医院-社区-家庭一体化心脏康复模式改善射血分数保留型心力衰竭患者心肺功能的研究

目的探讨医院-社区-家庭一体化心脏康复模式对射血分数保留型心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者心肺功能的改善效果。方法选取本院2018年6月至2019年6月心内科收治的116例HFpEF患者,按随机数字表法分为对照组和观察组各58例。对照组患者予以常规慢性心力衰竭治疗与护理,观察组在此基础上采用医院-社区-家庭一体化心脏康复模式进行干预管理。比较两组患者康复前后心肺储备功能、6分钟步行距离(6MWT)、血清中N末端B型利钠肽原(NT-pro BNP)水平和肿瘤坏死因子α(TNF-α)、白介素-1β(IL-1β)、一氧化氮(NO)水平变化,评估康复效果。结果康复干预1年后,两组患者心肺运动实验指标peak VO2、VO2 AT以及6MWD水平均较康复干预前升高,且观察组高于对照组(P<0.05);两组患者心功能指标LAVI、NT-pro BNP以及炎性指标TNF-α、IL-1β均较干预前降低,且观察组低于对照组(P<0.05)。结论医院-社区-家庭一体化心脏康复模式较常规慢性心力衰竭治疗与护理更有利于HFPEF患者的心肺储备功能的恢复和患者炎症水平的降低,预后更好,值得临床推广。

Hospital-community-family integrated cardiac rehabilitation model improves cardiopulmonary function of patients with heart failure with ejection fraction retention

Objective To investigate the improvement effect of hospital-community-home integrated cardiac rehabilitation for cardiopulmonary function in patients with heart failure with preserved ejection fraction(HFpEF).Methods From June 2018 to June 2019,116 patients with HFpEF were randomly divided into a control group and an observation group,58 in each group.The control group was given routine treatment and nursing for chronic heart failure.The observation group was applied with hospital-community-home integrated cardiac rehabilitation model for intervention management on the basis of routine treatment and nursing of chronic heart failure.Cardiopulmonary reserve,6-minute walk distance(6MWT),levels of serum N-terminal pro-B-type natriuretic peptide(NT-proBNP),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and nitric oxide(NO)before and after rehabilitation were collected,and were compared between the two groups.Results After 1 year of rehabilitation intervention,the levels of peakVO2,VO2AT,and 6MWD in the two groups were higher than those before rehabilitation intervention,and the observation group was higher than the control group(P<0.05).LAVI,NT-proBNP,TNF-α,and IL-1βin the two groups were lower than those before intervention(P<0.05),and those in the observation group was lower than the control group(P<0.05).Conclusion Compared with routine treatment and nursing,the model is more beneficial to the recovery of cardiopulmonary reserve and the reduction of inflammatory level in patients with HFPEF.The patients have a better prognosis.It is worthy of clinical promotion.