多学科协作下的阶段性康复训练对置入起搏器患者术后心功能的影响

doi:10.3760/cma.j.issn.1007-1245.2024.14.010

摘要/Abstract

摘要：

目的　探索多学科协作下的阶段性康复训练对置入起搏器患者术后心功能的影响。方法　选取2020年1月至2022年12月期间咸阳市中心医院收治的98例起搏器置入患者。根据入院顺序分为试验组（49例）和对照组（49例）。试验组男25例，女24例，年龄（60.52±7.21）岁，起搏器置入类型：单腔起搏器20例，双腔起搏器29例。对照组男26例，女23例，年龄（60.78±7.09）岁，起搏器置入类型：单腔起搏器21例，双腔起搏器28例。对照组术后接受常规护理，试验组在此基础上进行多学科协作下的阶段性康复训练。两组均干预至术后3个月。通过运动耐力（6 min步行距离）、心功能［N端前脑钠肽（NT-proBNP）和左心室射血分数（LVEF）］、上肢活动能力、并发症（出血、感染、肩关节疼痛、电极脱位）、舒适度［简化舒适状况量表（GCQ）评分］等指标评估干预效果。统计学方法使用独立样本t检验、χ²检验。结果　干预后，试验组6 min步行距离为（290.14±34.16）m，长于对照组（138.75±14.34）m，NT-proBNP水平为（262.11±68.12）ng/L，低于对照组（398.93±76.69）ng/L，LVEF水平为（69.82±4.73）%，高于对照组（52.53±5.44）%，差异均有统计学意义（t=28.604、9.337、16.789，均P<0.05）。术后3个月，试验组的内收、外展、前屈和后伸的活动度为（18.27±6.02）°、（52.67±10.33）°、（64.37±7.14）°、（22.78±3.96）°，高于对照组（12.78±5.39）°、（45.34±9.33）°、（51.36±6.93）°、（18.61±3.78）°，差异均有统计学意义（t=4.756、3.686、9.153、5.332，均P<0.05）。试验组的并发症发生率为4.08%（2/49），低于对照组的16.33%（8/49），差异有统计学意义（χ²=4.009，P=0.045）。干预后，试验组GCQ评分中的环境、生理、社会文化、心理精神评分为（3.72±0.67）、（3.24±0.53）、（3.90±0.42）、（3.68±0.54）分，高于对照组（2.38±0.42）、（2.49±0.36）、（2.75±0.27）、（3.17±0.35）分，差异均有统计学意义（t=11.537、7.951、15.276、5.431，均P<0.05）。结论　多学科协作下的阶段性康复训练对置入起搏器患者术后有积极影响，能够改善患者的运动耐力、心功能、上肢活动能力，减少并发症发生，增强患者舒适度和日常生活自理能力，具有重要的临床应用价值。

关键词:

起搏器置入, 多学科协作, 阶段性康复训练, 运动耐力, 心功能, 上肢活动能力, 并发症, 舒适度, 自理能力

Abstract:

Objective　To explore the impact of phased rehabilitation training under multidisciplinary collaboration on cardiac function in patients after pacemaker implantation. Methods　A prospective study design was used, including 98 pacemaker implantation patients treated at Xianyang Central Hospital from January 2020 to December 2022. The patients were divided into an experimental group (49 cases) and a control group (49 cases) based on the admission order. In the experimental group, there were 25 males and 24 females, aged (60.52±7.21) years, and the type of pacemaker implantation was single-chamber pacemaker in 20 cases and dual-chamber pacemaker in 29 cases. In the control group, there were 26 males and 23 females, aged (60.78±7.09) years, and the type of pacemaker implantation was single-chamber pacemaker in 21 cases and dual-chamber pacemaker in 28 cases. The control group received routine postoperative care, and the experimental group underwent phased rehabilitation training under multidisciplinary collaboration on the basis. The intervention lasted until 3 months after surgery in both groups. The intervention effect was evaluated by exercise endurance (6 min walking distance), cardiac function [N-terminal pro-B-type natriuretic peptide (NT-proBNP) and left ventricular ejection fraction (LVEF)], upper limb mobility, complications (bleeding, infection, shoulder pain, and lead dislodgment), and comfort level [General Comfort Questionnaire (GCQ) score]. Independent sample t test and χ² test were used for statistical methods. Results　After intervention, the 6-min walking distance of the experimental group was (290.14±34.16) m, which was longer than that of the control group [(138.75±14.34) m], the level of NT-proBNP was (262.11±68.12) ng/L, which was lower than that of the control group [(398.93±76.69) ng/L], and the LVEF level was (69.82±4.73)%, which was higher than that of the control group [(52.53±5.44)%], with statistically significant differences (t=28.604, 9.337, and 16.789, all P<0.05). At 3 months after surgery, the ranges of motion in adduction, abduction, flexion, and extension in the experimental group were (18.27±6.02)°, (52.67±10.33)°, (64.37±7.14)°, and (22.78±3.96)°, which were greater than those in the control group [(12.78±5.39)°, (45.34±9.33)°, (51.36±6.93)°, and (18.61±3.78)°], with statistically significant differences (t=4.756, 3.686, 9.153, and 5.332, all P<0.05). The incidence of complications in the experimental group was 4.08% (2/49), which was lower than that in the control group [16.33% (8/49)], with a statistically significant difference (χ²=4.009, P=0.045). After intervention, the GCQ scores for environmental, physiological, sociocultural, and psychological dimensions of the experimental group were (3.72±0.67), (3.24±0.53), (3.90±0.42) and (3.68±0.54) points, which were higher than those of the control group [(2.38±0.42), (2.49±0.36), (2.75±0.27), and (3.17±0.35) points], with statistically significant differences (t=11.537, 7.951, 15.276, and 5.431, all P<0.05). Conclusion　Phased rehabilitation training under multidisciplinary collaboration has a positive impact on postoperative outcomes for patients with pacemakers, improving the exercise endurance, cardiac function, and upper limb mobility, and reducing the complications, thereby enhancing their comfort and daily self-care abilities, with significant clinical value.

Key words:

Pacemaker implantation, , Multidisciplinary collaboration, , Phased rehabilitation training, , Exercise endurance, , Cardiac function, , Upper limb mobility, , Complications, , Comfort, , Self-care ability

张博许岭平封琳李小花.

多学科协作下的阶段性康复训练对置入起搏器患者术后心功能的影响 [J]. 国际医药卫生导报, 2024, 30(14): 2332-2337.

Zhang Bo, Xu Lingping, Feng Lin, Li Xiaohua.

Effect of phased rehabilitation training under multidisciplinary collaboration on cardiac function in patients after pacemaker implantation [J]. International Medicine and Health Guidance News, 2024, 30(14): 2332-2337.

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