【作者】 高丽；

【导师】 李峥； David Arthur； David Thompson；

【作者基本信息】 中国协和医科大学 ， 护理学， 2007， 硕士

【摘要】 背景：急性心肌梗死的康复效果已经被众多研究所验证，目前国内的心脏康复形式主要是院内康复和家庭社区康复。程序繁琐、康复实施时间固定且常与工作时间相冲突、缺少家庭支持、交通不便、费用较高等原因导致康复参加率低、依从性不理想。大多数心肌梗死患者出院前仅接受简单的康复指导，如逐渐增加活动量、改变不良饮食习惯、戒烟戒酒等，内容并不具体。自助式心脏康复作为一种新型的院外心脏康复形式已在英国发展并应用于心脏病发作后的患者，其特点是简单易行、费用低，而在我国还未见报道。目的：本研究通过对急性心肌梗死患者进行院外自助式心脏康复的实验性研究，来探讨这种新型康复形式的效果。方法：便利选取北京市某心血管专科医院的首发急性心肌梗死患者136例，按照分段随机分组的原则分为对照组和干预组，各68例。干预组在出院前除接受医护人员给予的一般康复指导外，还由研究者在患者出院前1～2天将院外自助式心脏康复手册发放和介绍给患者及家属，向患者演示正确的锻炼和放松方法，并鼓励家属参加到康复计划中来以帮助患者坚持执行计划。患者出院后按手册进行心脏康复，研究者定期通过电话督导来检查计划的进展情况、锻炼和放松进行情况、危险因子的控制情况，回答患者提出的问题并对患者在坚持执行计划的过程中遇到的困难提出建议。对照组的患者只在出院前接受医护人员给予的一般康复指导，包括冠心病运动锻炼和生活方式改变等出院指导，不进行电话督导。研究者分别在两组患者出院后3周、6周和12周评价心脏康复效果，指标有：心理状态，包括焦虑(HAD-14)、自尊(RSE-10)、心理健康状况(GHQ-12)；生活质量(SF-12)；生活方式改变情况，包括吸烟和锻炼情况；临床情况，包括胸部不适发作及看门诊和再入院情况。结果：共对122例患者完成全部资料的收集，其中干预组63例，对照组59例。本研究结果显示，进行院外自助式心脏康复的干预组患者较对照组而言，焦虑、抑郁和心理健康状况得到明显改善；某些不良生活方式，如吸烟和缺乏运动得到改善：胸部不适得到缓解：患者看门诊率和再入院率得以降低；但两组自尊状况和生活质量没有明显的差异。结论：院外自助式心脏康复是一种简单、经济、有效的新型心脏康复形式，值得在急性心肌梗死患者中间大力推广。更多还原

【Abstract】 Background: In the West, a growing number of patients who have had amyocardial infarction are referred to or enrolled in cardiac rehabilitation programs,which not only reduce morbidity and mortality but also promote quality of life aswell as physical and psycho-social status. But, in many parts of the world, especiallyAsia, many hospitals do not offer such programs after their discharge from thehospital, and even if they do many patients find it difficult to attend.Objective: To compare the effectiveness of a home-based self-help pack (HP)versus usual care for patients who have had a myocardial infarction, 136 patientswere randomly allocated to the treatment group (HP and usual care) and thecontrol group (usual care)Methods: Patients were randomized before commencing the study and makingbaseline measures. For subjects in the treatment group, the researcher introduced theHP to the patient and their partner/family one or two days prior to discharge fromhospital. At the initial meeting the correct way to do the exercises and relaxation wasdemonstrated to the patient. The patient’s partner/family member was encouraged tojoin in with the program and help the patient to adhere to it. The researcher checkedon the progress of the patient on exercise and relaxation and risk factors reductioncontrol, answer any questions that the patient had and made suggestions to thepatient to overcome difficulties to promote adherence by phone. Subjects in thecontrol group received usual care, including discharge education for exercise andlifestyle changes in CHD before discharge. They did not receive the protocol ofphone calls after discharge. The effects were measured by phone in the 3rd weeks,6th weeks and 12th months after their discharge from the hospital. The instrumentsand outcome measures included: psychological distress (Hospital Anxiety andDepression Scale, Rosenberg Self-Esteem Scale, General Health Questionnaire);health-related quality of life (SF-12 Health Survey); lifestyle changes (exercise adherence and rate of smoking); clinical aspects (readmission rate after discharge,rate of visits to GPs for cardiac reasons and number of episodes of chest pain).Results: 122 subjects finished the whole data collection, 63 patients in thetreatment group and 59 patients in the control group. Patients who received the HPas well as usual care had better health outcomes than those who received usual carealone. These outcomes included: less anxiety and depression, better physical activityexercise, and a lower use of health services, including fewer GP consultations and alower readmission rate. However, the differences of self-esteem and quality of lifebetween the intervention group and control group were insignificant.Conclusion: The finding of this study demonstrates that the home-based self-helppack may benefit the acute myocardial infarction patients in many aspects andindicates that it might be worth offering such a self-help package to all patients withacute myocardial infarction.更多还原