早期康复护理对老年心血管病患者的效果观察

目的探讨老年心血管病患者的早期康复护理效果。方法选取我院2014年5月~2016年2月收治的老年心血管病患者114例作为研究对象,将其随机分为观察组与对照组,各57例。观察组采用常规护理+早期康复护理,对照组采用常规护理。比较两组患者对于疾病的认知程度,评价其生存质量。结果观察组患者对于心血管病的认知程度为95.5%明显优于对照组的80.3%(P0.05);而观察组患者在心理功能、社会功能、躯体功能以及物质生活状态等方面的生活质量评分均高于对照组,差异有统计学意义(P0.05)。结论开展早期康复护理,有效促进老年心血管病患者治疗与康复,取得了十分显著的成效,值得临床推广。     

早期康复护理对老年心血管病患者的效果和护理满意度的影响

目的探讨早期康复护理对老年心血管病患者的效果和护理满意度。方法选取2015年1月~2016年6月我院收治的老年心血管病患者150例为研究对象,随机分成观察组和对照组,各75例。对照组行常规护理,观察组在常规护理基础上,实施早期康复护理干预,并院外随访3个月,观察两组效果和护理满意度。结果观察组治疗有效率和护理满意度分别为81.33%、94.67%,明显高于对照组57.33%和74.67%,差异有统计学意义(P0.05)。结论早期康复护理干预对老年心血管病患者的效果有明显提高,更能增加护患关系,使患者满意,临床应用值得推广。     

武术为基石的肺康复对老年慢性阻塞性肺疾病病人疗效及依从性的研究

目的研究传统武术(太极拳、八段锦、形意拳)对老年慢性阻塞性肺疾病(COPD)病人的近期及远期疗效。方法将我院就诊的COPD病人60例,随机分为传统肺康复组(对照组)和武术为基石的肺康复组(观察组),进行6个月的医院内规律康复训练,之后在医院指导下进行社区康复,于6个月和1年时对2组进行心肺功能评价和肺康复坚持率比较。结果 6个月随访时,观察组第1秒用力呼气容积占预计值百分比(FEV1%)较对照组明显提高,差异有统计学意义(P0. 05)。1年随访时,对照组组仅有17. 4%的病人仍坚持每周2次的肺康复锻炼,而观察组为44. 8%,2组比较差异有统计学意义(P0. 05)。结论基于中华传统武术的肺康复与西方传统的肺康复方法相比,提高老年COPD病人心肺功能的疗效接近,但传统武术可以提高病人的康复锻炼坚持率。     

早期康复护理对老年心血管病患者的效果观察

目的观察早期康复护理在老年心血管病患者中的应用效果。方法选取2013年2月~2014年2月我院收治的老年心血管病患者120例作为研究对象,按随机数字表法分为对照组和观察组,各60例,对照组采取常规护理,观察组在常规护理的基础上采取早期康复护理,对比两组患者生活自理能力、运动能力以及并发症发生情况。结果护理后,观察组患者生活自理能力Barthel指数、运动能力FMA评分均显著高于对照组,差异有统计学意义(P0.05)。观察组并发症发生率为5%,明显低于对照组的20%,差异有统计学意义(P0.05)。结论对老年心血管病患者,采取早期康复护理效果显著,值得临床应用。     

针对老年心血管病人应用早期康复护理的效果分析

目的观察老年心血管病人应用早期康复护理的效果。方法选择本院2016年3月~2017年3月接收的老年心血管病患者110例,随机抽取55例作为干预组,给予早期康复护理,另55例作为对照组,给予常规护理,观察护理前后患者生活自理能力及运动能力,评价患者生活质量及护理满意度。结果护理前,干预组生活自理能力评分、运动能力评分均与对照组相近,无明显差异(P0.05);护理后,干预组生活自理能力评分、运动能力评分、生活质量评分、护理满意度高于对照组,差异显著(P0.05)。结论早期康复护理应用于老年心血管病患者中后,可提高疾病康复效果,促进患者康复,提升其生活质量及对护理满意度。     

