冠状动脉搭桥术后心脏康复的经验：对健康和危险因素的影响。

Experience of cardiac rehabilitation after coronary artery surgery: effects on health and risk factors.

作者信息

Lindsay G M, Hanlon W P, Smith L N, Belcher P R

机构信息

University of Glasgow, Nursing and Midwifery School, Glasgow, UK.

出版信息

Int J Cardiol. 2003 Jan;87(1):67-73. doi: 10.1016/s0167-5273(02)00208-5.

DOI:10.1016/s0167-5273(02)00208-5

PMID:12468056

Abstract

OBJECTIVE

Cardiac rehabilitation (CR) programs are provided to support the recovery process following acute myocardial infarction and coronary artery bypass grafting (CABG). Attendance varies. We related attendance following CABG to severity of cardiac symptoms, general health status (Short Form-36) and prevalence of modifiable coronary artery disease (CAD) risk factors.

METHODS

209 patients due to undergo CABG were recruited and assessed preoperatively as well as at a mean of 16.4 months postoperatively. General health status was measured using the Short Form-36 questionnaire. Severity of cardiac symptoms was assessed on a visual analogue scale. Modifiable coronary artery disease risk factors (smoking, body mass index, hypertension and elevated cholesterol) and social deprivation index were noted.

RESULTS

There were ten early and three late deaths. Thirteen patients withdrew consent for investigation, therefore 183 were fully studied. Of these 65.0% completed a CR programme and 24.6% did not attend any programme; 10.4% partially completed (less than 50% of time) and were excluded from analysis. Nonattenders were more likely to be smokers (P=0.002), diabetic (P=0.028) and were more from socially deprived geographical areas (P=0.013), but the proportion of patients with BMI>25, BP>140/90 or cholesterol >5.0 mmol l(-1) were the same. There were no differences in age, preoperative NYHA score, number of grafts, angina recurrence (46 vs. 38%, P=0.35) or breathlessness (62 vs. 69%, P=0.40) between attenders and nonattenders. The severity scores of angina (2.7 vs. 3.2, P=0.286) and breathlessness (3.5 vs. 3.6; P=0.79) were no different. However, four of the eight health domains measured showed significantly better values for attenders than nonattenders; namely: general health (60 vs. 46%, P=0.001), physical function (64 vs. 51% P=0.01), role limitation physical (48 vs. 29%; P=0.02) and social function 74 vs. 62%, P=0.04).

CONCLUSIONS

This is the first report using SF 36 to evaluate benefits from attending CR. Higher general health scores (SF-36) were associated with attendance at CR although CAD risk factors and cardiac symptoms were not improved but this may be due to the long interval between assessments.

摘要

目的

提供心脏康复（CR）项目以支持急性心肌梗死和冠状动脉旁路移植术（CABG）后的恢复过程。参与率各不相同。我们将CABG后的参与情况与心脏症状的严重程度、总体健康状况（简短形式-36）以及可改变的冠状动脉疾病（CAD）危险因素的患病率相关联。

方法

招募209例计划接受CABG的患者，在术前以及术后平均16.4个月时进行评估。使用简短形式-36问卷测量总体健康状况。通过视觉模拟量表评估心脏症状的严重程度。记录可改变的冠状动脉疾病危险因素（吸烟、体重指数、高血压和胆固醇升高）以及社会剥夺指数。

结果

有10例早期死亡和3例晚期死亡。13例患者撤回调查同意书，因此对183例患者进行了全面研究。其中65.0%完成了CR项目，24.6%未参加任何项目；10.4%部分完成（时间少于50%）并被排除在分析之外。未参与者更可能是吸烟者（P = 0.002）、糖尿病患者（P = 0.028），并且更多来自社会贫困地区（P = 0.013），但体重指数>25、血压>140/90或胆固醇>5.0 mmol l(-1)的患者比例相同。参与者和未参与者在年龄、术前纽约心脏协会（NYHA）分级、移植血管数量、心绞痛复发（46%对38%，P = 0.35）或呼吸困难（62%对69%，P = 0.40）方面没有差异。心绞痛（2.7对3.2，P = 0.286）和呼吸困难（3.5对3.6；P = 0.79）的严重程度评分没有差异。然而，所测量的八个健康领域中的四个领域显示，参与者的值明显优于未参与者；即：总体健康（60%对46%，P = 0.001）、身体功能（64%对51%，P = 0.01）、身体角色限制（48%对29%；P = 0.02）和社会功能（74%对62%，P = 0.04）。