康复宣教指导对心脏再同步化治疗患者体能、生存质量和心理状态的影响

发布时间：2018-06-28 08:07

本文选题：慢性心力衰竭 + 心脏再同步化治疗　；参考：《浙江大学》2016年硕士论文

【摘要】：目的我国心脏病防治仍停留在发达国家20世纪60年代水平,随着心脏病发病率的逐年上升,近10年来国内心脏康复也逐渐发展和完善,但最要还是集中在冠心病等慢性心血管内科疾病的康复,随着心血管介入医学的发展,心脏康复治疗也从传统的心血管内科的康复发展到心血管介人性治疗后康复,在国外有研究实践证明,康复运动治疗对于心血管介入术后,从生理、心理、社会等多种角度提高患者的生活质量,有极其重要的意义；在国内目前还没有关于心脏再同步化治疗(cardiac resynchronization therapy,CRT)术后康复的相关研究报道。因此,我们对探讨系统康复宣教、专业康复指导对CRT患者体能、生存质量和心理状态的影响做了相关研究。方法选取CRT患者58例,随机分为康复组(n=28)和对照组(n=30),康复组患者在相关临床治疗、护理宣教的基础上由康复医师进行系统宣教,在建立健康生活方式,改变不良生活习惯及体能、功能锻炼专业指导；对照组只进行常规临床相关治疗和护理宣教。比较两组患者CRT术后出院时,术后1个月、术后3个月和术后6个月门诊定期复诊和电话随访,在生活方式的转变,体能(6分钟步行测试、Borg指数)和生存质量、心理状态(SF-36健康调查量表中文版)的差异,以分析不同干预措施对患者的影响。结果CRT术后出院时,术后1个月、术后3个月和术后6个月的门诊定期复诊和电话随访评估中,康复组患者建立良好生活方式达标率更高,体能改善更为明显(6分钟步行试验、Borg指数)(P0.01),SF-36健康调查量表中文版中的躯体功能、一般健康状况、精力、情感职能和心理健康评分均显著改善,差异具有统计学意义(P0.01)。三者相辅相成,患者生活质量明显提高。结论①系统、专业的康复健康宣教学习对心脏在同步化治疗术后患者的干预后,提高慢性心力衰竭患者自我对疾病认识和保健意识,对危险因素的控制更加严格,积极建立健康的生活方式,养成良好的生活习惯和心理思维方式,提高CRT术后疗效；②康复运动指导,改变患者术后卧床休息的老观念,增强患者的活动意识,让患者早期参加活动,体能恢复更快,促进术后恢复,提高生活质量。③系统、专业的康复健康宣教学习对心脏在同步化治疗术后患者的干预后,患者的心理状况发生了变化,主要集中在生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能以及精神健康等8个方面发生了变化,生活质量明显提高。
[Abstract]:Objective the prevention and treatment of heart disease in China is still at the level of the developed countries in the 1960s. With the increase of the incidence of heart disease year by year, the heart rehabilitation in China has gradually developed and improved in the past 10 years. However, it is most important to focus on the rehabilitation of chronic cardiovascular diseases such as coronary heart disease. With the development of cardiovascular interventional medicine, cardiac rehabilitation treatment has also developed from the rehabilitation of traditional cardiovascular medicine to the rehabilitation of cardiovascular mediating humanity. Research practice in foreign countries has proved that rehabilitation exercise therapy is of great significance to improve the quality of life of patients from the aspects of physiology, psychology, society and so on. There are no reports on cardiac resynchronization after (cardiac resynchronization therapy in China. Therefore, we studied the effects of systematic rehabilitation education and professional rehabilitation guidance on the physical ability, quality of life and mental state of CRT patients. Methods Fifty-eight patients with CRT were randomly divided into two groups: rehabilitation group (n = 28) and control group (n = 30). Patients in rehabilitation group were given systematic education by rehabilitation doctors on the basis of related clinical treatment and nursing education, and healthy lifestyle was established. The patients in the control group were given routine clinical treatment and nursing education. To compare the two groups of CRT patients were discharged from hospital, 1 month, 3 months and 6 months after operation, regular follow-up and telephone follow-up, changes in lifestyle, physical fitness (6-minute walking test of Borg index) and quality of life (QOL) were compared between the two groups. Mental state (Chinese version of SF-36 Health Survey scale) to analyze the influence of different intervention measures on patients. Results at the time of discharge after CRT, the rate of establishing a good lifestyle was higher in the rehabilitation group than in the rehabilitation group during the regular follow-up and telephone follow-up at 1 month, 3 months and 6 months after CRT. The improvement of physical fitness (6-minute walking test Borg index) (P0.01) and the Chinese version of SF-36 health survey scale showed significant improvement in physical function, general health status, energy, emotional function and mental health score (P0.01), and the difference was statistically significant (P0.01). The three supplement each other, and the quality of life of the patients is obviously improved. Conclusion (1) systematic, professional rehabilitation and health education for patients with chronic heart failure after synchronous treatment can improve their self-awareness of the disease and health care, and control the risk factors more strictly. We should actively establish a healthy lifestyle, develop good habits of life and mental thinking, improve the curative effect of CRT and improve the rehabilitation exercise guidance, change the old concept of bed rest after CRT, and enhance the activity consciousness of the patients. Let the patients take part in the activities early, recover the physical ability faster, promote the postoperative recovery, improve the quality of life system. The psychological status of the patients has changed after the intervention of the professional rehabilitation health education and study to the patients after the synchronous treatment of the heart. It is mainly focused on 8 aspects, such as physiological function, body pain, general health condition, energy, social function, emotional function and mental health, and the quality of life has been improved obviously.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R473.5

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