血清白蛋白水平对老年髋关节骨折手术病人术后康复的意义

目的 探讨血清白蛋白水平对老年髋关节骨折手术病人术后康复的意义。方法 选取2019年12月至2021年12月我院100例老年髋关节骨折病人作为研究对象,检测入院时、术后1 d及1周血清白蛋白水平。术后随访3个月,采用髋关节Harris评分评估病人康复效果,比较不同康复效果病人临床资料、血清白蛋白水平;采用Lasso回归和Logistic回归分析影响病人术后康复效果的因素,并采用ROC曲线评估血清白蛋白预测术后康复效果的效能。结果 不同康复效果病人年龄、合并内科疾病、术后延迟负重比例比较,差异有统计学意义(P<0.05);康复不佳病人术后1周血清白蛋白水平低于康复良好病人(P<0.05);Lasso回归和Logistic回归分析显示,年龄、合并内科疾病、术后延迟负重及术后1周血清白蛋白水平是病人术后康复效果的影响因素(P<0.05);相关分析显示,术后1周血清白蛋白水平与髋关节Harris评分呈正相关(P<0.05);ROC曲线显示,术后1周血清白蛋白水平预测术后康复效果的AUC为0.806,敏感度和特异度分别为80.41%、87.53%。结论 血清白蛋白水平与老...     

我国康复心脏病学发展的回顾与展望

(2012年12月2日中国康复医学会心血管病专业委员会换届会上的发言)前言经中国康复医学会(以下简称总会)批准,中国康复医学会心血管病专业委员会于1991年3月22日在福建省老年医院成立,至今已经历了一、二、三届时期,历届领导成员组成如下:第一届主任委员:刘江生(时任福建省老年医院院长,主任医师),副主任委员:曲镭(河北省人     

老年心血管病患者睡眠质量评估及护理干预

目的分析研究老年心血管疾病病人采取临床睡眠护理模式的临床效果。方法抽取2012年4月-2014年1月在我院收治的患有心血管疾病的老年病人65例(实验组),并抽取同一时间的健康人群65例作为对照组,采取PQSI(匹兹堡睡眠质量指数)对患有心血管病老年病人睡眠质量给予全面评估,并且通过对患有心血管病的老年病人实施临床护理干预模式,对比临床护理干预之前和临床护理干预以后老年心血管病人睡眠质量的改善情况。结果采取PQSI(匹兹堡睡眠质量指数)给予对比分析,实验组病人的睡眠质量明显低于对照组,两组间差异具有统计学意义(P0.05);实验组病人采取临床护理干预以后,睡眠治疗明显优于临床护理干预之前,其差异具有统计学意义(P0.05)。结论患有心血管病的老年人大部分都存在睡眠质量相对较差的问题,采取相对应的临床护理干预以后,可以使老年心血管病病人的睡眠质量明显得到提高,使病人健康生活质量得到明显提高,具有临床推广价值。     

健康教育对老年冠心病患者康复运动依从性的影响

目的:探讨健康教育对老年冠心病患者康复运动依从性的影响。方法:对108例冠心病患者进行疾病有关的教育,运动的指导和运动依从性观察(教育组),并与105例对照者进行比较对照,进行依从性评估。结果:随访1年,教育组康复运动依从性达 69.4％,显著高于对照组的30.5％(P<0.005)。结论:健康教育可明显提高老年冠心病人康复运动的依从性,且实用可行。     

老年骨折病人焦虑抑郁症状现状调查

目的了解老年骨折病人的焦虑抑郁现状及相关影响因素。方法选择2017年7～9月深圳市某三甲医院老年(年龄≥65岁)骨折病人为调查对象,采用自编调查问卷收集病人一般人口学特征和疾病特征信息,使用医院抑郁焦虑量表(HADS)对病人焦虑抑郁症状进行筛查,以HADS评分≥8分判定为焦虑抑郁。采用Logistic回归分析焦虑抑郁的相关影响因素。结果 313例病人的焦虑抑郁总发生率为11. 8%,Logistic回归分析结果显示:受教育程度较高、无其他慢性疾病可能是焦虑抑郁的保护因素(P0. 05);患有其他慢性疾病、基本日常生活能力(basic activities of daily living,BADL)评分60分、主观睡眠质量不好可能是焦虑抑郁症状的危险因素(P0. 05)。结论老年骨折病人可能伴有焦虑抑郁症状,教育水平、主观睡眠质量、慢性疾病、自理能力中重度依赖是焦虑抑郁的影响因素,医护人员需早期进行心理干预,提高病人治疗依从性,加速康复。     

