摘要
目的探讨术前心脏康复(CR)护理干预在重症瓣膜病患者中应用的可行性和安全性,评估术前运动介导的心脏康复护理治疗对患者术后临床结局的影响。方法选取2017年1-12月入住南京大学医学院附属鼓楼医院心胸外科需行瓣膜成形或置换手术患者,根据重症瓣膜病(AVHD)诊断标准,选择患者年龄≥18周岁、左室射血分数(LVEF)<40%、需同期行室间隔穿孔修补、室壁瘤切除、外科房颤射频消融术的瓣膜病患者共108例。通过随机数法分为对照组和心脏康复护理干预组(CR组),两组患者瓣膜病变主要以二尖瓣和主动脉瓣病变为主,术前疾病治疗原则相同。对照组患者入院后按护理常规护理。观察组患者入院后采用6分钟步行实验(6MWT)评估,根据6MWT距离,对Ⅰ、Ⅱ级实施MOTO Med护理干预。频率1次/d,每次30 min,首次运动阻力为1 kg,根据个体情况适当调整。对Ⅲ、Ⅳ级实施运动训练和有氧训练,重点训练下肢肌群、腹肌、胸大肌,1次/d,每次20 min。结果两组患者术后住院天数、ICU滞留时间、机械通气时间未见明显差异。CR组患者术后早期LVEF值高于对照组[(42.5±6.2)vs.(31.0±4.5),P<0.001)],术后6MWT(P=0.009)、自理能力(Barthel评分)(P=0.001)CR组优于对照组。术后30 d两组患者生活质量差异无统计学意义(P>0.05)。结论术前心脏康复护理干预可有效提高重症瓣膜病患者术后早期的心功能,增加患者术后早期运动耐量,提高患者术后早期自理能力,帮助患者更好更快康复。
Objective To explore the feasibility and safety of preoperative cardiac rehabilitation (CR) nursing intervention in patients with severe valvular disease, and to evaluate the effect of preoperative exercise-mediated cardiac rehabilitation nursing on the clinical outcomes of patients after operation. Methods From January to December of 2017, 108 patients with advanced valvular heart disease (AVHD) admitted in Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School were selected based on the diagnostic standard for AVHD. The AVHD patients should not be younger than 18 years old, left ventricular ejection fraction (LVEF) less than 40%, and need repair of interventricular septal perforation, resection of ventricular aneurysm and radiofrequency ablation of surgical atrial fibrillation simultaneously. Random number method was used to divide the patients into control group and cardiac rehabilitation nursing intervention group (CR group). Mitral and aortic valve lesions were the main types of valvular lesions in the two groups, and the principles of preoperative treatment were the same. Patients in the control group received routine nursing after admission. The patients in the observation group were evaluated by 6 minute walking test (6MWT) after admission. According to the distance of 6MWT, MOTO Med nursing intervention was carried out in gradeⅠ andⅡ. Frequency was once a day, 30 minutes each time, the first movement resistance was 1 kg, and was adjusted appropriately according to the individual situation. Exercise training and aerobic training were carried out for gradeⅢ andⅣ, with emphasis on lower limb muscles, abdominal muscles and ectopectoralis once a day for 20 minutes each time. Results There was no significant difference in hospital stay, ICU stay time and mechanical ventilation time between the two groups (P>0.05). The LVEF value of CR group was significantly higher than that of control group at the early stage after operation[(42.
作者
苏云艳
刘亮
刘春
班佳佳
蔡美玲
周申杰
熊剑秋
Su Yunyan;Liu Liang;Liu Chun;Ban Jiajia;Cai Meiling;Zhou Shenjie;Xiong Jianqiu(Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital , the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China;Department of Rehabilitation Medicine, Drum Tower Hospital Affiliated to Medical College of Nanjing University , Nanjing 210008, China)
出处
《中华现代护理杂志》
2019年第18期2324-2327,共4页
Chinese Journal of Modern Nursing
关键词
重症心脏瓣膜病
心功能
生活质量
术前心脏康复护理
Advanced valvular heart disease
Cardiac function
Quality of life
Preoperative cardiac rehabilitation nursing
