Ⅰ期综合心脏康复对ST段抬高型心肌梗死急诊经皮冠状动脉介入术后患者的疗效

doi:10.3969/j.issn.1006-5725.2024.05.016

Abstract

Abstract:

Objective This study aimed to investigate the effect of stageⅠcomprehensive cardiac rehabilitation in patients with acute ST elevation myocardial infarction （STEMI） after emergency percutaneous coronary intervention（PCI）. Methods A total of 72 patients with acute ST-segment elevation myocardial infarction combined with PCI admitted to the Department of Cardiovascular Medicine of Beijing Electric Power Hospital of State Grid Corporation from June 2021 to June 2022， which were selected as the research objectsand divided into control group and observation group randomly （36 cases in each group）. The control group was treated with routine nursing and health education， and the observation group with stageⅠcomprehensive cardiac rehabilitation， including initial assessment （cardiovascular comprehensive assessment）， exercise training （exercise training and breathing training）， daily activity suggestions and health education， discharge assessment （six-minute walking test and Barthel index assessment）. The score of Barthel index （BI） at discharge， the 6-minute walking test distance （6MWD） at discharge， the incidence of major adverse cardiovascular event （MACE） during hospitalization and within one month of discharge， and the length of stay were compared between the two groups. Results After intervention， the six-minute walking test distance（6MWD）and Barthel index（BI）score in the observation group were better than those in the control group， the difference was statistically significant （P < 0.05）. The incidence of major adverse cardiovascular events （MACE） during hospitalization and one month after discharge was lower in the observation group than in the control group， and the difference was statistically significant （P < 0.05）. The length of hospitalization in observation group was lower than that in control groupbut there was no statistical difference （P > 0.05）. Conclusion The application of phaseⅠcomprehensive cardiac rehabilitation training in patients with acute ST-segment elevation myocardial infarction combined with emergency PCI could improve the patients' exercise ability， improve their ability of daily activity， reduce the incidence of major adverse cardiovascular events （MACE） in the early stage of the disease， facilitate the patients to return to their families and society as soon as possible， and improve their quality of life. It has high clinical application value.

Key words: stage I cardiac rehabilitation, ST-segment elevation myocardial infarction, percutaneous coronary intervention, Barthel index, six-minute walk test, major adverse cardiovascular event

CLC Number:

R493

Yue REN,Ting TIAN,Guangsheng WEI,Ming ZHANG,Hong YU,Jie LI,Tingting DONG,Yinmei FENG,Hongchao CUI,Jiao. ZHANG. Effect of stage I comprehensive cardiac rehabilitation in patients with acute ST elevation myocardial infarctionafter emergency percutaneous coronary intervention[J]. The Journal of Practical Medicine, 2024, 40(5): 682-687.

Figures/Tables 5

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References 33

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项目	康复组（n = 36）	常规治疗组（n = 36）	χ²/t/U值	P值
性别			0.000	1.000
男	29（80.6）	29（80.6）
女	7（19.45）	7（19.45）
年龄（x ± s，岁）	57.14 ± 12.093	60.36 ± 11.087	-1.178	0.243
BMI（x ± s，kg/m²）	25.658 ± 3.728	26.350 ± 3.537	-0.808	0.422
合并症
高血压	14（38.9）	22（61.1）	3.556	0.059
高血脂	29（80.6）	30（83.3）	0.094	0.759
糖尿病	14（38.9）	10（27.8）	1.000	0.317
吸烟			0.000	1.000
是	21（58.3）	21（58.3）
否	15（41.7）	15（41.7）
体力活动			0.158	0.691
低水平	33（91.7）	32（88.9）
中水平	3（8.3）	4（11.1）
高水平	0（0）	0（0）
Killip分级			0.158	0.691
Ⅰ级	18（50.0）	23（63.9）
Ⅱ级	16（44.4）	12（33.3）
Ⅲ级	2（5.6）	1（2.8）
LVEF（x ± s，%）	59.11 ± 7.21	58.78 ± 7.93	0.187	0.852
peak-Tni［M（P₂₅， P₇₅）］	5.55（1.68，14.00）	7.30（3.30，23.5）	-1.058	0.290
支架数［M（P₂₅， P₇₅）］	1（1.00，1.00）	1（1.00，1.00）	0.645	0.645
LDL-C（x ± s，mmol/L ）	2.966 ± 0.793	2.680 ± 0.891	1.440	0.154
TG ［M（P₂₅， P₇₅），mmol/L］	2.36（1.30，4.43）	1.91（1.25，2.74）	-1.386	0.166
HbA1C ［M（P₂₅， P₇₅），%］	5.90（5.53，7.30）	5.90（5.53，7.83）	-0.688	0.492

训练阶段	训练内容	Borg评分	日常活动指导与健康教育
1	仰卧位，膈肌激活，腹式呼吸训练，1 min × 10/d；踝泵运动10 × 5/d	10分	床上活动，自主进食，辅助下如厕；介绍CCU病房，指导睡眠，介绍康复程序
2	仰卧位，膈肌激活，腹式呼吸训练，1 min × 10/d；踝泵运动10 × 5/d；下肢交替抬高30°，10 × 3/d；上肢配合呼吸交替上举，吸气举，呼气落， 8次 × 3/d	10 ~ 11分	床上活动，自主进食，辅助下如厕，床上半坐位保持5 ~ 10 min；介绍心血管危险因素及其控制措施，发放宣传资料
3	坐位10 min × 2/d；坐位腹式呼吸训练， 1 min × 10/d；坐位伸膝活动，10 × 5/d；坐位踝泵运动10 × 5/d。	10 ~ 11分	坐位活动，自主进食，辅助如厕；介绍心血管危险因素及其控制措施，发放宣传资料
4	床边站立5 min × 2/d；原地踏步或床边步行5 min × 3/d；站立位配合呼吸上举，8次 × 2/d，吸气举，呼气落；	11 ~ 12分	站立活动，独立洗漱，独立如厕；介绍心肌梗死的发病及可能的诱因，二级预防的措施及急救措施。
5	床边步行或室内步行10 min × 2/d；坐位八段锦，5 min/d	11 ~ 12分	指导二级预防用药；介绍2-3METs的日常活动
6	边步行或室内步行10 min × 2/d；提踵动作1 min × 3；坐位八段锦，5 min/d	11 ~ 12分	介绍二期康复，指导出院后的康复计划及定期复诊安排

组别	心绞痛	心律失常	心力衰竭	猝死	发生率
康复组	1	2	1	0	11.1%
常规治疗组	3	6	2	0	30.6%
χ²值					4.126
P值					0.042

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Effect of stage I comprehensive cardiac rehabilitation in patients with acute ST elevation myocardial infarctionafter emergency percutaneous coronary intervention

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