个体化心脏运动康复方案在老年冠心病合并慢性心力衰竭患者中的应用  

Application of individualized cardiac exercise rehabilitation program in elderly patients with coronary heart disease complicated with chronic heart failure

作　　者：毕瑞瑾 付新[1] 高雁歌 王艺源 王雯星 BI Rui-jin;FU Xin;GAO Yan-ge;WANG Yi-yuan;WANG Wen-xing(Second Ward,Comprehensive Department,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan,CHINA)

机构地区：[1]郑州大学第一附属医院综合科二病区,河南郑州450000

出　　处：《海南医学》2025年第7期1044-1049,共6页Hainan Medical Journal

基　　金：中国心血管健康联盟“进·阶研究基金2020”专项基金(编号:2020-CCA-ACCESS-087)。

摘　　要：目的探讨个体化心脏运动康复方案在老年冠心病合并慢性心力衰竭(CHF)患者中的应用效果。方法选择2022年2月至2023年10月郑州大学第一附属医院收治的84例老年冠心病合并CHF患者作为研究对象,按随机数表法分为对照组和研究组各42例。对照组患者采用常规干预,研究组患者在对照组基础上联合个体化心脏运动康复方案干预,均护理干预至患者出院,干预结束后随访3个月。比较两组患者干预前及随访3个月后的6 min步行距离(6MWT)、生活质量[采用明尼苏达心力衰竭生活质量量表(MLHFQ)和日常生活能力量表(ADL)评价]、心功能[左室收缩末期内径(LVDS)、左室舒张末期内径(LVDD)、左室射血分数(LVEF)]和血清N末端B型利钠肽原(NT-proBNP)、同型半胱氨酸(Hcy)水平;随访3个月后,比较两组患者的心血管不良事件发生率。结果随访3个月后,两组患者的6MWT、ADL评分均升高,MLHFQ评分均降低,且研究组患者的6MWT、ADL评分分别为(321.94±65.17)m、(86.12±8.52)分,明显高于对照组的(280.75±55.42)m、(77.04±8.32)分,而MLHFQ评分为(45.63±7.05)分,明显低于对照组的(54.12±8.42)分,差异均有统计学意义(P<0.05);随访3个月后,两组患者的LVDS、LVDD均缩小,LVEF均增加,而血清NT-proBNP及Hcy水平均降低,且研究组患者的LVDS、LVDD分别为(39.05±5.17)mm、(50.09±6.73)mm,明显小于对照组的(43.16±6.15)mm、(54.11±6.82)mm,LVEF为(55.49±6.93)%,明显高于对照组的(50.42±7.39)%,而血清NT-proBNP及Hcy水平分别为(805.82±106.77)ng/L、(10.02±2.15)μmol/L,明显低于对照组的(913.06±125.70)ng/L、(13.29±2.40)μmol/L,差异均有统计学意义(P<0.05);研究组患者的心血管不良事件发生率为4.76%,明显低于对照组的21.43%,差异有统计学意义(P<0.05)。结论个体化心脏运动康复方案能够改善老年冠心病合并慢性心力衰竭患者的运动耐力和心功能,提高患者生活质量,降低血清NT-proBNP及Hcy水平Objective To explore the application effect of individualized cardiac exercise rehabilitation program in elderly patients with coronary heart disease complicated with chronic heart failure(CHF).Methods Eighty-four elderly patients with coronary heart disease and CHF admitted to the First Affiliated Hospital of Zhengzhou University from February 2022 to October 2023 were selected and randomly divided into a control group(n=42)and a study group(n=42)using a random number table method.The patients in the control group received routine intervention,while those in the study group received individualized cardiac exercise rehabilitation program intervention on the basis of treatment in the control group.All patients received nursing intervention until discharge,and were followed up for 3 months after the intervention.The two groups were compared in the following indexes before intervention and after 3 months of follow-up:the 6-minute walk distance(6MWT),quality of life(evaluated using the Minnesota Living with Heart Failure Questionnaire[MLHFQ]and Activities of Daily Living[ADL]),cardiac function(left ventricular end-systolic diameter[LVDs],left ventricular end-diastolic diameter[LVDd],left ventricular ejection fraction[LVEF]),and serum N-terminal pro B-type natriuretic peptide(NT-proBNP),and homocysteine(Hcy)levels.After 3 months of follow-up,the incidence of cardiovascular adverse events was compared between the two groups of patients.Results After 3 months'follow-up,the scores of 6MWT and ADL in both groups increased,while the scores of MLHFQ decreased;the scores of 6MWT and ADL in the study group were(321.94±65.17)m and(86.12±8.52)points,which were significantly higher than(280.75±55.42)m and(77.04±8.32)points in the control group;the MLHFQ score was(45.63±7.05)points,which was significantly lower than(54.12±8.42)points of the control group;the difference were statistically significant(P<0.05).The LVDS and LVDD of the patients in the two groups decreased,the LVEF increased,and the serum NT-proBNP and Hcy level

关 键 词：老年 冠心病 慢性心力衰竭 个体化心脏运动康复方案 心功能 生活质量 心血管不良事件 

分 类 号：R541.4[医药卫生—心血管疾病]