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| 急性心肌梗死患者早期康复实践及影响因素分析 |
| 俞莞琦1△,洪雯2△,潘静薇2,黄晓莉2,赵清2,沈虹2,徐可1,沈成兴2* |
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(1. 上海交通大学医学院附属第六人民医院康复医学科, 上海 200233;
2. 上海交通大学医学院附属第六人民医院心内科, 上海 200233
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 探讨急性心肌梗死（AMI）患者住院期间早期康复训练的可行性和影响因素。方法 前瞻性纳入2021年2月至4月上海交通大学医学院附属第六人民医院心脏ICU收治的102例AMI患者。根据病情严重程度和入院后首次下床活动时间将患者分为早期活动组（首次下床活动时间≤48 h）和非早期活动组（首次下床活动时间>48 h），比较两组患者的临床资料和康复治疗数据，记录早期活动的不良事件及阻碍因素。采用多因素logistic回归分析探讨影响AMI患者下床活动时间的危险因素，ROC曲线分析相关指标对下床活动时间的预测价值。结果 102例AMI患者中，101例在出院时成功下床活动，其中62例归入早期活动组，39例归入非早期活动组。与早期活动组相比，非早期活动组患者年龄更大，全球急性冠状动脉事件登记（GRACE）评分更高，左心室射血分数（LVEF）更低，前壁心肌梗死占比更高，吸烟者占比更高，合并肾脏疾病和高脂血症者占比更高，辅助治疗措施应用更多，住院时间更长（P均<0.05）。多因素logistic回归分析结果显示高GRACE评分和低LVEF是影响早期下床活动的独立危险因素（OR=0.960，95% CI 0.939～0.981，P<0.001；OR=1.139，95% CI 1.038～1.251，P=0.006）。ROC曲线分析显示GRACE评分可作为AMI患者能否早期下床活动的预测因子（AUC=0.833，95% CI 0.742～0.924，P<0.001），其最佳临界值为167分（灵敏度为0.650，特异度为0.986）。结论 对AMI患者进行危险因素分级并实施早期康复训练安全、可行，GRACE评分和LVEF可作为判断能否实施早期康复训练的有效指标。 |
| 关键词: 急性心肌梗死 Ⅰ期心脏康复 早期活动 心脏重症监护 经皮冠状动脉介入术 |
| DOI：10.16781/j.CN31-2187/R.20220070 |
| 投稿时间：2022-01-18修订日期：2022-04-29 |
| 基金项目:上海市科学技术委员会科技创新行动计划（21Y1909400）. |
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| Early mobilization and its influencing factors in patients with acute myocardial infraction |
| YU Wan-qi1△,HONG Wen2△,PAN Jing-wei2,HUANG Xiao-li2,ZHAO Qing2,SHEN Hong2,XU Ke1,SHEN Cheng-xing2* |
(1. Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China;
2. Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To investigate the feasibility and influencing factors of early mobilization in acute myocardial infarction (AMI) patients. Methods A total of 102 AMI patients who were admitted to the cardiac intensive care unit of Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine were prospectively enrolled from Feb. to Apr. 2021. The patients were divided into early mobilization group (the time of admission to the first mobilization ≤ 48 h) and non-early mobilization group (the time of admission to the first mobilization>48 h) according to the severity of the patient's condition and the time of admission to the first mobilization. The clinical data and rehabilitation data of patients in the 2 groups were compared, and the adverse events and barriers to early mobilization were recorded. Multivariate logistic regression analysis was used to explore the risk factors affecting the time of early mobilization, and receiver operating characteristic (ROC) curve analysis was used to analyze the predictive value of related indicators on the time of early mobilization. Results Among 102 AMI patients, 101 were successfully mobilized at the time of discharge, of which 62 were included in the early mobilization group and 39 in the non-early mobilization group. Compared with that in the early mobilization group, the patients in the non-early mobilization group were older, had higher Global Registry of Acute Coronary Events (GRACE) score, lower left ventricular ejection fraction (LVEF), a higher proportion of anterior myocardial infarction, more smokers, more renal diseases and hyperlipidemia, more adjuvant therapy, and longer hospital stay (all P<0.05). Multivariate logistic regression analysis showed that high GRACE score and low LVEF were independent risk factors for early mobilization (odds ratio[OR]=0.960, 95% confidence interval[CI] 0.939-0.981, P<0.001; OR=1.139, 95% CI 1.038-1.251, P=0.006). ROC curve analysis showed that GRACE score could be used as a predictor for early mobilization of AMI patients (area under curve[AUC]=0.833, 95% CI 0.742-0.924, P<0.001), and the optimal cut-off value was 167 (sensitivity 0.650, specificity 0.986). Conclusion It is safe and feasible to grade the risk factors of AMI patients and implement early rehabilitation training. GRACE score and LVEF can be used as effective indicators to judge whether early rehabilitation training can be implemented. |
| Key words: acute myocardial infarction phaseⅠ cardiac rehabilitation early mobilization cardiac intensive care percutaneous coronary intervention |
