Influence of exercise rehabilitation nursing intervention on cardiac function and knowledge-attitude-practice level in patients with acute myocardial infarction after PCI
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摘要:
目的 评价运动康复护理干预在改善急性心肌梗死（AMI）经皮冠状动脉介入治疗（PCI）术后患者心功能、运动情况及知信行水平中的应用效果。 方法 选取2023年4月—2025年1月杭州市第九人民医院收治的94例AMI行PCI术患者。按照不同康复护理干预方法分为观察组（常规康复护理+运动康复护理干预，48例）和对照组（行常规康复护理干预，46例），比较2组心功能指标[左室射血分数（LVEF）、左室整体纵向应变（GLS）、每搏输出量（SV）]、运动行为[6分钟步行距离、国际体力活动短问卷（IPAQ-SF）]、知信行水平（AMI患者知信行评估量表）及主要不良心血管事件（MACE）发生率。 结果 出院后3个月，观察组LVEF[（58.19±5.42）% vs.（55.84±5.18）%]、SV[（57.96±10.45）mL vs. (53.14±11.63)mL]、GLS（-14.22±2.63 vs. -12.87±3.12）均优于对照组（t=2.147、2.115、2.272，均P < 0.05），且观察组干预前后的LVEF、GLS、SV差值均大于对照组（P < 0.05）；观察组6分钟步行距离长于对照组，IPAQ-SF高于对照组（P < 0.05）；观察组知信行评估量表各维度得分均高于对照组（P < 0.05）；观察组干预前后的IPAQ-SF、6分钟步行距离和知信行评估量表各维度得分差值均大于对照组（P < 0.05）；2组MACE总发生率差异无统计学意义（P>0.05）。 结论 对AMI行PCI术后患者实施运动康复护理干预，能有效改善其心功能、运动行为、知信行水平，且未增加MACE风险，值得推广。 Abstract:Objective To evaluate the effect of exercise rehabilitation nursing intervention on improving cardiac function, exercise condition, and knowledge-attitude-practice level in patients with acute myocardial infarction (AMI) following percutaneous coronary intervention (PCI). Methods A total of 94 patients with AMI who underwent PCI in Hangzhou Ninth People' s Hospital from April 2023 to January 2025 were selected. According to rehabilitation nursing intervention methods, the patients were classified into an observation group (routine rehabilitation nursing and exercise rehabilitation nursing intervention, n=48) and a control group (routine rehabilitation nursing intervention, n=46). The cardiac function indexes [left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (GLS), stroke volume (SV)], exercise behavior [6-minute walking distance, international physical activity questionnaire-short-form (IPAQ-SF)], knowledge-attitude-practice level (knowledge-attitude-practice assessment scale for patients with acute myocardial infarction), and incidence rates of major adverse cardiovascular events (MACE) were compared between groups. Results At 3 months after discharge, the observation group showed significantly higher LVEF [(58.19±5.42)% vs. (55.84±5.18)%], SV [(57.96±10.45) mL vs. (53.14±11.63) mL], and GLS (-14.22±2.63 vs. -12.87± 3.12) compared to control group (t=2.147, 2.115, 2.272, all P < 0.05). The pre- and post-intervention changes in LVEF, GLS, and SV in the observation group were also greater in the observation group (P < 0.05). The 6-min walking distance and IPAQ-SF in the observation group were higher than those in the control group (P < 0.05). The observation group showed higher scores of dimensions of knowledge-attitude-practice assessment scale (P < 0.05). Improvements in IPAQ-SF, 6-minute walking distance, and scores of dimensions of knowledge-attitude-practice assessment scale in the observation group before and after intervention were greater than those in the control group (P < 0.05). There was no statistical difference in the overall incidence rate of MACE between groups (P>0.05). Conclusion The implementation of exercise rehabilitation nursing intervention for patients with AMI after PCI can effectively improve cardiac function, exercise behavior, and knowledge-attitude-practice level without increasing the risk of MACE. -
