目的 研究影响冠状动脉粥样硬化性心脏病（冠心病）患者参与心脏康复意愿的因素及干预措施。方法 选取高州市人民医院 2021年1月—2022年3月收治的624例冠心病患者为研究对象,使用自行设计的调查问卷心脏康复参与意愿调查表及西雅图心绞痛量表对患者进行调查评估,分析冠心病患者心脏康复参与意愿现状及其影响因素。结果 624例冠心病患者中,162例愿意参加（25.96%）,126例希望参加（20.19%）,66例计划参加（10.58%）;单因素分析显示影响冠心病患者心脏康复参与意愿的因素主要包括社会支持、文化水平、娱乐活动、呼吸困难及心绞痛,社会支持方面,主观支持、客观支持、支持利用度得分分别为（2.32±0.41）（2.99±0.74）（2.58±0.95）分,组间比较差异有统计学意义（F=53.428,P<0.001）;文化水平方面,初中及以下、高中及中专、大专及以上得分分别为（2.35±0.18）（2.61±0.90）（3.09±0.63）分,组间比较差异有统计学意义（F=29.947,P<0.001）;娱乐活动方面,无、偏少、正常得分分别为（2.60±0.12）（2.88±0.29）（3.13±0.72）分,组间比较差异有统计学意义（F=44.903,P<0.001）;呼吸困难方面,≥1次/天、≥1次/周、<1次/月或无得分分别为（2.09±0.84）（2.31±0.70）（3.06±0.53）分,组间比较差异有统计学意义（F=116.082,P<0.001）;心绞痛方面,≥1次/天、≥1次/周、<1次/月或无得分分别为（2.51±0.33）（2.82±0.76）（3.15±0.87）分,组间比较差异有统计学意义（F=16.442,P<0.001）;多因素分析显示影响冠心病患者心脏康复参与意愿的独立影响因素主要包括文化程度、娱乐活动、呼吸困难及社会支持,结果有统计学意义（P<0.05）。结论 文化程度、娱乐活动、呼吸困难及社会支持等因素是导致冠心病患者心脏康复参与意愿较低的主要原因,临床上应对此予以重视,并采取康复教育、实施延续性护理、建立支持环境等措施,促使冠心病患者积极参与到心脏康复中,从而有效改善其预后。

Objective To study the factors and intervention measures that affect the willingness of coronary heart disease patients to participate in cardiac rehabilitation．Methods A total of 624 patients with coronary heart disease admitted to Gaozhou People's Hospital from January 2021 to March 2022 were selected as the research subjects．A self-designed survey questionnaire on willingness to participate in cardiac rehabilitation and the Seattle Angina Pectoris Scale were used to investigate and evaluate the patients．The current status and influencing factors of willingness to participate in cardiac rehabilitation in coronary heart disease patients were analyzed．Results Among 624 patients with coronary heart disease,162 were willing to participate（25.96%）,126 hoped to participate（20.19%）,and 66 planned to participate（10.58%）．Uunivariate analysis showed that the main factors affecting the willingness of coronary heart disease patients to participate in cardiac rehabilitation included social support,education level,entertainment activities,breathing difficulties,and angina．In terms of social support,subjective support,objective support,and support utilization scores were（2.32±0.41）points,（2.99±0.74）points,and（2.58±0.95）points,respectively,with statistically significant differences（F=53.428,P<0.001）．In terms of education level,the scores for middle school and below,high school and vocational school,college and above were（2.35±0.18）points,（2.61±0.90）points,and（3.09±0.63）points,respectively,with statistically significant differences（F=29.947,P<0.001）．In terms of entertainment activities,the scores for none,less and normal were（2.60±0.12）points,（2.88±0.29）points,and（3.13±0.72）points,respectively,with statistically significant differences（F=44.903,P<0.001）．In terms of breathing difficulties,the scores for ≥1 time/day,≥1 time/week,<1 time/month,or no were（2.09±0.84）points,（2.31±0.70）points,and（3.06±0.53）points,respectively,with statistical significance（F=116.082,P<0.001）．In terms of angina,the scores for ≥1 time/day,≥1 time/week,<1 time/month,or no were（2.51±0.33）points,（2.82±0.76）points,and（3.15±0.87）points,respectively,with statistical significance（F=16.442,P<0.001）．Multivariate analysis showed that the independent influencing factors on the willingness of coronary heart disease patients to participate in cardiac rehabilitation mainly include education level,entertainment activities,breathing difficulties,and social support,and the results were statistically significant（P<0.05）．Conclusions Education level,entertainment activities,breathing difficulties,and social support are the main reasons for the low willingness of coronary heart disease patients to participate in cardiac rehabilitation．Clinical attention should be paid to this and measures such as rehabilitation education,implementation of continuity of care,and establishment of a supportive environment should be taken to encourage coronary heart disease patients to actively participate in cardiac rehabilitation and effectively improve their prognosis．

