on the traditional routine rehabilitation mode. To provide the patients with early, individualized and accurate quantitative new cardiac rehabilitation regimen for 6 months, the latest cardiac rehabilitation concept accepted by Avans St RAdboud School of Medicine and Queen Elizabeth Hospital in Hong Kong was synthesized. The patients in each group underwent echocardiography immediately after PCI (before rehabilitation) and 6 months after cardiac rehabilitation (after rehabilitation). Measurement of left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), wall motion integral index (WMSI). Serum levels of tumor necrosis factor 偽 (TNF- 偽), nitric oxide (NO), endothelin 1 (ET-1) and soluble vascular cell adhesion molecule 1 (sVCAM-1) were measured. To observe the incidence of malignant arrhythmia, angina pectoris, heart failure and sudden death during cardiac rehabilitation intervention. Results there was no significant difference in the levels of LVEF,LVESV,LVEDV,WMSI,TNF- 偽 noumenon ET-1 and sVCAM-1 between the three groups before rehabilitation (P0.05). After rehabilitation, the WMSI of the traditional enhancement group was lower than that of the traditional routine group, and the LVEF of the new optimized group was higher than that of the conventional group and the traditional reinforcement group (P0.05). The LVEF of the new optimized group was higher than that of the pre-rehabilitation group (P0.05). After rehabilitation, the level of TNF- 偽 -ET-1 and sVCAM-1 in the conventional enhancement group was lower than that in the conventional group, and the level of no in the conventional group was higher than that in the conventional group. The level of TNF- 偽 -ET-1 / sVCAM-1 in the new optimized group was lower than that in the conventional group and the traditional reinforcement group (P0.05). The level of TNF- 偽 -ET-1 / sVCAM-1 was higher than that of the pre-rehabilitation group (P0.05). The cardiac rehabilitation intervention of the patients in the group (P0.05) was higher than that in the pre-rehabilitation group (P0.05), and the level of TNF- 偽 -ET-1 / sVCAM-1 was lower than that in the pre-rehabilitation group (P0.05). A comparison of the incidence of malignant arrhythmias during the period, The difference was statistically significant (P0.05); the incidence of angina pectoris and heart failure had no statistical significance (P0.05). Conclusion early cardiac rehabilitation training can significantly improve the cardiac function and prognosis of patients after AMI PCI. The new rehabilitation model can effectively realize the individualization of rehabilitation mode, humanize, and protect the cardiac function of AMI patients to the maximum extent. To improve the prognosis of AMI patients.
【作者單位】： 浙江省紹興市人民醫(yī)院浙江大學(xué)紹興醫(yī)院;
【基金】：浙江省中醫(yī)藥科學(xué)研究基金項目(2014ZA113)
【分類號】：R542.22

【參考文獻】

相關(guān)期刊論文 前2條

1 倪明科;林t ;宗文霞;張明;李昌;;心臟康復(fù)治療對缺血性心肌病室性心律失常的影響[J];中國康復(fù)醫(yī)學(xué)雜志;2016年07期

2 孔雪;高方明;;急性心肌梗死患者急診行經(jīng)皮冠狀動脈介入術(shù)后早期康復(fù)治療對心臟射血分數(shù)的影響[J];中國康復(fù)醫(yī)學(xué)雜志;2015年08期

【共引文獻】

相關(guān)期刊論文 前10條

1 蔡燕;馬建林;;冠心病合并糖尿病老年患者冠狀動脈介入治療后護理干預(yù)效果分析[J];河北醫(yī)藥;2017年16期

2 徐苗蓁;周晴;宋艷;周英智;;醫(yī)學(xué)論文統(tǒng)計表的“不一致”現(xiàn)象[J];編輯學(xué)報;2017年04期

3 蔣承建;潘孫雷;池菊芳;周昌鉆;林輝;孟立平;翟小亞;郭艷;郭航遠;;不同心臟康復(fù)模式在急性心肌梗死經(jīng)皮冠狀動脈介入治療術(shù)后早期的臨床價值研究[J];中國全科醫(yī)學(xué);2017年20期

4 袁惠萍;李麗青;何婉玲;;延續(xù)性護理對PCI術(shù)后冠心病患者護理效果與依從性研究[J];護理實踐與研究;2017年12期

5 林海玲;趙紅;;老年急性心肌梗死患者住院期間康復(fù)治療的遠期效果[J];雙足與保健;2017年12期

6 渠林楠;崔玉芳;虞彬;;早期康復(fù)對經(jīng)橈動脈行急診PCI的急性心�；颊咦笫疑溲謹�(shù)及運動耐量的影響[J];實用臨床醫(yī)藥雜志;2017年08期

7 蔡澤坤;徐琳;馬駿;邱健;李國英;黃曉民;許業(yè)灝;;早期心臟康復(fù)程序?qū)毙孕募」Ｋ阑颊呓?jīng)皮冠狀動脈介入術(shù)后心臟收縮功能的影響[J];中國康復(fù)醫(yī)學(xué)雜志;2017年04期

8 馬云飛;王洪娟;王俊峰;劉全;;急性心肌梗死患者PCI術(shù)后的心臟康復(fù)現(xiàn)狀及進展[J];中國老年學(xué)雜志;2017年07期

9 鄭奇;;急性心肌梗死患者急診行經(jīng)皮冠狀動脈介入術(shù)后早期康復(fù)治療對心臟射血分數(shù)的影響[J];雙足與保健;2017年07期

10 馮麗霞;;缺血性心肌病患者運用心臟康復(fù)治療對其室性心律失常的影響[J];臨床醫(yī)藥文獻電子雜志;2017年24期

【二級參考文獻】

相關(guān)期刊論文 前9條

1 劉淑芬;陳麗霞;;慢性心力衰竭患者的康復(fù)治療[J];中國康復(fù)醫(yī)學(xué)雜志;2014年01期

2 劉洵;林青華;李淑榮;姚莉;譚思潔;;冠心病患者運動中心率-收縮壓雙乘積與血乳酸濃度和ST段水平的關(guān)系[J];中國康復(fù)醫(yī)學(xué)雜志;2013年08期

3 韓呈武;侯來永;孔晶;程文立;陳莉;陳剛;姜國臣;彭靖嬪;李鴻;;有氧康復(fù)運動療法對冠脈成形術(shù)后患者血清超氧化物歧化酶活性及泛素水平影響的臨床研究[J];中國康復(fù)醫(yī)學(xué)雜志;2013年06期

4 呂云;劉洵;譚思潔;李承蒙;石曉明;趙楠楠;;L型鈣通道阻滯藥對冠心病患者運動康復(fù)前后鈣磷代謝和骨密度的影響[J];中國康復(fù)醫(yī)學(xué)雜志;2012年11期

5 王釗;陳s，

本文編號：2205001