远程辅助居家心脏康复对经皮冠状动脉介入治疗后患者血压和血脂的影响

Effect of tele-monitored home-based cardiac rehabilitation on blood pressure and lipids in patients with coronary heart disease after percutaneous coronary intervention

摘要:

目的 探讨远程监督和指导的居家心脏康复治疗对行经皮冠状动脉介入(PCI)术冠心病患者血压和血脂的影响。方法 入选2016年1月至2018年3月解放军总医院第一医学中心心血管内科门诊PCI术后冠心病患者266例,随机数表法分为研究组(远程辅助居家心脏康复组)和对照组,每组133例。对照组接受基础的二级预防健康教育和药物治疗,研究组在此基础上依据运动处方进行居家心脏康复,同时接受以智能手机为媒介的来自康复医师、技师和护士的远程心率监督和康复指导。随访患者12个月,比较2组患者康复前后血压和血脂水平。应用SPSS 17.0统计软件对数据进行分析。依据数据类型采用t检验或χ²检验进行组间比较。多重线性回归分析血压和血脂变化的独立影响因素。结果 相比康复前,研究组患者康复后收缩压[(123.7±13.7)和(128.2±14.5)mmHg(1mmHg=0.133kPa)]和舒张压[(77.6±11.1)和(80.7±10.3)mmHg]下降,收缩压达标比例[72.9%(97/133)和58.6%(78/133)]增高,低密度脂蛋白胆固醇水平[(1.64±0.42)和(1.90±0.59)mmol/L]明显下降,达标比例明显升高[42.1%(56/133)和26.3%(35/133)]；对照组患者康复后收缩压达标比例[48.1%(64/133)和59.4%(79/133)]降低,低密度脂蛋白胆固醇水平[(2.23±0.84)和(2.03±0.80)mmol/L]明显增高,达标比例[17.3%(23/133)和22.6 %(30/133)]明显下降,2组患者康复后舒张压达标比例[63.2%(84/133)和50.4%(67/133)；51.9%(69/133)和45.1%(60/133)]均增高,差异均有统计学意义。研究组相比对照组患者康复后收缩压[(-4.6±14.5)和(0.2±15.0)mmHg]和低密度脂蛋白胆固醇下降程度[(-0.26±0.54)和(0.20±0.63)mmol/L]大,差异均有统计学意义(P均＜0.05)。多重线性回归分析结果表明远程辅助居家心脏康复(P=0.006)和年龄(P=0.010)是收缩压变化的独立影响因素,远程辅助居家心脏康复(P＜0.001)和二氧化碳通气当量(P=0.007)是低密度脂蛋白胆固醇变化的独立影响因素。结论 远程辅助的居家心脏康复可明显降低PCI术后冠心病患者收缩压和低密度脂蛋白胆固醇水平,提高收缩压和低密度脂蛋白胆固醇的达标率,有助于血压和血脂的控制。

Abstract:

Objective To investigate the effect of tele-monitored home-based cardiac rehabilitation on blood pressure and lipid in patients with coronary heart disease undergoing percutaneous coronary intervention (PCI). Methods A total of 266 patients from January 2016 to March 2018 in our department with coronary heart disease after PCI were enrolled. They were randomly divided into study group (tele-monitored home-based cardiac rehabilitation group) and control group, with 133 cases in each group. The control group received the basic 2-level prevention health education and drug therapy. On the basis of these treatments, the study group received exercise prescription and remote heart rate supervision and rehabilitation guidance from rehabilitation physicians, technicians and nurses with aid of smart phones. The patients were followed up for 12 months, and the blood pressure and lipid levels before and after rehabilitation were compared between the 2 groups. SPSS statistics 17.0 was used to analyze the data. Student′s t test orChi-square test was employed to compare the data between groups. Multiple linear regression analysis was applied to analyze the independent influencing factors of blood pressure and lipid changes. Results In the study group, rehabilitation resulted in significant declines in systolic blood pressure [SBP, (123.7±13.7) vs (128.2±14.5) mmHg] and diastolic blood pressure [DBP, (77.6±11.1) vs (80.7±10.3)mmHg], with increased proportion of those meeting SBP standard [72.9%(97/133) vs 58.6%(78/133)], and in low-density lipoprotein cholesterol (LDL-C) level [(1.64±0.42) vs (1.90±0.59)mmol/L], with larger proportion of normal level [42.1%(56/133) vs 26.3%(35/133)]. While, in the control group, the proportion of the patients meeting the SBP standard was decreased [48.1%(64/133) vs 59.4%(79/133)], and the LDL-C level [(2.23±0.84) vs (2.03±0.80)mmol/L] was increased, with less patients meeting the standard [17.3%(23/133) vs 22.6%(30/133)]. The proportions of the patients meeting DBP standard were increased in both groups [63.2%(84/133) vs 50.4%(67/133), 51.9%(69/133) vs 45.1%(60/133)]. More significant changes were seen in the declines of SBP [(-4.6±14.5) vs (0.2±15.0)mmHg] and LDL-C level [(-0.26±0.54) vs (0.20±0.63)mmol/L] in the study group than the control group. Multiple linear regression analysis showed that tele-monitored home-based cardiac rehabilitation (P=0.006) and age (P=0.010) were independent influencing factors of SBP changes, and tele-monitored home-based cardiac rehabilitation (P<0.001) and carbon dioxide ventilation equivalent (P=0.007) were independent influencing factors for LDL-C changes. Conclusion Tele-monitored home-based cardiac rehabilitation significantly reduces SBP and LDL-C in patients with coronary heart disease after PCI, improves the proportions of those meeting the standards, and helps the control of blood pressure and blood lipid.