作者：桂沛君，吴坚，史昊楠，张勃，吴春薇，陈宸，谢瑛

单位：

100050北京市，首都医科大学附属北京友谊医院康复医学科

Units：

Department of Rehabilitation Medicine, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing 100050,China

关键词：

心肌梗死；心脏康复；干预时机；影响因素分析

Keywords：

Myocardial infarction; Cardiac rehabilitation; Intervention timing; Root cause analysis

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.191

Funds：

北京市优秀人才培养资助项目（2018000021469G204）；北京市医院管理局“青苗”计划专项（QML20200109）

摘要：

目的　分析急性心肌梗死（AMI）患者经皮冠状动脉介入治疗（PCI）后急性期心脏康复干预时机及其影响因素。方法　于首都医科大学附属北京友谊医院心血管中心CBD-Bank数据库选取2017年5月至2019年12月PCI后接受心脏康复的AMI患者409例。以PCI后即刻至急性期心脏康复开始时间为3 d作为截点，将所有患者分为早期心脏康复组（PCI后即刻至心脏康复开始时间≤3 d，n=252）和延迟心脏康复组（PCI后即刻至心脏康复开始时间＞3 d，n=157）。比较两组患者临床资料、住院期间主要不良心血管事件（MACE）发生情况、出院前6 min步行试验情况（完成情况及6 min步行距离）、恢复期心脏康复干预情况及出院后1年因急性冠脉综合征（ACS）再住院率、戒烟率。AMI患者PCI后急性期心脏康复干预时机的影响因素分析采用多因素Logistic回归分析。结果　本组患者PCI后即刻距心脏康复开始时间≤3 d者252例，占61.61%。早期心脏康复组患者腹型肥胖者占比高于延迟心脏康复组，ST段抬高型心肌梗死、行急诊PCI者占比低于延迟心脏康复组（P ＜0.05）。多因素Logistic回归分析结果显示，腹型肥胖〔OR =1.783，95%CI （1.123，2.832）〕、心肌梗死类型〔OR =0.490，95%CI （0.269，0.891）〕及PCI类型〔OR =0.240，95%CI （0.137，0.421）〕是AMI患者PCI后急性期心脏康复干预时机的独立影响因素（P ＜0.05）。早期心脏康复组患者心源性死亡率及恶性心律失常发生率低于延迟心脏康复组，出院前6 min步行距离长于延迟心脏康复组（P ＜0.05）；早期心脏康复组ST段抬高型心肌梗死患者出院前6 min步行距离长于延迟康复组ST段抬高型心肌梗死患者（P ＜0.05）。结论　AMI患者PCI后行早期心脏康复者占61.61%。早期心脏康复能有效改善AMI患者PCI后心肺耐量，尤其是ST段抬高型心肌梗死患者。腹型肥胖、心肌梗死类型及PCI类型是AMI患者PCI后急性期心脏康复干预时机的独立影响因素，其中腹型肥胖、行择期PCI的AMI患者及非ST段抬高型心肌梗死患者更有可能参与早期心脏康复。

Abstract：

Objective　To analyze the intervention timing and influencing factors of cardiac rehabilitation duringthe acute phase in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) . Methods　A total of 409 AMI patients receiving cardiac rehabilitation after PCI from May 2017 to December 2019 were selected from theCBD-Bank database of Capital Medical University Affiliated Beijing Friendship Hospital. The 3 d of time from immediatelyafter PCI to the start of cardiac rehabilitation during the acute phase was as the cut-off point, all patients were divided intoearly cardiac rehabilitation group (the time from immediately after PCI to the start of cardiac rehabilitation ≤ 3 d, n=252) anddelayed cardiac rehabilitation group (the time from immediately after PCI to the start of cardiac rehabilitation > 3 d, n=157) . Theclinical data, incidence of major adverse cardiovascular events (MACE) during hospitalization, 6 min walking test before discharge(completion and 6 min walking distance) , cardiac rehabilitation intervention during recovery period, rehospitalization rate due toacute coronary syndrome (ACS) and smoking cessation rate 1 year after discharge were compared between the two groups. Theinfluencing factors of cardiac rehabilitation during the acute phase in patients with AMI after PCI was analyzed by multivariateLogistic regression analysis. Results　In this group, the time from immediately after PCI to the start of cardiac rehabilitation ≤3 d was 252 patients (61.61%) . The proportion of patients with abdominal obesity in the early cardiac rehabilitation group washigher than that in the delayed cardiac rehabilitation group, and the proportion of patients with ST-segment elevation myocardialinfarction and emergency PCI was lower than that in the delayed cardiac rehabilitation group (P < 0.05) . Multivariate Logisticregression analysis showed that abdominal obesity [OR =1.783, 95%CI (1.123, 2.832) ] , myocardial infarction type [OR =0.490,95%CI (0.269, 0.891) ] and PCI type [OR =0.240, 95%CI (0.137, 0.421) ] were independent influencing factor of intervention timeof cardiac rehabilitation during the acute phase in patients with AMI after PCI (P < 0.05) . The incidence of cardiac death andmalignant arrhythmia in the early cardiac rehabilitation group was lower than that in the delayed cardiac rehabilitation group, andthe 6 min walking distance before discharge was longer than that in the delayed cardiac rehabilitation group (P < 0.05) . The 6min walking distance before discharge of ST-segment elevation myocardial infarction patients in the early cardiac rehabilitationgroup was longer than that in the delayed rehabilitation group (P < 0.05) . Conclusion　In this group, 61.61% of AMI patientsreceived early cardiac rehabilitation after PCI. Early cardiac rehabilitation can effectively improve the cardiopulmonarytolerance of AMI patients after PCI, especially those with ST-segment elevation myocardial infarction. Abdominal obesity,myocardial infarction type and PCI type are independent influencing factors of intervention time of cardiac rehabilitation duringthe acute phase in patients with AMI after PCI. Among them, AMI patients with abdominal obesity and selective PCI, non STsegmentelevation myocardial infarction patients are more likely to participate in early cardiac rehabilitation.

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