冠心病患者PCI术后康复治疗意义探析.docVIP

冠心病患者PCI术后康复治疗意义探析【摘要】 目的 观察康复治疗对冠心病PCI术后患者生理、心理恢复的影响。方法 平均将64例PCI术后患者随机分为两组:康复治疗组、对照组。观察术后2周及3个月时两组6 min步行试验时的距离及心绞痛诱发情况。同时调查患者的生活质量满意度。并作统计学分析。结果 两组间6 min步行试验距离、满意度均有显著差异,诱发心绞痛的情况也有不同。结论 康复治疗有助于进一步提高生活质量及运动耐量、减少心绞痛的发生。? 【关键词】 经皮冠状动脉介入治疗;冠心病;康复?? Effects of rehabilitation training on the patients with coronary heart disease after percutaneous coronary intervention ZHANG Zhi-yong. Department of Cardiology, Su Qian People?s Hospital affiliated to Nanjing Drum Tower Hospital Group, Jiang Su 223800,China 【Abstract】 ObjectiveTo observe the effects of rehabilitation training on physical and psychological recovery in patients with coronary heart disease after percutaneous coronary intervention(PCI). Methods64 cases of coronary heart disease after PCI were given routine medical treatment and divided randomly into a rehabilitation training group(32 cases)and a control group (32 cases).The distance during 6-minute walking test(6-MWT) was observed after 2 weeks and 3 months for statistical analysis, as well as the incidence of angina episodes and satisfaction of patients for quality of life were observed.ResultsThe results showed that rehabilitation training could not only prolong the patient?s distance during 6-minute walking test, but also improve satisfaction for the quality of life (P0.05),具有可比性。所有患者术前常规检查肝、肾功能,血糖、血脂、PT、APTT,超声检查评价心脏功能无异常。对照组在PCI术后常规药物治疗的基础上采取常规护理及指导,康复治疗组在PCI术后常规药物治疗的基础上进行康复治疗,内容包括康复运动和健康教育。康复运动方案依据年龄、心肺功能,参照美国心脏病学会制定的冠状动脉的特征制定。一般包括三个阶段:第一阶段:早期康复(术后3天内)。根据穿刺动脉不同,患者的制动有所不同。穿刺股动脉的患者通常术后3 h～4 h拔动脉鞘管,局部压迫止血后,术侧下肢制动3 h~1 2 h,12 h后主动翻身。1 2 h~24 h内指导患者侧身或屈曲。轻度的伸缩及间歇半卧位,术后12 h～24 h 患者可下床自由活动。采取桡动脉途径介入治疗的患者,术后即刻拔出鞘管,局部加压包扎,2~3小时后松解压力,观察是否出血,如无出血,3 h～4 h 后去掉压迫带,可不限制活动。介入治疗后早期康复运动前3天以低强度为主:缓慢步行,每次5～10 min。靶心率小于症状限制性心率的50%,以间歇运动为主。维持运动强度1.2 METs～2.0 METs。第二阶段:中期康复(通常从出院或介入治疗后的3 d～4 d)开始,进行有节律的低强度运动,根据冠心病的血管病变类型不同运动量有所不同,开始在室内、走廊内步行,距离由25 m逐步增加至800 m,间断或持续完成,每天2次。逐步过渡到步行或慢速上下楼梯,每次5～10 min,每天3～4次,靶心率约为症状限制性心率的50%。如果患者感觉到胸闷或胸痛等症状,应立刻停止运动。可缓慢地进行上下肢活动和转体运动