CAJ | 학술논문

目的：评估远程监护指导慢性心力衰竭患者康复训练的临床应用价值。方法将100例慢性心力衰竭患者随机分为试验组(50例)和对照组(50例),对照组在常规药物治疗的基础上于家中或社区实施康复训练；试验组在对照组的基础上根据心脏远程监护结果指导康复训练。试验组和对照组分别应用心脏远程监护和常规心电图检查检测心肌缺血,记录检出率,并比较两组患者治疗32 w 后的6 min 步行距离、生活质量评分和再入院率、死亡率。结果随访32 w,试验组发现无症状性心肌缺血34例,检出率为68%；对照组发现无症状性心肌缺血12例,检出率为26%,试验组检出率明显高于对照组(X2=3.581,P =0.023)；试验组在心脏远程监护指导下进行康复训练,出现胸闷、憋气、呼吸急促症状患者15例(30.0%),对照组出现胸闷、憋气、呼吸急促症状患者27例(54.0%),试验组明显少于对照组(X2=4.303,P =0.031)。康复训练治疗32 w 后,试验组与对照组比较,平均6 min 步行距离[(441.75±39.02)m 比(391.25±63.31)m,t =4.721,P =0.032]、生活质量评分(43.26±9.61比55.83±6.42,t =8.132,P =0.043)、再入院率(18%比32%,t =6.412,P =0.020),差异均有统计学意义,但死亡率差异无统计学意义(0比4%,P =0.893)。结论心脏远程监护指导慢性心力衰竭患者的康复训练能够增加康复训练的安全性,明显改善患者运动耐力,减少再入院,提高生活质量,具有较高的临床应用价值。
목적：평고원정감호지도만성심력쇠갈환자강복훈련적림상응용개치。방법장100례만성심력쇠갈환자수궤분위시험조(50례)화대조조(50례),대조조재상규약물치료적기출상우가중혹사구실시강복훈련；시험조재대조조적기출상근거심장원정감호결과지도강복훈련。시험조화대조조분별응용심장원정감호화상규심전도검사검측심기결혈,기록검출솔,병비교량조환자치료32 w 후적6 min 보행거리、생활질량평분화재입원솔、사망솔。결과수방32 w,시험조발현무증상성심기결혈34례,검출솔위68%；대조조발현무증상성심기결혈12례,검출솔위26%,시험조검출솔명현고우대조조(X2=3.581,P =0.023)；시험조재심장원정감호지도하진행강복훈련,출현흉민、별기、호흡급촉증상환자15례(30.0%),대조조출현흉민、별기、호흡급촉증상환자27례(54.0%),시험조명현소우대조조(X2=4.303,P =0.031)。강복훈련치료32 w 후,시험조여대조조비교,평균6 min 보행거리[(441.75±39.02)m 비(391.25±63.31)m,t =4.721,P =0.032]、생활질량평분(43.26±9.61비55.83±6.42,t =8.132,P =0.043)、재입원솔(18%비32%,t =6.412,P =0.020),차이균유통계학의의,단사망솔차이무통계학의의(0비4%,P =0.893)。결론심장원정감호지도만성심력쇠갈환자적강복훈련능구증가강복훈련적안전성,명현개선환자운동내력,감소재입원,제고생활질량,구유교고적림상응용개치。
Objective To explore the application value of cardiac remote monitoring in rehabilitation training with chronic heart failure patients. Methods A total of 100 chronic heart failure patients who came from Jinan luo-yuan, er-qi, and other eight communities from January 2011 to January 2012 were randomly divided into two groups, the experimental group ( n = 50, received usual exercise training) and the control group ( n = 50, received cardiac remote monitoring based on usual exercise training). Period of treatment was 32 weeks. The experimental group and the control group respectively applying cardiac remote monitoring and normal ECG examination to detect myocardial ischemia, and record the detection rate. The 6 minutes walking distance ( 6MWD), quality of life score, readmission and mortality rate were compared between the two groups after 32 weeks. Results During the follow-up period, the experimental group found 34 cases of asymptomatic myocardial ischemia, the detection rate was 68% , and the control group found 12 cases of asymptomatic myocardial ischemia, the detection rate was 26% (X2= 3. 581, P = 0. 023). There were 15 patients with symptoms of chest tightness, suffocation and shortness of breath in experimental group, and 27 patients in control group (30% vs. 54% , X2 = 4. 303, P = 0. 031). After 32 weeks of treatment, compared with control group, the 6MWD was significantly increased [(441. 75 ± 39. 02) m vs. (391. 25 ± 63. 31) m, t = 4. 721, P = 0. 032], quality of life score was significantly decreased (43. 26 ± 9. 61 vs. 55. 83 ± 6. 42, t = 8. 132, P = 0. 043) and readmission rate was significantly decreased (18% vs. 32% , t = 6. 412, P = 0. 020) in experimental group. There was no significant difference in mortality rate between the two groups (0 vs. 4% , P = 0. 893). Conclusions The guidance of remote monitoring can increase the security of rehabilitation training for the patients with chronic heart failure, and improve the exercise endurance, reduce readmission rate, improve the quality of life significantly, it has a high value in clinical application.