作者：王用，邢玉龙，史云桃，刘华英，刘秀玲，邢建东，王文彬

单位：

211300江苏省南京市高淳人民医院心内科

Units：

Department of Cardiology, Nanjing Gaochun People's Hospital, Nanjing 211300, China

关键词：

心力衰竭；心脏康复；心脏有氧康复训练；医联体；生存质量；预后

Keywords：

Heart failure; Cardiac rehabilitation; Cardiac-aerobic rehabilitation training; Medical consortium; Quality of life; Prognosis

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.196

Funds：

十三五南京市卫生青年人才培养工程（QRX17212）；江苏卫生健康职业学院校级科研项目（JKC201945）

摘要：

目的　分析基于医联体模式下的心脏有氧康复训练对心力衰竭患者生存质量和预后的影响。方法　选取2020年1月至2021年6月于南京市高淳人民医院住院的心力衰竭患者110例为研究对象，采用计算机将其随机分为观察组和对照组，各55例。对照组进行常规治疗，观察组在对照组的基础上进行基于医联体模式下的心脏有氧康复训练，两组均干预6个月。比较两组一般资料和干预前后心功能指标〔包括6 min步行距离（6MWD）、左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）、N末端脑钠肽前体（NT-proBNP）〕、明尼苏达心力衰竭生存质量量表（MLHFQ）评分及主要不良心血管事件（MACE）发生率。心力衰竭患者发生MACE的影响因素分析采用单因素、多因素Cox回归分析。结果　有5例患者失访、中途退出本研究，最终共有105例患者完成本研究，其中观察组53例、对照组52例。观察组干预后6MWD长于对照组，LVEF、LVEDD大于对照组，NT-proBNP低于对照组（P ＜0.05）。观察组干预后MLHFQ评分低于对照组（P ＜0.05）。观察组MACE发生率低于对照组（P ＜0.05）。单因素Cox回归分析结果显示，病程、高血压史、入院时血肌酐、干预前6MWD、干预前LVEF、干预前MLHFQ评分、接受基于医联体模式下的心脏有氧康复训练是心力衰竭患者发生MACE的影响因素（P ＜0.05）。多因素Cox回归分析结果显示，高血压史〔HR =2.585，95%CI （1.034，6.461）〕、接受基于医联体模式下的心脏有氧康复训练〔HR =3.158，95%CI（1.273，7.837）〕是心力衰竭患者发生MACE的独立影响因素（P ＜0.05）。结论　基于医联体模式下的心脏有氧康复训练可改善心力衰竭患者的心功能，提高其生存质量，降低MACE发生风险，从而改善其预后。

Abstract：

Objective　To analyze the effect of cardio-aerobic rehabilitation training based on medical consortium model on the quality of life and prognosis of patients with heart failure. Methods　A total of 110 patients with heart failure who were hospitalized in Nanjing Gaochun People's Hospital from January 2020 to June 2021 were selected as the research objects, and they were randomly divided into observation group and control group by computer, with 55 cases ineach group. The control group received routine treatment, and the observation group received cardiac-aerobic rehabilitation training based on medical consortium model on the basis of the control group. Both groups were intervened for 6 months.The general data and cardiac function indexes [including 6 minute walk distance (6MWD) , left ventricular ejection fraction(LVEF) , left ventricular end diastolic diameter (LVEDD) , N-terminal pro brain natriuretic peptide (NT-proBNP) ] andMinnesota Living with Heart Failure Questionnaire (MLHFQ) score before and after intervention, and the incidence of majoradverse cardiovascular events (MACE) were compared between the two groups. Univariate and multivariate Cox regressionanalysis was used to analyze the influencing factors of MACE in patients with heart failure. Results　Five patients werelost to follow-up and dropped out of the study. In the end, a total of 105 patients completed the study, including 53 casesin the observation group and 52 cases in the control group. After intervention, 6MWD of the observation group was longerthan that of the control group, LVEF and LVEDD were bigger than those of the control group, and NT-proBNP was lowerthan that of the control group (P < 0.05) . The MLHFQ score of observation group was lower than that of control group afterintervention (P < 0.05) . The incidence of MACE in the observation group was lower than that in the control group (P < 0.05) .Univariate Cox regression analysis showed that the course of disease, history of hypertension, blood creatinine at admission,6MWD before intervention, LVEF before intervention, MLHFQ score before intervention, and cardiac-aerobic rehabilitationtraining based on medical consortium model were influencing factors of MACE in patients with heart failure (P < 0.05) .Multivariate Cox regression analysis showed that history of hypertension [HR =2.585, 95%CI (1.034, 6.461) ] and cardio-aerobicrehabilitation training based on medical consortium model [HR =3.158, 95%CI (1.273, 7.837) ] were independent influencingfactors for MACE in patients with heart failure (P < 0.05) . Conclusion　Cardiac-aerobic rehabilitation training based on themedical consortium model can improve the cardiac function of patients with heart failure, improve their quality of life, reduce therisk of MACE, and thus improve their prognosis.

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