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心脏康复对心肺运动阳性的高原非阻塞性冠状动脉疾病患者症状和生活质量的影响

Effects of Cardiac Rehabilitation on Symptoms and Quality of Life in Cardiopulmonary Exercise Test-Positive Patients With Non-Obstructive Coronary Artery Disease From High Altitudes

  • 摘要:
    目的 评估心脏康复对心肺运动试验阳性的高原非阻塞性冠状动脉疾病患者症状和生活质量的影响。
    方法 通过随机对照方法,选取高原怀疑冠心病住院患者进行冠脉造影检查。根据检查结果,对非阻塞性冠状动脉疾病患者进行心肺运动试验评估,将结果为阳性的患者纳入。心肺运动试验阳性患者根据数字表、完全随机被分为两组:一组(试验组)接受心脏康复(个体化制定运动方案)+常规治疗,另一组(对照组)只接受常规治疗,在入组时和随访3个月时进行西雅图心绞痛量表(Seattle Angina Questionnaire, SAQ)和36条简明健康状况(36-item Short-Form Health Survey, SF-36)调查表评分。通过分析两组数据,评估心脏康复对心肺运动试验阳性的高原非阻塞性冠状动脉疾病患者症状和生活质量的影响。
    结果 本研究共纳入100例患者,试验组和对照组各为50例。试验组平均年龄(55.0±6.8)岁,对照组平均年龄(56.6±9.1)岁。入组时,两组在SAQ各指标上的差异均无统计学意义。然而,在3个月随访时,试验组在躯体活动受限程度(75.6±5.0 vs. 72.1±5.9)、心绞痛稳定状态(69.6±6.4 vs. 62.5±9.6)、心绞痛发作情况(70.8±9.1 vs. 65.3±9.3)、治疗满意程度(79.5±5. 0vs. 76.3±4.7)和疾病认识程度(84.9±5.2 vs. 80.4±3.8)方面的评分高于对照组(P<0.05)。入组时,两组在SF-36各指标上的差异均无统计学意义。然而,在3个月随访时,试验组在生理功能(27.4±2.4 vs. 25.8±3.0)、生理职能(6.6±1.2 vs. 6.0±0.8)、躯体疼痛(4.7±1.3 vs. 4.1±1.0)、一般健康状况(20.2±2.2 vs. 19.0±1.8)、精力(15.8±2.1 vs. 14.5±2.1)、社会功能(7.2±1.3 vs. 6.4±1.1)、情感职能(5.2±1.1 vs. 4.7±1.2)和精神健康(22.9±2.7 vs. 20.8±2.1)评分方面均优于对照组(P<0.05)。
    结论 心脏康复有利于改善心肺运动试验阳性的高原非阻塞性冠状动脉疾病患者症状和提高生活质量,康复期间患者均未发生不良心血管事件,其安全性和有效性得到初步验证。

     

    Abstract:
    Objective To assess the effect of cardiac rehabilitation on symptoms and quality of life in patients with coronary artery disease (Non-obCAD) living at high altitudes who have positive results for cardiopulmonary exercise testing.
    Methods A randomized controlled study was conducted. Hospitalized patients with suspected coronary heart disease were enrolled for coronary angiography. Based on the angiography findings, patients with Non-obCAD underwent cardiopulmonary exercise testing, and those with positive results were included in the study. With a random number table, patients with positive results for cardiopulmonary exercise testing were assigned to two groups, an experimental group receiving cardiac rehabilitation (individualized exercise plan) plus standard treatment and a control group receiving standard treatment alone. At enrollment and the 3-months follow-up, Seattle Angina Questionnaire (SAQ) and the 36-item Short-Form Health Survey (SF-36) were used to evaluate the patients. The data of the two groups were analyzed and compared to evaluate the effect of cardiac rehabilitation on the symptoms and quality of life in Non-obCAD patients living at high altitudes who have positive results for cardiopulmonary exercise testing.
    Results A total of 100 patients were included in the study, with 50 patients in the experimental group and 50 in the control group. The mean age in the experimental group was (55.0±6.8) years, while that in the control group was (56.6±9.1) years. Notably, at the time of enrollment, no significant differences were found between the two groups across all the SAQ measures. However, after 3 months of follow-up, the experimental group scored higher than the control group did in terms of physical limitation (75.6±5.0 vs. 72.1±5.9), angina stability (69.6±6.4 vs. 62.5±9.6), angina frequency (70.8±9.1 vs. 65.3±9.3), treatment satisfaction (79.5±5.0 vs. 76.3±4.7), and disease perception (84.9±5.2 vs. 80.4±3.8), with statistically significant differences between the two groups (P<0.05). At the time of enrollment, the two groups showed no significant differences in any of the SF-36 measures. However, at the 3-month follow-up, the experimental group had better scores than the control group did in physiological functioning (27.4±2.4 vs. 25.8±3.0), role—physical (6.6±1.2 vs. 6.0±0.8), bodily pain (4.7±1.3 vs. 4.1±1.0), general health (20.2±2.2 vs. 19.0±1.8), vitality (15.8±2.1 vs. 14.5±2.1), social functioning (7.2±1.3 vs. 6.4±1.1), role—emotional (5.2±1.1 vs. 4.7±1.2), and mental health (22.9±2.7 vs. 20.8±2.1) (P<0.05).
    Conclusion Cardiac rehabilitation is conducive to improvements in symptom and quality of life in Non-obCAD patients in high altitude areas with positive results for cardiopulmonary exercise testing. No adverse cardiovascular events occurred during the rehabilitation period, which validates preliminarily the safety and efficacy of cardiac rehabilitation in this patient population.

     

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