表 1 2组AMI患者临床资料比较
Table 1. Comparison of clinical data between two groups of AMI patients
项目 观察组(n=48) 对照组(n=46) 统计量 P值 性别[例(%)] 0.135a 0.713 男性 32(66.67) 29(63.04) 女性 16(33.33) 17(36.96) 年龄(x±s，岁) 57.72±8.24 56.46±7.52 0.773b 0.441 NYHA分级[例(%)] 0.336c 0.737 Ⅰ级 11(22.92) 12(26.09) Ⅱ级 28(58.33) 26(56.52) Ⅲ级 9(18.75) 8(17.39) 梗死部位[例(%)] 0.357a 0.837 前壁 21(43.75) 18(39.13) 下壁 15(31.25) 17(36.96) 其他 12(25.00) 11(23.91) 合并症[例(%)] 高血压 29(60.42) 27(58.70) 0.029a 0.865 糖尿病 14(29.17) 12(26.09) 0.111a 0.739 高血脂 21(43.75) 24(52.17) 0.668a 0.414 注：a为χ2值，b为t值，c为Z值。 
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表 2 2组AMI患者干预前后心功能比较(x±s)
Table 2. Comparison of cardiac function between two groups of AMI patients before and after intervention(x±s)
组别 例数 LVEF(%) GLS SV(mL) 干预前 干预后 差值 干预前 干预后 差值 干预前 干预后 差值 观察组 48 53.48±5.34 58.19±5.42a 4.71±1.02 -11.67±3.24 -14.22±2.63a 2.55±0.62 50.68±11.24 57.96±10.45a 7.28±2.03 对照组 46 52.79±6.07 55.84±5.18a 3.05±0.98 -12.04±3.43 -12.87±3.12 0.83±0.25 51.12±11.97 53.14±11.63 2.02±0.59 t值 0.586 2.147 8.040 0.538 2.272 17.498 0.184 2.115 16.900 P值 0.559 0.034 < 0.001 0.592 0.025 < 0.001 0.855 0.037 < 0.001 注：与同组干预前比较，aP < 0.05。
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表 3 2组AMI患者干预前后运动行为比较(x±s)
Table 3. Comparison of exercise behavior between two groups of AMI patients before and after intervention(x±s)
组别 例数 IPAQ-SF(MET-min/week) 6分钟步行距离(m) 干预前 干预后 差值 干预前 干预后 差值 观察组 48 1 552.64±324.62 2 057.81±467.28a 505.17±125.32 284.56±34.72 325.48±41.34a 40.92±11.38 对照组 46 1 517.68±316.24 1 856.74±424.61a 339.06±102.41 286.43±35.24 304.47±42.36a 18.04±5.17 t值 0.529 2.180 7.020 0.259 2.434 12.458 P值 0.598 0.032 < 0.001 0.796 0.017 < 0.001 注：与同组干预前比较，aP < 0.05。
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表 4 2组AMI患者干预前后知信行评分比较(x±s，分)
Table 4. Comparison of Knowledge-attitude-practice scores between two groups of AMI patients before and after intervention(x±s, points)
组别 例数 健康行为 知识 健康信念 干预前 干预后 差值 干预前 干预后 差值 干预前 干预后 差值 观察组 48 4.86±1.36 6.48±1.14a 1.62±0.41 25.06±3.09 28.18±2.47a 3.12±0.96 3.51±0.76 4.62±0.84a 1.11±0.29 对照组 46 4.72±1.21 5.85±1.32a 1.13±0.32 25.28±3.22 26.74±2.64a 1.46±0.34 3.62±0.58 4.14±0.93a 0.52±0.12 t值 0.526 2.480 6.440 0.338 2.732 11.079 0.786 2.628 12.787 P值 0.600 0.015 < 0.001 0.736 0.008 < 0.001 0.434 0.010 < 0.001 注：与同组干预前比较，aP < 0.05。
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表 5 2组AMI患者MACE发生率比较[例(%)]
Table 5. Comparison of MACE incidence rates between two groups of AMI patients[cases(%)]
组别 例数 心源性死亡 再发心肌梗死 靶血管再次血运重建 心力衰竭再入院 总MACE 观察组 48 0 0 1(2.08) 1(2.08) 2(4.17) 对照组 46 0 1(2.17) 2(4.35) 2(4.35) 5(10.87) 注：2组总MACE发生率比较，χ2=0.713, P=0.398。
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