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    冠心病PCI术后中西医结合心脏康复模式的探讨

    Application of cardiac rehabilitation model based on integrated traditional Chinese and western medicine after PCI for coronary heart disease

    • 摘要: 目的 对冠心病经皮冠状动脉介入治疗术(PCI)后患者进行三级医院指导下的社区中西医结合心脏康复,初步探讨该模式的有效性。方法 将首次行PCI治疗的冠心病患者95例,按随机原则分为常规治疗组(对照组,46例)和心脏康复组(康复组,49例)。对照组给予冠心病的常规二级预防治疗,康复组给予三级医院指导下的社区中西医结合心脏康复治疗,2组均随访6个月。收集2组患者基线资料和干预后6个月的6分钟步行试验(6MWT)距离、左室射血分数(LVEF)、N末端B型利钠肽原(NT-proBNP)水平、焦虑评分(PHQ-9量表)、抑郁评分(GAD-7量表)、主要心脏不良事件(MACE)的发生率及因胸部不适及焦虑等原因再入院率。结果 康复组干预6个月后的6MWT距离明显大于对照组,NT-proBNP水平明显低于对照组,差异均有统计学意义(P<0.05)。康复组干预6个月后的焦虑评分较干预前明显下降,差异有统计学意义(P<0.05);对照组干预前后对比,差异无统计学意义(P>0.05)。干预6个月后,对照组总MACE事件、心肌梗死、再次血运重建的发生率虽较康复组有所增加,但差异无统计学意义(P均>0.05)。康复组较对照组患者再入院率低,差异有统计学意义(P<0.05)。在整个康复过程中未发生运动意外伤害及运动相关的心血管事件。结论 对冠心病PCI术后患者实施三级医院指导下的社区中西医结合心脏康复,安全、有效且可行,值得进一步观察研究。

       

      Abstract: Objective To preliminarily explore the effectiveness of community cardiac rehabilitation based on integrated traditional Chinese and Western medicine under the guidance of third-grade hospitals for patients who undergo percutaneous coronary intervention (PCI) for coronary heart disease (CHD). Methods A total of 95 patients initially treated with PCI for CHD were enrolled. They were randomly divided into two groups: a conventional treatment group (a control group, n=46) and a cardiac rehabilitation group (a rehabilitation group, n=49). The control group received conventional treatment for secondary prevention of CHD, while the rehabilitation group received community cardiac rehabilitation based on integrated traditional Chinese and Western medicine under the guidance of third-grade hospitals. Both groups were followed up for six months. Then, their six-minute walk distance (6MWD), left ventricular ejection fraction (LVEF), N-terminal pro b-type natriuretic peptide (NT-proBNP), patient health questionaire-9 (PHQ-9) score, generalized anxiety disorder-7 (GAD-7) score, the incidence of major adverse cardiovascular events (MACEs), as well as the rate of readmission due to chest discomfort and anxiety were recorded at baseline and six months after intervention. Results Six months after intervention, the rehabilitation group presented remarkable decrease in 6MWD and NT-proBNP levels, compared with the control group (P<0.05). Six months after intervention, the rehabilitation group presented remarkable decreases in PHQ-9 score compared with the baseline levels (P<0.05). There was no statistical difference in PHQ-9 score in the control group before and after intervention (P>0.05). Six months after intervention, the incidences of total MACEs, myocardial infarction, and repeat revascularization increased in the control group compared with the rehabilitation group, without statistical difference (all P>0.05). The readmission rate was remarkably lower in the rehabilitation group than that in the control group (P<0.05). No accidental exercise injuries or exercise-related cardiovascular events were reported throughout the rehabilitation process. Conclusions For patients undergoing PCI for CHD, community cardiac rehabilitation based on integrated traditional Chinese and Western medicine under the guidance of third-grade hospitals is safe, effective and feasible, which is worthy of further observational studies.

       

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