早期康复对急性脑卒中患者运动功能的影响

目的探讨早期康复对急性脑卒中患者运动功能的影响。方法采用以Bobath和Brunnstrom方法为主的现代康复治疗技术,对30例急性脑卒中患者进行临床对照研究,并用Fugl-Meyer评分表评定运动功能。结果经治疗康复组运动功能明显改善,73.33%恢复达轻～中度运动障碍,20%为明显运动障碍,6%为严重运动障碍,对照组仅20%恢复达轻～中度运动障碍,60%为明显运动障碍,20%为严重运动障碍,两组差异非常显著(P<0.05)。结论早期康复能明显地改善急性脑卒中患者的运动功能,提高生命质量。     

老年高血压病人心血管内分泌激素与胰岛素抵抗作用的探讨

目的：探讨老年高血压病人的心血管内分泌激素与胰岛素抵抗的关系。方法：对老年I，II期高血压病人40例与健康对照组30例测定了血清（血浆）t-PA,PAI活性，ANP，ET，AI，AII水平，分析了胰岛素敏感性（IS）与纤溶活性，BMI，ANP，ET，AII，BP的相关性，结果：老年高血压组PAI，ANP，ET，AII，总胆固醇，甘油三酯水平明显高于健康对照组，而t-PA，IS是明显低于健康对照组，结论：心血管内分泌激素与胰岛素抵抗在老年高血压病人的发生，发展中起着极为重要的作用。     

早期康复护理对急性心肌梗死患者生活质量和对医护满意度的影响

目的：探讨早期康复护理对急性心肌梗死（AMI）患者的生活质量和医护满意度的影响。方法：选择我院2012年9月至2013年10月接诊的100例 AMI 患者为研究对象,按数字表法随机分为常规护理组（50例）,早期康复护理组（50例,在常规护理的基础上实施早期康复护理）,采用中国心血管病人生活质量评定问卷（CQQC）评定生活质量,比较两组患者的护理效果。结果：实施3周护理后,早期康复组患者对医护态度、医护水平、健康宣教及心理干预等满意度均明显高于常规护理组患者（分别为98.0％比78.0％、100％比76.0％、96.0％比80.0％、100％比82.0％）,差异具有统计学意义（P ＜0.05～＜0.01）,早期康复组患者的 CQQC 各项评分均明显优于常规护理组患者,组间差异具有统计学意义（P 均＜0.01）。结论：早期康复护理对急性心肌梗死患者有利于病情改善,可大大提高患者的生活质量及对医护工作的满意度,值得临床推广。     

End-of-life care preferences of patients enrolled in cardiovascular rehabilitation programs

STUDY OBJECTIVES: The study assessed the interests of ambulatory cardiac patients in advance planning and their willingness to participate in rehabilitation program-based end-of-life education. DESIGN: Observational survey study. SETTING: Fourteen outpatient cardiac rehabilitation programs in 11 states. PARTICIPANTS: Four hundred fifteen subjects enrolled in cardiac rehabilitation. MEASUREMENTS AND RESULTS: A questionnaire determined patient preferences for advance planning, completion of advance directives, completion of patient-physician discussions on end-of-life care, and effects of health status on patient acceptance of life-sustaining interventions. Seventy-two percent of patients wanted to direct their own end-of-life care, 86% desired more information on advance directives, 62% wanted to learn about life-sustaining care, and 96% were receptive to advance-planning discussions with their physicians. Seventy-two percent of patients had considered that they might require life-sustaining care in the future; acceptability of resuscitative care depended on health status and probability of survival. However, only 15% had discussed advance planning with their physicians, and 10% were confident that their physicians understood their end-of-life wishes. Physicians and cardiovascular rehabilitation programs were considered desirable sources of information on advance planning. CONCLUSIONS: Cardiac patients enrolled in rehabilitation programs want to learn more about end-of-life care and need more opportunities to discuss advance planning with their physicians. Patients consider cardiovascular rehabilitation programs to be acceptable sites for advance planning education.     

