心脏康复：历史和近50年概况.ppt

1970 – 1980Establishment of outpatient cardiac rehabilitation program Patients referred 12-24 weeks post myocardial infarctionGraded exercise testing utilizedRisk stratification popularized In the 70s“For cardiac rehabilitation to be complete, it must include:1. Psychological rehabilitation2. Sociological rehabilitation3. Vocational rehabilitation 1970scardiac rehabilitation to includesecondary prevention CARDIAC REHABILITATION:Historical Perspectives and the Last Fifty YearsAdolfo B. Bellosillo, MDFACC, FSGC, FPCC, FPCP, FPCCPMakati Medical CenterMakati CityPhilippines Although the concept of cardiac rehabilitation as a means by which a person can be restored to an optimal physical, medical,physiological, social, emotional, sexual, vocational and economic status prior to a cardiovascular event may have gained momentum ONLY in the late 1950’s, As early as 250 years ago, Heberden already advocated physical activity for patients with angina claiming it to be beneficial. 1912Herrickdescription of the clinical characteristics of myocardial infarction. Mallorypathologic studies showingit would take 6 weeks for themyocardial tissue to form a firm scar 1933Lewis advocated 6-8 weeks of bed rest,the patient to be guarded day andnight, nursed and helped in every way to avoidvoluntary effort or movement. Activity as strenuous as climbing up a flight of stairswere deferred until after one year.Return to productive livingwas practically unknown. In the first half of the 1900s, the mainstays of treatment of  acute myocardial infarction: 1. Protracted bed rest 2. Prolonged hospitalization WHY? Physical activity would cause 1. Recurrence of MI 2. Ventricular aneurysm 3. Ventricular rupture 4. Serious arrhythmias 5. Sudden cardiac death 1930sRedwood, Rosing and Epstein: Physical activity 1. Decrease in HR 2. Decrease in systolic BP 3. Increase in O2 utilization 4. Increase in physical capaci