基于家庭医生管理的增强型体外反搏辅助社区Ⅲ期心脏康复模式在老年冠心病患者中的实施与功能改善评价：一项前瞻性单臂队列研究

Implementation and Evaluation of Functional Improvement in Elderly Patients with Coronary Heart Disease Using an Enhanced Community-Based Phase III Cardiac Rehabilitation Model with External Counterpulsation Support Managed by Family Physicians: A Prospective Single-Arm Cohort Study

摘要: 目的：探讨家庭医生管理下增强型体外反搏(Enhanced External Counterpulsation, EECP)辅助社区Ⅲ期心脏康复模式在老年冠心病患者中的实施可行性，并评价12周康复后患者运动功能及健康状态的变化。方法：采用单中心、前瞻性单臂队列研究，于2025年6~10月连续纳入上海市某社区卫生服务中心接受Ⅲ期心脏康复的老年冠心病患者40例，实施为期12周的医学评估、EECP辅助治疗、运动康复及家庭医生连续管理。主要观察指标为六分钟步行距离(6-Minute Walking Distance, 6MWD)，次要指标包括西雅图心绞痛量表(Seattle Angina Questionnaire, SAQ)评分、左心室射血分数(Left Ventricular Ejection Fraction, LVEF)、医院焦虑抑郁量表(Hospital Anxiety and Depression Scale, HADS)评分及康复实施指标。比较干预前后各指标，并采用多元线性回归探索康复实施程度与6MWD变化值(Δ6MWD)的关联。结果35例患者完成康复，完成率为87.5%。EECP、运动训练和家庭医生随访平均完成率分别为89.1% ± 5.2%、84.9% ± 5.5%和93.5% ± 4.1%。完成者的6MWD由(298.4 ± 22.2) m提高至(347.0 ± 25.6) m，SAQ评分由(58.6 ± 3.5)分提高至(75.0 ± 3.1)分，LVEF由(49.9% ± 2.4%)提高至(52.6% ± 2.0%)，HADS评分由(13.5 ± 1.8)分下降至(8.7 ± 1.4)分(均P < 0.001)；BMI和收缩压亦较基线下降(P = 0.033和P < 0.001)。年龄、性别及各项康复完成情况与Δ6MWD均无显著关联(均P > 0.05)。康复期间未发生急性冠脉事件、心力衰竭加重或严重不良事件。结论：家庭医生管理下EECP辅助社区Ⅲ期心脏康复模式具有较好的实施可行性和安全性。12周康复后，患者运动功能、疾病相关生活质量及部分健康指标较基线改善。该模式可作为进一步开展多中心、对照性研究的实践基础。

Abstract: Objective: To evaluate the feasibility of a family physician-managed, enhanced external counterpulsation (EECP)-assisted, community-based phase III cardiac rehabilitation program for older patients with coronary heart disease and to assess changes in exercise capacity and health status after 12 weeks of rehabilitation. Methods: This single-center, prospective, single-arm cohort study consecutively enrolled 40 older patients with coronary heart disease who underwent phase III cardiac rehabilitation at a community health service center in Shanghai between June and October 2025. Participants received a 12-week comprehensive program comprising medical assessment, EECP, exercise training, and continuous family physician management. The primary outcome was six-minute walking distance (6MWD). Secondary outcomes included Seattle Angina Questionnaire (SAQ) score, left ventricular ejection fraction (LVEF), Hospital Anxiety and Depression Scale (HADS) score, and program implementation measures. Changes from baseline were assessed, and multivariable linear regression was used to explore associations between program completion and change in 6MWD (Δ6MWD). Results: Of the 40 participants, 35 completed the program, yielding a completion rate of 87.5%. The mean completion rates for EECP, exercise training, and family physician follow-up were 89.1% ± 5.2%, 84.9% ± 5.5%, and 93.5% ± 4.1%, respectively. Among completers, 6MWD increased from 298.4 ± 22.2 m to 347.0 ± 25.6 m, SAQ score increased from 58.6 ± 3.5 to 75.0 ± 3.1, LVEF increased from 49.9% ± 2.4% to 52.6% ± 2.0%, and HADS score decreased from 13.5 ± 1.8 to 8.7 ± 1.4 (all P < 0.001). Body mass index and systolic blood pressure also decreased from baseline (P = 0.033 and P < 0.001, respectively). Age, sex, and completion of individual program components were not significantly associated with Δ6MWD (all P > 0.05). No acute coronary events, worsening heart failure, or serious adverse events occurred during rehabilitation. Conclusion: The family physician-managed, EECP-assisted, community-based phase III cardiac rehabilitation program demonstrated good implementation feasibility, with no serious adverse events observed. Exercise capacity, disease-specific quality of life, and selected health indicators improved after 12 weeks. These findings provide a practical basis for further multicenter controlled studies.