Umgang mit sexuellen Funktionsstörungen in der Rehabilitation kardiovaskulärer Erkrankungen

BACKGROUND AND PURPOSE: Many studies demonstrate a high prevalence of erectile dysfunction (ED) in cardiovascular patients. Findings show that patients often do not talk about their sexual problems. Many patients believe that their physician would not take their problem seriously. However, they wish to be asked by their physician and want to get information. The medical staff also avoids to broach the issue of sexual problems even when they assume an ED. Reasons for an insufficient inquiry are often lack of time or knowledge as well as emotional inhibitions. METHODS: 51 members of the medical staff of five hospitals for rehabilitation of cardiovascular diseases filled in a standardized, anonymous five-page questionnaire. It consisted of questions regarding sociodemography, estimated prevalence of sexual dysfunction, knowledge, responsibility, impediments for adequate diagnosis and therapy, as well as need for continuing medical education. Likely predictors (age, sex, profession, knowledge, and responsibility) for an active attitude were examined using relative risks. RESULTS: Of the 51 employees, 54% were men, more than half were physicians. The mean age was 44.3 years. The estimated prevalence of sexual dysfunction was 45.4 +/- 20.3%. Less than half of the medical professionals rated their knowledge concerning therapy motivation (47.9%) and general consultation of cardiovascular patients (38.8%) as at least good (see Figure 1). While more than two thirds felt responsible for motivation to subsequent treatment of sexual dysfunction, less than one quarter motivated the patients actively. Over 50% felt responsible for consultation and information, but only 27% did it actively (see Figure 2). The main impediment for an adequate management of sexual problems was the lack of time (38.3%). However, every fourth also believed that the patient would not accept the diagnosis (29.2%) or a therapy (22.9%). One third of the employees agreed that the own lack of knowledge makes care of sexual problems difficult. On the question what would be helpful to improve the management with sexual concerns, most employees said that education and training (85.7%) would be the most effective method (see Figure 3). The highest need for training can be seen in diagnostics (64.4%; see Figure 4). Almost all professionals believed that a screener would be reasonable. A higher knowledge state was the only significant predictor for an active management of sexual problems (see Table 1). CONCLUSION: The reported prevalence of sexual dysfunction in cardiac rehabilitation is very high. This requires skills concerning diagnosis and treatment of sexual dysfunction, which are only scarcely present. Furthermore, there are many impediments that are mainly positioned in the health-care system. The skills should be improved by an effort in continuing medical education. Patients with ED often have depression and a reduced quality of life. To improve the quality of life of patients in the cardiovascular rehabilitation, the treatment of ED is a necessary condition. Trials show that a widespread rehabilitation program which includes a sexual education leads to a better sexual activity. The patients' quality of life can only be improved, if the medical staff includes relevant concomitant disorders to cardiovascular disease, like ED, in the treatment program of patients.     

心理健康教育对抑郁症患者心血管系统症状的疗效

目的：探讨对抑郁症患者的心理健康教育,提高其心理健康水平,改善心血管系统症状的效果。方法：采取整体抽样的方法对心理门诊确诊为抑郁症并伴有心血管系统症状的68例患者,进行分组和为期4周的心理健康教育,每周1次,每次进行时间不少于1h。分别于就诊时和4周后采用症状自评量表进行心理检测。结果：68例患者接受心理健康教育并完成调查。心理健康教育后症状自评量表的：人际敏感、抑郁、焦虑、敌对、偏执因子分明显降低（P〈0.01）,其它各因子分均有不同程度的降低。患者自身评估结果为：自感症状消失者32例,占47.1%;能够主动和社会及他人接触者28例,占41.2%;试图建立良好的人际关系环境者19例,占27.9%;自述通过心理健康教育能明白很多事情,并从中得到较多启发者35例,占51.5%;能够正确地找到良好的情绪发泄途径和发泄方法者21例,占30.9%。结论：心理健康教育是治疗抑郁的重要方法,也是改善心血管系统症状的主要方法。     

Cardiac rehabilitation after coronary artery bypass surgery: 10-year results on mortality, morbidity and readmissions to hospital.

AIM: To evaluate the long-term secondary preventive effect of a comprehensive rehabilitation programme after coronary artery bypass grafting (CABG). METHODS: The study group included 49 consecutive patients who underwent bypass surgery and were then offered a rehabilitation programme consisting of education in risk-factor control, a physical training programme and regular follow-up at a post-CABG clinic. The control group (n = 98), consisting of two well-matched CABG patients for each study patient, was offered the usual care with no access to a cardiac rehabilitation programme. The two groups were followed for 10 years and the results regarding cardiovascular mortality, morbidity, total cardiac events and readmissions to hospital were compared. RESULTS: The total mortality (study group 8.2%, control group 20.4%) and cardiovascular mortality (8.2 versus 15.3%) after 10 years did not differ significantly between the groups. In the study group, nine patients (18.4%) had 10 cardiac events (four cardiovascular deaths, five non-fatal myocardial infarctions and one CABG) compared to 34 patients (34.7%, P < 0.05) suffering 46 (P < 0.01) cardiac events (15 cardiovascular deaths, 18 non-fatal myocardial infarctions, eight CABG, five coronary angioplasties) in the control group. The number of readmissions to hospital (2.1 versus 3.5 per patient) and length of admissions (11 versus 26 days per patient) was significantly lower in the study group (P < 0.01). CONCLUSION: A comprehensive cardiac rehabilitation programme offered to patients after coronary artery bypass surgery will improve the long-term prognosis and reduce the need for hospital care.     

