分级运动康复训练在慢性心力衰竭患者的临床应用效果

陈凌云; 秦琼; 王丽娟; 黄宇理

doi:10.16766/j.cnki.issn.1674-4152.002591

分级运动康复训练在慢性心力衰竭患者的临床应用效果

doi: 10.16766/j.cnki.issn.1674-4152.002591

1.
阜阳市第五人民医院心血管科，安徽阜阳 236000
2.
蚌埠医学院第一附属医院心血管科，安徽蚌埠 233004

基金项目:

安徽省教育厅人文社科重点项目 SK2020A0351

详细信息

通讯作者:
黄宇理, E-mail: 13956382692@163.com

中图分类号: R541.6 R493
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- 被引次数: 0
出版历程
- 收稿日期: 2021-07-16

Clinical application effect study of graded exercise rehabilitation training in patients with chronic heart failure

1.
Department of Cardiovascular Medicine, the Fifth People' s Hospital of Fuyang, Fuyang, Anhui 236000, China

摘要

摘要: 目的通过对慢性心力衰竭患者进行心功能分级，实施分级运动康复训练干预，探讨康复训练对慢性心力衰竭患者治疗总体疗效、心功能相关指标和生活质量水平的干预效果，为慢性心力衰竭患者制定安全有效的康复运动方案提供理论依据。方法选取2020年1—12月阜阳市第五人民医院心血管科收治的慢性心力衰竭患者72例，应用随机数字表法分为对照组和干预组各36例。对照组采用临床药物治疗，干预组在药物治疗的基础上增加分级运动康复训练。比较2组患者治疗前后总体疗效、心功能相关指标和生活质量水平变化情况。结果对照组患者总有效率为61.11%，干预组为94.44%，干预组总有效率高于对照组，差异有统计学意义(χ²=11.571，P=0.001)。对于心功能Ⅱ级和Ⅲ级患者，干预组LVEF分别为(49.97±6.12)%和(47.83±5.33)%，均优于对照组的(43.41±5.22)%和(41.17±5.08)%；6MWT距离分别为(402.57±69.13)m和(388.48±67.56)m，均优于对照组的(338.11±64.56)m和(332.82±62.31)m；BNP值分别为(215.33±48.72)pg/mL和(376.17±54.47)pg/mL，均低于对照组的(314.43±51.52)pg/mL和(474.92±58.49)pg/mL(均P < 0.05)；生活质量总分分别为(43.02±12.48)分和(45.64±13.20)分，均低于对照组的(55.96±12.11)分和(60.72±12.78)分，差异均有统计学意义(均P < 0.05)。结论分级运动康复训练在慢性心力衰竭患者的临床应用中，能提高总体疗效，改善心功能，提升生活质量水平，是慢性心衰患者二级预防的重要措施，值得推广应用。
- 慢性心力衰竭 /
- 分级运动康复 /
- 心功能
Abstract: Objective Through grading the cardiac function of patients with chronic heart failure, implementation of graded exercise rehabilitation training intervention, to explore the intervention effect of rehabilitation training on the overall therapeutic effect, cardiac function related indexes and life quality level of patients with chronic heart failure, so as to provide theoretical basis for developing safe and effective rehabilitation exercise plan for patients with chronic heart failure. Methods A total of 72 patients with chronic heart failure who came from the Department of Cardiovascular Medicine, the Fifth People' s Hospital of Fuyang from Jan. 2020 to Dec. 2020 were selected. They were divided into control group and intervention group with 36 cases each using the random number table method. The control group was treated with routine drugs, and the intervention group received exercise rehabilitation training on the basis of drug treatment. The overall efficacy, cardiac function indicators and quality of life were compared between the two groups before and after treatment. Results The total effective rate in the intervention group (94.44%) was higher than that in the control group (61.11%), and the difference was statistically significant (χ²=11.571, P=0.001). For patients with grade Ⅱ and Ⅲ cardiac function, the LVEF in the intervention group was (49.97±6.12)% and (47.83±5.33)%, which were better than those in the control group [(43.41±5.22)% and (41.17±5.08)%]; the 6MWT distance were [(402.57±69.13) m and (388.48±67.56) m, which were both better than the control group [(338.11±64.56) m and (332.82±62.31) m]; BNP values were [(215.33±48.72) pg/mL and (376.17±54.47) pg/mL], respectively, which were both lower than the control group [(314.43±51.52) pg/mL and (474.92±58.49) pg/mL, all P < 0.05]; the total quality of life scores were (43.02±12.48) points and (45.64±13.20) points, respectively, which were lower than those of the control group [(55.96±12.11) points and (60.72±12.78) points], and the differences were statistically significant (all P < 0.05). Conclusion Clinical application of graded exercise rehabilitation training in patients with chronic heart failure can improve overall efficacy, improve cardiac function and promote the quality of life. It is an important measure for secondary prevention of patients with chronic heart failure so it is deserved to be applied.
- Chronic cardiac failure /
- Graded exercise rehabilitation /
- Cardiac function
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表 1 2组CHF患者一般资料比较(x±s)

