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背景:在传统的急性心肌梗死治疗中,要求患者绝对卧床休息1～4周,近年研究表明心肌梗死患者早期进行康复运动能改善心功能储备,增加运动耐量,增加心肌血液灌注,减少心肌缺血,并减少焦虑和抑郁情绪。目的:观察早期康复运动对急性心肌梗死患者日常生活能力、入院天数、平均住院花费、心律失常的发生率及两年内心肌梗死再发率影响。设计:非随机化同期对照分析。单位:北京天坛医院。对象:选择2002-08/2003-10在北京天坛医院循环内科住院的急性心肌梗死患者80例,所有患者年龄≤70岁,病情稳定,左心室射血分数>35%,不合并严重的高血压、严重的肺部疾病、神经和运动系统疾病。方法:将入选病例按患者意愿分成两组(n=40):①早期康复组:常规药物治疗。绝对卧床休息24h;第2天床头抬高30°左右,肢体关节的被动运动;第3～5天床上坐起,3次/d;第6～7天床边站立,3次/d;第8～9天床边活动四肢关节,在室内慢走;第10～14天练习步行。在进行康复运动出现心绞痛发作、严重心律失常或呼吸困难登症状时,应暂停运动或将运动强度返回前一阶段水平。②绝对卧床组:绝对卧床,只进行常规药物治疗,不进行康复训练。主要观察指标:采用Barthel指数(满分100分,<60分为不能自理)评定患者的日常生活能力,并对比两组的平均住院天数,住院期间的平均花费,心律失常的发生率及两年内心肌梗死的再发率。结果:80例患者均完成了治疗和随访进入结果分析。①早期康复组平均住院天数和平均住院花费较绝对卧床组少(17.1d比24.5d;9021.23元比12383.45元;P<0.05)。②Barthel指数:治疗前两组无差异,出院前早期康复组显著高于绝对卧床组(81.43±13.57,70.68±11.48,P<0.05)。③早期康复组和绝对卧床组分别有6,7例发生心律失常。④追踪观察两年,早期康复组心肌梗死的再发率(5%,2/40)明显低于绝对卧床组(22%,9/40)。结论:早期康复训练有利于提高心肌梗死患者的日常生活能力,减少平均住院天数及平均住院花费,降低再发率。
Background: In the traditional treatment of acute myocardial infarction, patients are required to rest in bed for 1 to 4 weeks. In recent years, studies have shown that early rehabilitation of patients with myocardial infarction can improve cardiac function reserve, increase exercise tolerance, increase myocardial blood perfusion and decrease myocardial ischemia , And reduce anxiety and depression. OBJECTIVE: To observe the effects of early rehabilitation exercise on daily living ability, hospitalization days, average hospitalization expenses, incidence of arrhythmia and recurrence rate of myocardial infarction within two years in patients with acute myocardial infarction. Design: Non-randomized simultaneous control analysis. Unit: Beijing Tiantan Hospital. PARTICIPANTS: Eighty - eight patients with acute myocardial infarction hospitalized in Department of Cardiology, Beijing Tiantan Hospital from August 2002 to October 2003 were selected. All patients were ≤70 years of age with stable disease. The left ventricular ejection fraction was> 35%, without severe hypertension , Severe lung disease, nervous and motor system diseases. Methods: The patients were divided into two groups according to their wishes (n = 40): ① early rehabilitation group: conventional drug treatment. Absolute bed rest 24h; on the 2nd day bed up about 30 °, passive movement of limb joints; bed 3 to 5 days sit up, 3 times / d; 6-7 days bedside stand, 3 times / d; The first 8 to 9 bedside activities joints, walk slowly indoors; 10 to 14 days walk practice. During rehabilitation exercise angina pectoris, severe arrhythmia or dyspnea symptoms should be suspended or the exercise intensity to the level of the previous stage. ② absolute bed group: absolute bed rest, only conventional drug treatment, not rehabilitation training. MAIN OUTCOME MEASURES: Barthel index (out of 100 points, <60 points can not be self-care) to assess the daily living ability of patients and compared the average length of stay in the two groups, the average cost of hospitalization, the incidence of arrhythmia and myocardium within two years The recurrence rate of infarction. Results: All 80 patients completed the treatment and follow-up into the result analysis. ① The average hospitalization days and average hospitalization costs of the early rehabilitation group were less than that of the absolute bed group (17.1d vs 24.5d; 9021.23 vs 12383.45 yuan; P <0.05). ② Barthel index: there was no difference between the two groups before treatment, and the rate of early recovery group was significantly higher than that of absolute bed group (81.43 ± 13.57,70.68 ± 11.48, P <0.05). ③ Early rehabilitation group and absolute bed group were 6,7 cases of arrhythmia. ④ Follow-up observation for two years showed that the rate of recurrent myocardial infarction (5%, 2/40) in early rehabilitation group was significantly lower than that in absolute bed group (22%, 9/40). Conclusion: Early rehabilitation training can improve daily living ability of patients with myocardial infarction, reduce the average length of stay and hospitalization, and reduce the recurrence rate.