Knowledge of cardiovascular risk factors and recommended lifestyle modifications in patients after an acute coronary syndrome. The influence of short-term, stationary rehabilitation. Preliminary results

BACKGROUND: Education on behavioural risk factors and lifestyle modification is one of the core components of comprehensive cardiac rehabilitation. AIM: To assess the level of knowledge of cardiovascular risk factors and recommended lifestyle changes in patients rehabilitated after an acute coronary syndrome (ACS). METHODS: The study group consisted of 31 consecutive patients (22 males, 56.6+/-10.9 years) participating in short-term, early, comprehensive cardiac rehabilitation. On admission, at discharge and 3 months after discharge patients' knowledge was assessed with a questionnaire worked out by the authors. RESULTS: On admission, patients had poor knowledge of cardiovascular risk factors and recommended lifestyle modifications, especially concerning diabetes, hypertension, and diet. After completing the rehabilitation programme, significantly higher percentage of patients gave correct answers to questions concerning diabetes and cholesterol-rich diet as cardiovascular risk factors, and substitution of vegetable fat for animal fat as a lifestyle modification, and significantly higher proportion of patients gave the correct value for elevated systolic blood pressure. CONCLUSIONS: Patients after ACS have poor knowledge of cardiovascular risk factors and recommended lifestyle modifications. The level of knowledge improves after short-term, stationary cardiac rehabilitation; however, the degree of this improvement is not completely satisfactory.     

中国心血管疾病患者居家康复专家共识

心脏康复已被证实可有效减少心血管疾病患者再入院率、死亡率以及心血管事件风险,并改善与健康相关的生活质量。居家心脏康复作为门诊心脏康复的替代选择,可通过远程监护间接指导患者进行康复训练,克服了交通、时间不便等诸多障碍,扩大了患者健康教育、康复咨询和康复监督的范围。但这种模式在中国尚刚起步,且大多数国内机构无标准流程和实践经验参考。本专家共识从居家心脏康复管理的路径及纳入标准、核心组成部分（运动、营养、睡眠、心理、危险因素等的管理）、质量评价指标、存在问题以及开展策略等方面提出初步建议,提供居家心脏康复医疗质量与医疗安全的质控措施,供拟开展居家心脏康复的机构进行参考,提供规范服务。     

Can a Chronic Care Model Collaborative Reduce Heart Disease Risk in Patients with Diabetes?

BACKGROUND: There is a need to identify effective practical interventions to decrease cardiovascular disease risk in patients with diabetes. OBJECTIVE: We examine the impact of participation in a collaborative implementing the chronic care model (CCM) on the reduction of cardiovascular disease risk in patients with diabetes. DESIGN: Controlled pre- and postintervention study. PATIENTS/PARTICIPANTS: Persons with diabetes receiving care at 13 health care organizations exposed to the CCM collaborative and controls receiving care in nonexposed sites. MEASUREMENTS AND MAIN RESULTS: Ten-year risk of cardiovascular disease; determined using a modified United Kingdom Prospective Diabetes Study risk engine score. A total number of 613 patients from CCM intervention sites and 557 patients from usual care control sites met the inclusion criteria. The baseline mean 10-year risk of cardiovascular disease was 31% for both the intervention group and the control group. Participants in both groups had improved blood pressure, lipid levels, and HbA1c levels during the observation period. Random intercept hierarchical regression models showed that the intervention group had a 2.1% (95% CI -3.7%, -0.5%) greater reduction in predicted risk for future cardiovascular events when compared to the control group. This would result in a reduced risk of one cardiovascular disease event for every 48 patients exposed to the intervention. CONCLUSIONS: Over a 1-year interval, this collaborative intervention using the CCM lowered the cardiovascular disease risk factors of patients with diabetes who were cared for in the participating organization's settings. Further work could enhance the impact of this promising multifactorial intervention on cardiovascular disease risk reduction.