作者：陈岩1 ，韦丽华2 ，钟美容1，2 ，黎景徽3 ，吴国凤1 ，程树锦1 ，吴帆1 ，胡丽芳1

单位：

1.530001广西壮族自治区南宁市，广西中医药大学护理学院　2.530011广西壮族自治区南宁市，广西中医 药大学附属瑞康医院心脏康复中心　3.415099湖南省常德市，湖南中医药大学附属常德医院护理部

Units：

1.School of Nursing, Guangxi University of Chinese Medicine, Nanning 530001, China 2.Heart Rehabilitation Center, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning 530011, China 3.Nursing Department, Changde Hospital Affiliated to Hunan University of Chinese Medicine, Changde 415099, China

关键词：

　冠心病；经皮冠状动脉介入治疗；行为改变轮；运动恐惧；康复

Keywords：

Coronary disease; Percutaneous coronary intervention; Behavior change wheel; Kinesophobia; Rehabilitation

CLC：

R 541.4

DOI：

10.12114/j.issn.1008-5971.2023.00.316

Funds：

广西壮族自治区卫生健康委员会自筹经费科研课题项目（Z20201491）

摘要：

目的　探讨基于行为改变轮（BCW）理论的线上线下居家康复方案在行PCI的老年冠心病患者中的应 用效果。方法　采用便利抽样法，选取2021年11月—2022年9月在广西中医药大学附属瑞康医院接受PCI的老年冠心病 患者为研究对象，采用抛硬币法将患者分为观察组45例和对照组46例。对照组患者进行常规护理、常规康复运动指导 以及运动安全教育，并且开展院内示教形式的培训；观察组患者在对照组的基础上实施基于BCW理论的线上线下居家 康复方案，干预时间均为6个月。比较两组干预前及干预后6个月心肺功能指标〔左心室射血分数（LVEF）、峰值摄 氧量（VO2 peak）、无氧阈（AT）〕、6分钟步行距离（6MWD），干预前及干预后3、6个月中文版心脏疾病患者运动 恐惧量表（TSK-Heart）评分、中文版患者积极度量表（PAM13）评分。结果　干预后，观察组LVEF、VO2 peak、AT 高于对照组，6MWD长于对照组（P＜0.05）。时间与治疗方法在中文版TSK-Heart评分上存在交互作用（P＜0.05）； 时间、治疗方法在中文版TSK-Heart评分上主效应显著（P＜0.05）。干预后3、6个月，观察组中文版TSK-Heart评分低 于对照组（P＜0.05）。干预后3、6个月，观察组中文版PAM13评分高于对照组（P＜0.05）。结论　基于BCW理论的 线上线下居家康复方案可改善行PCI的老年冠心病患者的心肺功能，延长6MWD，降低运动恐惧程度，提高自我管理积 极度。

Abstract：

Objective To investigate the application effect of online and offline home rehabilitation programs based on behavior change wheel (BCW) theory in elderly patients with coronary heart disease undergoing PCI. Methods A convenience sampling method was used to select elderly coronary heart disease patients who underwent PCI at Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine from November 2021 to September 2022. The patients were divided into the observation group (n=45) and the control group (n=46) using a coin-tossing method. Patients in the control group received routine care, regular rehabilitation exercise guidance, and exercise safety education, along with in-hospital demonstration training. Patients in the observation group received online and offline home rehabilitation programs based on BCW theory on the basis of the control group, the intervention time was all 6 months. Cardiopulmonary function indicators [left ventricular ejection fraction (LVEF) , peak oxygen uptake (VO2 peak) , anaerobic threshold (AT) ] , and 6-minute walking distance (6MWD) before intervention and at 6 months after intervention, Chinese version Tampa Scale for Kinesiophobia Heart (TSK-Heart) score, and Chinese version Patient Activation Measure 13 (PAM13) score before intervention and at 3, 6 months after intervention were compared between the two groups. Results After intervention, the LVEF, VO2 peak, AT in the intervention group were higher than those in the control group, 6MWD in the intervention group was longer than that in the control group (P < 0.05) . There was an interaction between time and treatment method on the Chinese version TSK-Heart score (P < 0.05) , both time and treatment method produced significant main effects on the Chinese version TSK-Heart score (P < 0.05) . At 3, 6 months after intervention, the Chinese version TSK-Heart score in the intervention group was lower than that in the control group (P < 0.05) . At 3, 6 months after intervention, the Chinese version PAM13 score in the intervention group was higher than that in the control group ( P < 0.05) . Conclusion Online and offline home rehabilitation programs based on BCW theory can improve the cardiopulmonary function of elderly patients with coronary heart disease undergoing PCI, extend 6MWD, reduce patients' degree of kinesophobia, and enhance their self-management positivity.

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