共享决策管理的家庭心脏康复对冠状动脉旁路移植术术后患者运动依从性及康复效果影响  

Impact of shared decision-making in home cardiac rehabilitation on exercise compliance and rehabilitation outcomes of patients after coronary artery bypass grafting

作　　者：白霞 刘金成 段维勋 吕向妮 张婷 Bai Xia;Duan Weixun;Lv Xiangni;Zhang Ting(Cardiovascular Surgical Care Unit,The First Affiliated Hospital of Air Force Military Medical University,Shaanxi Xi’an 710032,China)

机构地区：[1]空军军医大学第一附属医院心血管外科监护室,西安710032

出　　处：《中国体外循环杂志》2024年第5期407-411,共5页Chinese Journal of Extracorporeal Circulation

基　　金：国家自然科学基金(81870218);陕西省重点研发计划项目(2022ZDLSF01-09)。

摘　　要：目的探究共享决策(SDM)的家庭心脏康复对冠状动脉旁路移植术(CABG)术后患者运动依从性、生活质量、心功能等康复效果的影响。方法纳入于空军军医大学第一附属医院接受CABG手术患者,对照组和SDM组各110例。两组术后Ⅰ期心脏康复相同,Ⅱ期康复对照组在运动风险评估基础上提供出院后医学运动处方,嘱患者进行家庭康复运动6个月,SDM组运动方案制定及运动指导随访采用SDM法,以SDM模式延续护理6个月。对两组患者运动依从性、入组时和6个月后两组自我效能[一般自我效能量表(GSES)]、生活质量[西雅图心绞痛调查量表(SAQ)]、桥血管通畅率及心功能(左室舒张末期内径、左室射血分数)进行比较。结果SDM组6个月的运动依从良好率为87.61%,高于对照组的52.42%(P<0.05);6个月后两组患者GSES得分、SAQ评分、LVEF水平均较入组时升高,SDM组均高于对照组(P<0.05)。SDM组桥血管通畅率为96.55%,高于对照组的92.22%,但两组间差异无统计学意义(P>0.05)。结论在CABG患者家庭康复训练中应用SDM模式,可以提高患者自我效能,进而提高运动依从性,改善患者心功能、提高生活质量。Objective To explore the impact of shared decision-making(SDM)in home cardiac rehabilitation on outcomes such as exercise compliance,quality of life,and cardiac function in patients after coronary artery bypass grafting(CABG).Methods Patients who underwent CABG surgery at the First Affiliated Hospital of Air Force Medical University were included,with 110 patients in the control group and 110 patients in the SDM rehabilitation group.The two groups received the same stage I cardiac rehabilitation,while the stage II rehabilitation control group were provided medical exercise prescriptions after discharge based on exercise risk assessment,and instructed patients to engage in home rehabilitation exercise for 6 months.The SDM rehabilitation group adopted the SDM method for developing exercise plans and providing follow-up exercise guidance and continued nursing care for 6 months in the SDM mode.Exercise compliance,self-efficacy(General Self Efficacy Scale(GSES)),quality of life(Seattle Angina Questionnaire(SAQ)),bridge vessel patency rate,and cardiac function(left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF))between the two groups of patients were compared at enrollment and 6 months later.Results The good exercise compliance rate of the SDM rehabilitation group at 6 months was 87.61%,which was higher than that of the control group’s 52.42%(P<0.05).After 6 months,the GSES score,SAQ score,and LVEF level of both groups of patients increased compared to the time of enrollment,however,these improvements were greater in the SDM rehabilitation group than in the control group(P<0.05).The patency rate of bridge vessels in the SDM rehabilitation group was 96.55%,which was higher than that in the control group(92.22%),but the difference between the two groups was not statistically significant(P>0.05).Conclusion The application of SDM mode in home rehabilitation training for CABG patients can improve their self-efficacy,thereby enhancing exercise compliance,improving their cardiac function,

关 键 词：冠状动脉旁路移植术 心脏康复 共享决策 自我效能 生活质量 

分 类 号：R654.2[医药卫生—外科学]