2023 年第 9 期 第 18 卷

急性冠状动脉综合征患者完全血运重建术后不同模式远程心脏康复治疗对心肺功能的改善效果研究

Effect of different modes of remote cardiac rehabilitation on the improvement of cardiopulmonary function in patients with acute coronary syndrome after complete revascularization surgery

作者：陈婉萍1冯妍1张兆国2于美丽2顾伟3吴嘉慧1刘文娴1

英文作者：Chen Wanping1 Feng Yan1 Zhang Zhaoguo2 Yu Meili2 Gu Wei3 Wu Jiahui1 Liu Wenxian1

单位：1首都医科大学附属北京安贞医院心脏康复中心，北京100029；2北京市中西医结合医院心内科，北京100039；3首都医科大学附属北京安贞医院心内十五病房，北京100029 陈婉萍为首都医科大学全科医学与继续教育学院研究生

英文单位：1Cardiac Rehabilitation Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Cardiology Beijing Hospital of Integrated Traditional Chinese and Western Medicine Beijing 100039 China; 3the 15th Ward Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：急性冠状动脉综合征；心肺运动试验；远程心脏康复

英文关键词：Acutecoronarysyndrome;Cardiopulmonaryexercisetest;Remotecardiacrehabilitation

• 摘要：

• 目的  探讨急性冠状动脉综合征（ACS）患者完全血运重建术后不同模式远程心脏康复治疗对心肺功能的改善效果。方法 选取2021年4—9月首都医科大学附属北京安贞医院和北京市中西医结合医院心内科收治的ACS完全血运重建术后1个月以上病情稳定的60例患者为研究对象。按照随机数字表法分为对照组和观察组，各30例。对照组采用完全远程康复模式；观察组采用部分远程康复模式，每周至少1次于医联体内就近的医院网点进行心脏康复治疗，在医师现场指导下进行运动康复训练并进行及时的反馈，剩余的次数同对照组相同，居家完成。2组患者居家期间均通过互联网平台不定时与医师交流或向医师反馈信息，2组均进行每周3～5次的运动康复治疗，持续干预12周。比较心脏康复治疗前后心肺运动试验指标。结果 2组患者性别分布、年龄、体重指数、左心室射血分数、低密度脂蛋白胆固醇水平及高血压病史、糖尿病史、高脂血症史比例差异均无统计学意义（均P＞0.05）。对照组干预前后心肺运动试验各指标差异均无统计学意义（均P＞0.05）。干预后观察组最大代谢当量、最大运动负荷、无氧阈摄氧量、峰值摄氧量均高于对照组［（6.6±1.1）比（5.4±1.0）、（136±33）W比（119±27）W、（15.3±3.2）ml/(min·kg)比（13.1±3.3）ml/(min·kg)、（23±4）ml/(min·kg)比（19±4）ml/(min·kg)］，差异均有统计学意义（均P＜0.05）。结论 心脏康复治疗有助于改善ACS完全血运重建术后患者的心肺耐力，提高患者生活质量，且部分远程心脏康复模式在短期内对心肺功能的改善较完全远程康复模式效果更显著。

• Objective To investigate the effect of different modes of remote cardiac rehabilitation on the improvement of cardiopulmonary function in patients with acute coronary syndrome (ACS) after complete revascularization surgery. Methods Sixty patients with stable ACS more than one month after complete revascularization surgery admitted to Beijing Anzhen Hospital, Capital Medical University and Beijing Hospital of Integrated Traditional Chinese and Western Medicine from April to September 2021 were selected as the research subjects. According to the random number table method, they were divided into control group and observation group, with 30 cases each. The control group adopted a complete remote rehabilitation mode. The observation group adopted a partial remote rehabilitation mode, with cardiac rehabilitation conducted at least once a week at the nearest hospital branch within the medical association; exercise rehabilitation training was conducted under the guidance of doctors on-site and timely feedback was provided; the remaining times were the same as the control group, and completed at home. During their stay at home, both groups of patients communicated and provided feedback to physicians through internet platforms from time to time. Both groups received exercise rehabilitation treatment 3-5 times a week, with continuous intervention for 12 weeks. Cardiopulmonary exercise test indicators before and after cardiac rehabilitation were compared. Results There were no significant differences between the two groups in gender distribution, age, body mass index, left ventricular ejection fraction, low-density lipoprotein cholesterol level and the proportion of hypertension history, diabetes mellitus history and hyperlipidemia history(all P>0.05). There were no statistically significant differences in all indicators of cardiopulmonary exercise test before and after intervention in the control group(all P>0.05). After the intervention, the maximum metabolic equivalent, maximum exercise load, anaerobic threshold oxygen uptake and peak oxygen uptake in the observation group were higher than those in the control group［(6.6±1.1) vs (5.4±1.0), (136±33)W vs (119±27)W, (15.3±3.2)ml/(min·kg) vs (13.1±3.3)ml/(min·kg), (23±4)ml/(min·kg) vs (19±4)ml/(min·kg)］, with statistically significant differences(all P<0.05). Conclusions  sCardiac rehabilitation therapy can help improve the cardiopulmonary endurance and quality of life of patients after complete revascularization surgery for ACS, and the partial remote cardiac rehabilitation model has a more significant effect on cardiopulmonary function in the short term than the complete remote rehabilitation model.