目的 探索心脏康复干预对房颤合并高血压患者的血脂血压变化、运动耐量、心脏功能、肺功能等指标的影响。方法 选取房颤合并高血压患者96例,随机分为常规治疗组和心脏康复(CR)组,每组各48例患者。常规治疗组给予规范的药物治疗,CR组在规范药物治疗的基础上予运动干预6个月,对比治疗前后2组甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)水平,左心房直径(LA)、左心室射血分数(LVEF)、左心室舒张末内径(LVEDd),无氧阈值(AT)、峰值公斤摄氧量(PeakVO₂/kg)、峰值通气量(VEpeak)、每搏输出量(SV)、峰值氧脉搏(PeakO₂pluse),收缩压(SBP)与舒张压(DBP)变化情况,6分钟步行距离(6MWD),以及Borg劳累评估量表评分、焦虑自评量表(SAS)和抑郁自评量表(SDS)评分。结果 2组患者治疗6个月时,TC、TG、LDL-C水平以及SBP、DBP均下降(P<0.05),但2组之间比较,3项血脂指标无统计学差异(P>0.05),而CR组血压显著下降(P<0.05) 。2组患者治疗6个月时,LA、LVEDd减小(P<0.05),而LVEF无变化(P>0.05),CR组LA较常规治疗组缩小(P<0.05)。治疗6个月时,CR组AT、PeakVO₂/kg、VEpeak、SV和PeakO₂plus水平均升高(P<0.05),而常规治疗组的上述相关指标无明显变化(P>0.05)。治疗6个月时,2组患者6分钟步行距离均增加,CR组较常规组增加(P<0.05)。治疗6个月时,CR组Borg劳累评估量表评分、SAS评分及SDS评分均下降,而常规治疗组上述3项评分较治疗前无变化(P>0.05),与常规治疗组比较,CR组上述3项评分降低(P<0.05)。结论 以中等强度运动干预为主导的心脏康复治疗能够降低房颤合并高血压患者的血脂水平、控制血压状态、改善左心房及左心室结构重构,还可以增加该群体的运动耐力及心肺功能、减少消极情绪并提高生活质量。

Objective To evaluate the impact of cardiac rehabilitation on blood lipid level,blood pressure control,exercise endurance,cardiac function, quality of life and lung function in patients with hypertension and atrial fibrillation (AF). Methods This prospective cohort study enrolled 96 patients with AF and hypertension, who were randomly and evenly assigned to the conventional group and the cardiac rehabilitation (CR) group, both treated for at least 6 months. Research indicators included the levels of triglycerides (TG), total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C); left atrial diameter (LA), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDd), anaerobic threshold (AT), peak oxygen uptake volume per kilogram (PeakVO₂/kg), peak ventilation volume (VEpeak), stroke volume (SV), peak oxygen pulse (PeakO₂pluse), changes in blood pressure, 6 minutes walking distance, Borg Fatigue Scale score, Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores. Results At the 6th month of the treatment, the levels of TG, TC, LDL-C, systolic blood pressure (SBP), diastolic blood pressure (DBP) were significantly reduced (P<0.05) in both groups. However, there was no statistical difference among the three blood lipid indicators between the conventional group and the CR group after treatment (P>0.05). Blood pressure dropped significantly(P<0.05) in both groups, especially in the CR group. Meanwhile, after treatment, LA and LVEDd decreased significantly (P<0.05) in both groups, except LVEF. LA decreased significantly (P<0.05) in CR group, compared with conventional group. In addition, AT, PeakVO₂/kg, VEpeak, SV and PeakO₂pluse levels were significantly elevated (P<0.05) in CR group compared with the conventional group after the treatment. There was no significant difference (P>0.05) in the indicators above in the conventional group. Six minutes walking distance were significantly increased (P<0.05) in both groups at 6th month of treatment, compared with the conventional group, the CR group increased more (P<0.05). Borg Fatigue Scale score, SAS score and SDS score were significantly reduced (P<0.05) in CR group at 6th month of treatment, however, there was no statistical difference (P>0.05) in the conventional group compared with that before treatment. The scores above were significantly reduced (P<0.05) in CR group compared with the conventional group after the treatment. Conclusions Cardiac rehabilitation therapy dominated by moderate-intensity exercise intervention can reduce the blood lipid level of atrial fibrillation and hypertension patients, control the blood pressure, improve the left atrial and left ventricular structure reconstruction, increase the exercise endurance, improve cardiopulmonary function, reduce negative emotions and improve the quality of life.

