急性心肌梗死患者3周康复干预程序在市级医院心内科实施的观察

背景20世纪80年代国内即开始了急性心肌梗死的康复治疗,但在市级医院因其条件的限制开展得不普遍.目的探讨市级医院心内科实施3周康复干预对急性心肌梗死患者的可能性.设计分组对照、回顾性分析.单位营口市中心医院心内科.对象选择1996年营口市中心医院心内科收入的急性心肌梗死患者60例为实验组,选择1986年该院收入的急性心肌梗死患者58例为对照组.实验组男44例,女16例,年龄34～79岁,有心功能不全和心率失常者45例,对照组例数与实验组基本接近.实验组干预中10例出现胸闷症状,3例不敢接受,经监护及教育均参加和完成了实验过程.方法对照组仅进行合理的临床治疗措施.实验组在实施治疗措施的同时,采用急性心肌梗死3周康复程序进行早活动、早离床、早出院的康复治疗.康复程序遵守循序渐进逐渐增加运动量和酌情个体化原则,依照患者年龄、病情、心理状态等情况加以调整.如出现过负荷指征,暂时停止活动或减少活动强度.主要观察指标两组患者3周后运动耐量及运动恢复时间和患者住院时间的比较.结果实验组患者全部完成了3周康复干预.实验组急性心肌梗死后3周运动耐量达5～6运动当量者较对照组多(78%,12%,P＜0.05).能上下楼者较对照组多(83%,7%,P＜0.05),住院日＜3周者比对照组多(78%,10%,P＜0.05).结论在市级医院开展急性心肌梗死的康复程序干预是可行和安全的,早期康复活动可明显加快心肌梗死患者的恢复过程.

Implementedobservation on three-week rehabilitation intervention procedure in patients with acutemyocardial infarction in cardiological department of municipal hospital

BACKGROUND: The rehabilitation treatment for acute myocardial infarction has started since 1980' s, but it has not been popularized yet in municipal hospitals due to limited conditions.OBJECTIVE: To probe into the possibility of 3-week rehabilitation intervention in patients with acute myocardial infarction implemented in municipal hospitals.DESIGN: Controlled retrospective analysis was designed.SETTING: Department of Cardiology of YingKou Center Hospital.PARTICIPANTS: Sixty cases of acute myocardial infarction were collected in Department of Cardiology of Center Hospital in Yingkou City in 1996 and they were taken as experimental group. Totally 58 cases of acute myocardial infarction hospitalized in 1986 were taken as the control. In experimental group, 44 cases were males and 16 cases females, aged varied from 34 to 79 years; of which, 45 cases were diagnosed as cardiac dysfunction and cardiac arrhythmia. The situation in the control was near basically to that in experimental group. During the intervention, in experimental group, 10 cases presented chest oppression, 3 cases were afraid to accept the intervention; but by monitoring and explanation, all of those accomplished the experiment.METHODS: In the control, only rational clinical management was given. In experimental group, at the same time of clinical management implemented,the rehabilitation treatment for 3 weeks was carried out for patients with acute myocardial infarction, aiming to earlier movement, earlier getting up, earlier discharge. The rehabilitation procedure stood by gradually increased exercise amount and individualization and it was adjusted according to age, situation of sickness and psychological state, etc. For instance, if the signs of over-endurance presented, the exercise would stop temporarily or the exercise intensity be reduced.MAIN OUTCOME MEASURES: Comparisons of exercise endurance, recovery time of exercise and hospitalizing time in 3 weeks of two groups.RESULTS: The patients in experimental group all accomplished 3-week rehabilitation intervention. In experimental group, the cases, in which, the exercise endurance was up to 5 to 6 equivalents 3 weeks after acute myocardial infarction, were more than the control (78%, 12%, P ＜ 0.05). The cases that were able to go up-down stairs were more than the control(83%, 7%, P＜ 0.05) . The cases hospitalized ＜ 3 weeks were more than the control (78%, 10%, P ＜0.05).CONCLUSION: It is practical and safe to carry on rehabilitation procedure for acute myocardial infarction in municipal hospital. Rehabilitation exercise at the early stage accelerates remarkably the recovery of acute myocardial infarction.