Bjarnason-Wehrens Birna, Benesch Lothar, Bischoff Karl Otto, Buran-Kilian Brigitte, Gysan Detlef, Hollenstein Ulrich, Mayer-Berger Wolfgang, McCabe Mike, Wilkniss Rolf, Sauer Gregor
Institut für Kreislaufforschung und Sportmedizin, Deutsche Sporthochschule, Cologne, Germany.
Herz. 2003 Aug;28(5):404-12. doi: 10.1007/s00059-003-2433-8.
In Germany, phase II cardiac rehabilitation has always been carried out on an inpatient basis. Meanwhile, the governmental health authorities are demanding more flexible solutions for cardiac rehabilitation. The objective of this study is to examine the effects of phase II cardiac rehabilitation performed on an outpatient basis (OCR) in a larger patient cohort. These are the first results of patients before and directly after the OCR performed at six different rehabilitation centers.
The study group consisted of 479 men and 74 women, 56.1 +/- 11.5 years. Cardiovascular indications for the OCR were myocardial infarction in 219 cases, coronary artery disease (CAD) in 92, in 84 cases with invasive procedures, coronary artery bypass graft in 185, cardiac valve surgery in 26, and other cardiac diseases in 29. 70% of the patients were worker, 25% without professional training. Staying with the family (42%) and aversion to stationary programs (61%)were the main reasons for the choice of OCR. Without OCR,27.4% would have refused any rehabilitation program.
Maximal physical performance increased from 97.8 + - 31.4 to 120.4 +/- 37.3 W (p < 0.001). LDL cholesterol was reduced from 145.9 +/- 42.7 to 117.5 +/- 34.7 mg% (p < 0.001), triglycerides from 203.3 +/- 136.0 to 161.9 +/- 91.6 mg% (p < ).010), HDL cholesterol increased from 39.8 + 11.2 to 41.0 +/- 11.3 mg% (p = 0.003). The use of lipid-lowering therapy in CAD patients increased from 63.1% to 80.7%. A reduction in body mass index from 27.1 +/- 3.6 to 26.9 +/- 3.5 kg/m2 (p = 0.010) was demonstrated. The number of active smokers decreased from 53.8% to 25.6%.
The results obtained are interesting with respect to the patients' social status. With 70% general laborers, our cohort is in contrast to previously published OCR data. On the whole, these results demonstrate that rehabilitative measures can also be implemented on an outpatient basis, without a decrease in the quality of treatment. This also applies to patients who represent lower socioeconomic levels. The results should motivate to work harder and more sufficiently on the development of more flexible cardiac rehabilitation programs.
在德国，心脏康复二期一直是在住院基础上开展的。与此同时，政府卫生当局要求提供更灵活的心脏康复解决方案。本研究的目的是在更大的患者队列中检验门诊心脏康复（OCR）的效果。这些是在六个不同康复中心进行OCR之前及之后直接对患者进行观察得到的首批结果。
研究组包括479名男性和74名女性，年龄56.1±11.5岁。进行OCR的心血管适应症包括：219例心肌梗死，92例冠状动脉疾病（CAD），84例接受侵入性手术，185例冠状动脉搭桥术，26例心脏瓣膜手术，以及29例其他心脏疾病。70%的患者为工人，25%未接受过专业培训。与家人同住（42%）和不愿参加住院项目（61%）是选择OCR的主要原因。若不进行OCR，27.4%的患者会拒绝任何康复项目。
最大体力活动能力从97.8±31.4瓦增加至120.4±37.3瓦（p<0.001）。低密度脂蛋白胆固醇从145.9±42.7毫克%降至117.5±34.7毫克%（p<0.001），甘油三酯从203.3±136.0毫克%降至161.9±91.6毫克%（p<0.010），高密度脂蛋白胆固醇从39.8±11.2毫克%增至41.0±11.3毫克%（p = 0.003）。CAD患者中降脂治疗的使用率从63.1%增至80.7%。体重指数从27.1±3.6千克/平方米降至26.9±3.5千克/平方米（p = 0.010）。现吸烟者数量从53.8%降至25.6%。
就患者的社会地位而言，所获得的结果很有意思。我们的队列中有70%是普通劳动者，这与之前发表的OCR数据不同。总体而言，这些结果表明康复措施也可以在门诊基础上实施，而不会降低治疗质量。这也适用于社会经济水平较低的患者。这些结果应促使人们更加努力且充分地去开发更灵活的心脏康复项目。