目的 分析基于微信平台步行运动训练对慢性充血性心力衰竭(CHF)患者心脏康复水平的影响。方法 本次研究对象来源于梅州市中医医院一内科2020年11月—2021年12月住院的90例CHF患者,根据随机数字表法分组(每组n=45),对比组给予常规药物治疗,观察组在对比组基础上给予基于微信平台步行运动训练治疗,对比两组临床疗效、心脏功能指标、血清NT-proBNP、D-D、6分钟步行距离、日常生活能力评分、明尼苏达心力衰竭生活质量调查表(MLHFQ)评分。结果 观察组临床总有效率(95.56%)高于对比组(66.67%),观察组治疗后左心室舒张末期内径、左心室收缩末期内径均低于对比组,观察组治疗后左室射血分数高于对比组,观察组治疗后血清NT-proBNP、D-D均低于对比组,观察组治疗后6分钟步行距离、日常生活能力评分均高于对比组,观察组治疗后MLHFQ评分低于对比组,P＜0.05(差异均具有统计学意义)。结论 基于微信平台步行运动训练可有效改善CHF患者心功能,抑制NT-proBNP、D-D高表达,提高日常生活能力、生存质量。

Objective To analyze the effect of walking training through Wechat on cardiac rehabilitation of chronic congestive heart failure (CHF) patients. Methods A total of 90 patients with CHF hospitalized in the First Internal Medicine Department of Meizhou Traditional Chinese Medicine Hospital from November 2020 to December 2021 were enrolled in this study. They were divided into two groups according to the random number table method (45 patients in each group).The control group was given routine drug treatment,and the observation group was given walking training through Wechat on the basis of control group. The clinical efficacy,cardiac function indexes,serum NT-proBNP,D-D levels,6-minute walking distance,ability of daily life (ADL) score and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score were compared between two groups. Results The total clinical effective rate of the observation group (95.56%) was higher than that of the control group (66.67%),the LVEDd and LVESd of the observation group were lower than those of the control group after treatment,the LVEF of the observation group was higher than that of the control group after treatment,the serum NT-proBNP and D-D levels of the observation group were lower than those of the control group after treatment,the 6-minute walking distance and ADL score of the observation group were higher than those of the control group after treatment,and the MLHFQ score of the observation group was lower than that of the control group after treatment,P<0.05 (the difference was statistically significant).Conclusions Walking training by Wechat could effectively improve the cardiac function of CHF patients,inhibit the high expression of NT proBNP and D-D,and improve the ability of daily living and quality of life.

目的 探讨健康信念对心脏直视手术患者围术期心脏康复的影响。方法 选取我院2015年1月—2015年12月在全麻体外循环下行心脏直视手术患者 312例,按便利抽样法分为观察组159例和对照组153例。对照组按传统的心脏术后护理常规进行护理,观察组在对照组的基础上引入健康信念模式。比较两组患者心理健康状况、术后康复情况、护理满意度情况等。结果 观察组出院前一日SCL评分138.05±19.04,低于对照组155.84±21.27(t=7.1561,P<0.01);观察组拔除气管插管后24h、48h、72h疼痛评分分别为(2.25±1.22,1.98±0.67,1.24±0.57),低于对照组(3.28±1.01,2.71±0.98,1.87±0.86)(t值分别为6.003,7.652,7.597,P<0.01);观察组术后肺部并发症发生率2.52%低于对照组5.88%(χ²=4.550,P<0.05);观察组术后住院时间(10.93±5.58)d,短于对照组(15.79±5.24)d(t =7.933,P<0.01);观察组护理满意度97.48%,高于对照组90.84%(χ²=6.310,P<0.05)。结论 将健康信念模式用于心脏直视手术后患者,能够减轻患者术后不适症状,促进患者早日下床活动,降低肺部并发症的发生率,缩短术后住院时间,提高患者护理满意度。