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经导管主动脉瓣植入术后患者的多组分心脏康复:功能和心理认知恢复的预测因素

Multicomponent cardiac rehabilitation in patients after transcatheter aortic valve implantation: Predictors of functional and psychocognitive recovery.

作者信息

Eichler Sarah, Salzwedel Annett, Reibis Rona, Nothroff Jörg, Harnath Axel, Schikora Martin, Butter Christian, Wegscheider Karl, Völler Heinz

机构信息

1 Centre of Rehabilitation Research, University of Potsdam, Germany.

2 Cardiological Outpatient Clinic Am Park Sanssouci, Potsdam, Germany.

出版信息

Eur J Prev Cardiol. 2017 Feb;24(3):257-264. doi: 10.1177/2047487316679527. Epub 2016 Nov 16.

Abstract

Background In the last decade, transcatheter aortic valve implantation has become a promising treatment modality for patients with aortic stenosis and a high surgical risk. Little is known about influencing factors of function and quality of life during multicomponent cardiac rehabilitation. Methods From October 2013 to July 2015, patients with elective transcatheter aortic valve implantation and a subsequent inpatient cardiac rehabilitation were enrolled in the prospective cohort multicentre study. Frailty-Index (including cognition, nutrition, autonomy and mobility), Short Form-12 (SF-12), six-minute walk distance (6MWD) and maximum work load in bicycle ergometry were performed at admission and discharge of cardiac rehabilitation. The relation between patient characteristics and improvements in 6MWD, maximum work load or SF-12 scales were studied univariately and multivariately using regression models. Results One hundred and thirty-six patients (80.6 ± 5.0 years, 47.8% male) were enrolled. 6MWD and maximum work load increased by 56.3 ± 65.3 m ( p < 0.001) and 8.0 ± 14.9 watts ( p < 0.001), respectively. An improvement in SF-12 (physical 2.5 ± 8.7, p = 0.001, mental 3.4 ± 10.2, p = 0.003) could be observed. In multivariate analysis, age and higher education were significantly associated with a reduced 6MWD, whereas cognition and obesity showed a positive predictive value. Higher cognition, nutrition and autonomy positively influenced the physical scale of SF-12. Additionally, the baseline values of SF-12 had an inverse impact on the change during cardiac rehabilitation. Conclusions Cardiac rehabilitation can improve functional capacity as well as quality of life and reduce frailty in patients after transcatheter aortic valve implantation. An individually tailored therapy with special consideration of cognition and nutrition is needed to maintain autonomy and empower octogenarians in coping with challenges of everyday life.

摘要

背景 在过去十年中,经导管主动脉瓣植入术已成为主动脉瓣狭窄且手术风险高的患者一种有前景的治疗方式。关于多成分心脏康复期间功能和生活质量的影响因素知之甚少。方法 2013年10月至2015年7月,将择期经导管主动脉瓣植入术及随后进行住院心脏康复的患者纳入前瞻性队列多中心研究。在心脏康复入院和出院时进行衰弱指数(包括认知、营养、自主性和活动能力)、简明健康调查问卷12项量表(SF-12)、6分钟步行距离(6MWD)和自行车测力计最大工作量评估。使用回归模型单因素和多因素研究患者特征与6MWD、最大工作量或SF-12量表改善之间的关系。结果 共纳入136例患者(80.6±5.0岁,47.8%为男性)。6MWD和最大工作量分别增加了56.3±65.3米(p<0.001)和8.0±14.9瓦(p<0.001)。SF-12量表有改善(生理维度2.5±8.7,p=0.001,心理维度3.4±10.2,p=0.003)。多因素分析中,年龄和高等教育与6MWD降低显著相关,而认知和肥胖显示出正预测价值。更高的认知、营养和自主性对SF-12生理维度有积极影响。此外,SF-12的基线值对心脏康复期间的变化有反向影响。结论 心脏康复可改善经导管主动脉瓣植入术后患者的功能能力以及生活质量并减轻衰弱。需要进行个体化定制治疗,特别考虑认知和营养,以维持自主性并使八旬老人有能力应对日常生活挑战。

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