以运动为核心的心衰管理对心衰患者预后的影响

Effect of Exercise-Centered Heart Failure Management on the Prognosis of Patients with Heart Failure

摘要: 目的：观察以运动康复为主导的心衰管理对于患者的心功能，心肺耐力以及再住院率的影响。 方法：纳入2021年9月~2022年11月在宁夏第五人民医院住院的心力衰竭患者，NAHY分级II~IV级，作为研究对象，在常规抗心衰治疗病情稳定好转出院以后，定时随访，严格容量管理，规律服用改善心衰预后的药物基础上，根据是否给予运动康复为主导的心脏康复将患者分成两组，即对照组和康复组。记录入选患者的一般临床资料，包括年龄，性别，心衰时间，合并症情况和服药情况，观察6个月，对比两组患者心率，血压(收缩压)，血氧饱和度。心脏超声的左室射血分数(EF值)，6分钟步行实验距离，以及患者的预后情况，包括6个月内再住院率情况和健康调查12条(SF-12)得分情况。结果：研究共纳入患者84例，对照组42例，康复组42例，两组患者在年龄，性别，BMI值，吸烟饮酒史以及生命体征包括血压、心率、血氧饱和度，心衰患病病程差异无统计学意义(P > 0.05)，在合并高血压、糖尿病、冠心病以及服用改善心衰预后的药物方面差异无统计学意义(P > 0.05)。随访6个月，与对照组比较，康复组心率更低、血氧饱和度更高、N末端B-型脑利钠肽前体浓度下降更明显，6分钟步行试验距离更远(P < 0.05)，SF-12各维度得分均有明显改善(P < 0.001)差异有统计学意义。康复组EF值有轻度提高，但是与对照组比较差异无统计学意义。结论：以运动康复为主导的心衰管理对心衰患者的心肺耐力有明显改善，在日常生活质量方面也有明显的提高，进一步降低了患者的再住院率。

Abstract: Objective: To observe the effect of heart failure management led by sports rehabilitation on cardiac function, cardiorespiratory endurance and rehospitalization rate. Methods: Patient with heart fail-ure hospitalized in Ningxia Fifth People’s Hospital from September 2021 to November 2022, with NAHY grade II~IV was enrolled as the research subject, and after the condition improved steadily with conventional anti-heart failure therapy and was discharged. On the basis of regular follow-up, strict volume management, and regular use of drugs to improve the prognosis of heart failure, pa-tients were divided into two groups according to whether or not to give cardiac rehabilitation led by exercise rehabilitation, namely the control group and the rehabilitation group. The general clinical data of the selected patients, including age, sex, duration of heart failure, comorbidities and drug use, were recorded and observed for 6 months, comparing heart rate, blood pressure (systolic blood pressure), and blood oxygen saturation between the two groups. Left ventricular ejection fraction (EF value), 6-minute walking distance, and some indicators of the patient’s prognosis, including re-hospitalization rates within 6 months and health questionnaires 12 (SF-12) Score situation. Results: A total of 84 patients were included, 42 in the control group and 42 in the rehabilitation group. Age, sex, BMI values, history of smoking and drinking, and vital signs including blood pressure, heart rate, oxygen saturation, and heart failure course were not statistically significant (P > 0.05). There were no significant differences in diabetes, coronary heart disease, and drugs taken to improve the prognosis of heart failure (P > 0.05). At 6 months of follow-up, the rehabilitation group had a lower heart rate, higher oxygen saturation, and the concentration of N-terminal B-type brain natriuretic peptide precursors decreased more significantly compared with the control group. And the 6-minute walk test distance was longer (P < 0.05), and the scores of SF-12 in all dimensions were significantly improved (P < 0.001). The difference was statistically significant. The EF value in the rehabilitation group increased slightly, but there was no significant difference compared with the control group. Conclusion: Heart failure management led by sports rehabilitation can significantly improve cardiorespiratory endurance in patients with heart failure, and also improve the quality of daily life, further reducing patient rehospitalization.