Table 1. Comparison of general data of CHF patients between the two groups(x±s)

组别	例数	性别(例)		年龄 (x±s，岁)	心功能分级(例)		BMI (x±s)	收缩压 (x±s，mm Hg)	舒张压 (x±s，mm Hg)	心率 (x±s，次/min)	病程(例)
组别	例数	男性	女性	年龄 (x±s，岁)	Ⅱ级	Ⅲ级	BMI (x±s)	收缩压 (x±s，mm Hg)	舒张压 (x±s，mm Hg)	心率 (x±s，次/min)	< 1年	1~5年	>5年
对照组	36	16	20	73.58±7.24	14	22	25.21±3.24	138.24±18.69	84.57±12.66	83.45±12.03	10	18	8
干预组	36	19	17	74.08±6.96	15	21	24.78±3.56	136.62±18.35	85.13±13.91	82.13±11.28	12	15	9
统计量		0.500^a		0.299^b	0.058^a		0.536^b	0.371^b	0.179^b	0.480^b	1.032^c
P值		0.479		0.766	0.810		0.594	0.712	0.859	0.633	0.302
注：^a为χ²值，^b为t值，^c为Z值。1 mm Hg=0.133 kPa。

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表 2 2组CHF患者临床总有效率比较

Table 2. Comparison of total clinical effective rate between two groups of CHF patients

组别	心功能分级	例数	显效(例)	有效(例)	无效(例)	总有效率(%)
对照组	Ⅱ级	14	3	6	5	64.29
	Ⅲ级	22	5	8	9	59.09
干预组	Ⅱ级	15	7	8	0	100.00
	Ⅲ级	21	8	11	2	90.48
注：2组心功能Ⅱ级患者总有效率比较，采用Fisher精确检验，P=0.017；2组心功能Ⅲ级患者总有效率比较，χ²=5.559，P=0.018。

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表 3 2组CHF患者心功能指标比较(x±s)

Table 3. Comparison of cardiac function indexes between two groups of CHF patients(x±s)

组别	心功能分级	例数	LVEDD(mm)		LVEF(%)		BNP(pg/mL)		6MWT(m)
组别	心功能分级	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	Ⅱ级	14	59.15±6.74	57.94±6.48	38.72±4.63	43.41±5.22^a	523.72±65.46	314.43±51.52^a	326.85±58.42	338.11±64.56
干预组	Ⅱ级	15	59.36±6.67	56.14±5.97	38.68±4.37	49.97±6.12^a	546.14±68.12	215.33±48.72^a	325.73±57.58	402.57±69.13^a
t值			0.084	0.778	0.024	3.094	0.901	5.324	0.052	2.588
P值			0.933	0.443	0.981	0.005	0.375	< 0.001	0.958	0.015
对照组	Ⅲ级	22	61.42±6.97	60.12±6.33	36.53±4.16	41.17±5.08^a	755.43±79.58	474.92±58.49^a	321.71±58.74	332.82±62.31
干预组	Ⅲ级	21	61.22±6.75	59.77±6.09	36.74±4.24	47.83±5.33^a	738.57±75.34	376.17±54.47^a	320.16±59.13	388.48±67.56^a
t值			0.095	0.184	0.163	4.195	0.712	5.722	0.086	2.810
P值			0.924	0.854	0.870	0.001	0.481	< 0.001	0.931	0.007
注：与同组干预前比较，^aP < 0.01。

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表 4 2组CHF患者生活质量比较(x±s, 分)

Table 4. Comparison of quality of life between two groups of CHF patients (x±s, scores)

组别	心功能分级	例数	身体领域		情绪领域		其他		生活质量总分
组别	心功能分级	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	Ⅱ级	14	27.57±4.06	25.66±3.84	9.67±3.16	9.15±3.07	21.54±4.19	21.15±3.68	58.78±12.28	55.96±12.11
干预组	Ⅱ级	15	27.82±4.13	20.77±2.98^a	9.75±4.14	5.79±2.61^a	21.76±4.21	16.46±3.14^a	59.33±12.65	43.02±12.48^a
t值			0.164	3.846	0.058	3.183	0.141	3.700	0.118	2.830
P值			0.870	< 0.001	0.954	0.004	0.889	0.001	0.906	0.009
对照组	Ⅲ级	22	28.93±4.22	27.16±4.55	11.97±4.37	10.54±3.15	23.69±4.81	22.72±4.13	64.59±13.12	60.72±12.78
干预组	Ⅲ级	21	29.21±4.47	22.52±3.24^a	12.23±4.49	6.33±2.74^a	23.44±4.75	16.79±3.45^a	64.88±13.65	45.64±13.20^a
t值			0.211	3.835	0.192	4.666	0.171	5.097	0.071	3.806
P值			0.833	< 0.001	0.848	< 0.001	0.864	< 0.001	0.943	0.005
注：与同组干预前比较，^aP < 0.01。

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