作者：阮甜甜，丁原，徐梦琦，朱凌燕

单位：

200030上海市，上海交通大学医学院附属第六人民医院护理部

Units：

Department of Nursing, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200030, China

关键词：

心力衰竭；心脏康复；居家心脏康复；循证医学；证据

Keywords：

Heart failure; Cardiac rehabilitation; Home-based cardiac rehabilitation; Evidence-based medicine;Evidence

CLC：

R 541.6

DOI：

10.12114/j.issn.1008-5971.2023.00.203

Funds：

摘要：

目的　总结慢性心力衰竭（CHF）患者开展居家心脏康复（HBCR）的最佳证据。方法　按照“6S”金字塔证据模型检索BMJ Best Practice、Up To Date、Google、澳大利亚乔安娜布里格斯研究所（JBI）循证卫生保健中心、美国国立指南库、苏格兰学院间指南网、英国国家卫生与临床优化研究所、国际网络指南网、医脉通、中华医学会等网站，Cochrane Library、Embase、PubMed、Engineering Village、EBSCO、中国知网、中国生物医学文献数据库、维普网、万方数据知识服务平台等数据库。检索时限为2016—2022年。3名研究者进行文献质量评价，2名研究者进行文献筛选、证据提取与证据等级评价。结果　共纳入15篇文献，其中指南8篇、专家共识4篇、临床决策1篇、最佳实践手册1篇、随机对照试验1篇。8篇指南中，3篇的推荐级别为A级，5篇的推荐级别为B级；4篇专家共识除条目6评价为“否”外，其余条目均评价为“是”；1篇随机对照试验条目2评价为“否”，条目4和条目5评价为“不适用”，条目7评价为“不清楚”，其余条目均评价为“是”。通过证据提取与整合，最终形成了CHF患者开展HBCR的评估、干预团队、运动管理、饮食管理、药物管理、心理干预、风险因素管理、中医特色和远程智能设备9个方面共56条最佳证据。结论　该研究总结了CHF患者开展HBCR的最佳证据，为我国CHF患者开展HBCR提供了借鉴。

Abstract：

Objective To summarize the best evidence for home-based cardiac rehabilitation (HBCR) in peoplewith chronic heart failure (CHF) . Methods Websites such as BMJ Best Practice, Up To Date, Google, Joanna Briggs Institute(JBI) Centre for Evidence-Based Health Care in Australia, National Guideline Clearinghouse, Scottish Intercollegiate GuidelinesNetwork, National Institute for Health and Clinical Excellence, Guidelines International Network, Medlive and Chinese MedicalAssociation, databases such as Cochrane Library, Embase, PubMed, Engineering Village, EBSCO, CNKI, CBM, VIP and WanfangData were searched according to the "6S" pyramid evidence model. The search period was from 2016 to 2022. Three investigatorsevaluated the quality of literature, and two investigators conducted literature screening, evidence extraction and evidence levelevaluation. Results A total of 15 articles were included, including 8 guidelines, 4 expert consensus, 1 clinical decisionmaking, 1 best practice manual, and 1 randomized controlled trial. Among the 8 guidelines, 3 were grade A of recommendationsand 5 were grade B of recommendations. Except for item 6, which was evaluated as "no" , all other items of four expert consensuswere evaluated as "yes" . Item 2 of one randomized controlled trial was evaluated as "no" , item 4 and item 5 were evaluated as"not applicable" , item 7 was evaluated as "unclear" , and other items were evaluated as "yes" . Through evidence extractionand integration, the best evidence summary of the assessment, intervention team, management of exercise, food and drugs,psychological intervention, management of risk factors, characteristics of traditional Chinese medicine, and remote intelligentdevices of HBCR were collected, including 9 aspects and 56 pieces of evidence. Conclusion This study summarizes the bestevidence of HBCR in patients with CHF, which can serve as a guide for the development of HBCR in patients with CHF in China.

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