本文選題：慢性心力衰竭 + 心臟再同步化治療　； 參考：《浙江大學》2016年碩士論文

【摘要】：目的我國心臟病防治仍停留在發(fā)達國家20世紀60年代水平,隨著心臟病發(fā)病率的逐年上升,近10年來國內心臟康復也逐漸發(fā)展和完善,但最要還是集中在冠心病等慢性心血管內科疾病的康復,隨著心血管介入醫(yī)學的發(fā)展,心臟康復治療也從傳統(tǒng)的心血管內科的康復發(fā)展到心血管介人性治療后康復,在國外有研究實踐證明,康復運動治療對于心血管介入術后,從生理、心理、社會等多種角度提高患者的生活質量,有極其重要的意義；在國內目前還沒有關于心臟再同步化治療(cardiac resynchronization therapy,CRT)術后康復的相關研究報道。因此,我們對探討系統(tǒng)康復宣教、專業(yè)康復指導對CRT患者體能、生存質量和心理狀態(tài)的影響做了相關研究。方法選取CRT患者58例,隨機分為康復組(n=28)和對照組(n=30),康復組患者在相關臨床治療、護理宣教的基礎上由康復醫(yī)師進行系統(tǒng)宣教,在建立健康生活方式,改變不良生活習慣及體能、功能鍛煉專業(yè)指導；對照組只進行常規(guī)臨床相關治療和護理宣教。比較兩組患者CRT術后出院時,術后1個月、術后3個月和術后6個月門診定期復診和電話隨訪,在生活方式的轉變,體能(6分鐘步行測試、Borg指數(shù))和生存質量、心理狀態(tài)(SF-36健康調查量表中文版)的差異,以分析不同干預措施對患者的影響。結果CRT術后出院時,術后1個月、術后3個月和術后6個月的門診定期復診和電話隨訪評估中,康復組患者建立良好生活方式達標率更高,體能改善更為明顯(6分鐘步行試驗、Borg指數(shù))(P0.01),SF-36健康調查量表中文版中的軀體功能、一般健康狀況、精力、情感職能和心理健康評分均顯著改善,差異具有統(tǒng)計學意義(P0.01)。三者相輔相成,患者生活質量明顯提高。結論①系統(tǒng)、專業(yè)的康復健康宣教學習對心臟在同步化治療術后患者的干預后,提高慢性心力衰竭患者自我對疾病認識和保健意識,對危險因素的控制更加嚴格,積極建立健康的生活方式,養(yǎng)成良好的生活習慣和心理思維方式,提高CRT術后療效；②康復運動指導,改變患者術后臥床休息的老觀念,增強患者的活動意識,讓患者早期參加活動,體能恢復更快,促進術后恢復,提高生活質量。③系統(tǒng)、專業(yè)的康復健康宣教學習對心臟在同步化治療術后患者的干預后,患者的心理狀況發(fā)生了變化,主要集中在生理機能、生理職能、軀體疼痛、一般健康狀況、精力、社會功能、情感職能以及精神健康等8個方面發(fā)生了變化,生活質量明顯提高。
[Abstract]:Objective the prevention and treatment of heart disease in China is still at the level of the developed countries in the 1960s. With the increase of the incidence of heart disease year by year, the heart rehabilitation in China has gradually developed and improved in the past 10 years. However, it is most important to focus on the rehabilitation of chronic cardiovascular diseases such as coronary heart disease. With the development of cardiovascular interventional medicine, cardiac rehabilitation treatment has also developed from the rehabilitation of traditional cardiovascular medicine to the rehabilitation of cardiovascular mediating humanity. Research practice in foreign countries has proved that rehabilitation exercise therapy is of great significance to improve the quality of life of patients from the aspects of physiology, psychology, society and so on. There are no reports on cardiac resynchronization after (cardiac resynchronization therapy in China. Therefore, we studied the effects of systematic rehabilitation education and professional rehabilitation guidance on the physical ability, quality of life and mental state of CRT patients. Methods Fifty-eight patients with CRT were randomly divided into two groups: rehabilitation group (n = 28) and control group (n = 30). Patients in rehabilitation group were given systematic education by rehabilitation doctors on the basis of related clinical treatment and nursing education, and healthy lifestyle was established. The patients in the control group were given routine clinical treatment and nursing education. To compare the two groups of CRT patients were discharged from hospital, 1 month, 3 months and 6 months after operation, regular follow-up and telephone follow-up, changes in lifestyle, physical fitness (6-minute walking test of Borg index) and quality of life (QOL) were compared between the two groups. Mental state (Chinese version of SF-36 Health Survey scale) to analyze the influence of different intervention measures on patients. Results at the time of discharge after CRT, the rate of establishing a good lifestyle was higher in the rehabilitation group than in the rehabilitation group during the regular follow-up and telephone follow-up at 1 month, 3 months and 6 months after CRT. The improvement of physical fitness (6-minute walking test Borg index) (P0.01) and the Chinese version of SF-36 health survey scale showed significant improvement in physical function, general health status, energy, emotional function and mental health score (P0.01), and the difference was statistically significant (P0.01). The three supplement each other, and the quality of life of the patients is obviously improved. Conclusion (1) systematic, professional rehabilitation and health education for patients with chronic heart failure after synchronous treatment can improve their self-awareness of the disease and health care, and control the risk factors more strictly. We should actively establish a healthy lifestyle, develop good habits of life and mental thinking, improve the curative effect of CRT and improve the rehabilitation exercise guidance, change the old concept of bed rest after CRT, and enhance the activity consciousness of the patients. Let the patients take part in the activities early, recover the physical ability faster, promote the postoperative recovery, improve the quality of life system. The psychological status of the patients has changed after the intervention of the professional rehabilitation health education and study to the patients after the synchronous treatment of the heart. It is mainly focused on 8 aspects, such as physiological function, body pain, general health condition, energy, social function, emotional function and mental health, and the quality of life has been improved obviously.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R473.5

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