孙凤媛 冯冬青 王雪梅 王冬梅 石艳辉

[摘要] 目的：探讨运动康复及心理干预对扩张型心肌病心力衰竭的影响。方法：回顾性分析我院2005年1月~2010年1月收治的扩张型心肌病患者100例临床资料，随机分为试验组和对照组，每组各50例。试验组实施运动康复治疗及心理干预，对照组进行常规治疗及健康宣教，评定两组患者并发症的发生情况。结果：随访1年中，试验组6 min步行试验完成50例，对照组完成42例，两组比较，差异有统计学意义（χ2=6.54，P<0.05）；试验组完成6 min步行试验平均距离为（207.66±36.48）m，对照组平均距离为（178.25±27.41） m，试验组明显高于对照组，差异有高度统计学意义（χ2=1.65，P<0.01）；两组患者LVEDD、LVEF等心功能指标进行性改善与干预前比较，差异有统计学意义（P<0.05）；试验组干预后心功能LVEDD、LVEF等指标分别为（55.08±5.71）mm和（45.68±4.57）%，对照组分别为（62.68±6.82）mm和（32.42±3.28）%，两组比较，差异具有统计学意义（t=3.67、t=3.092，均P<0.05）；试验组再住院5例，无死亡病例，对照组再住院20例，死亡2例，两组比较，差异具有统计学意义（χ2=8.16、4.35，均P<0.05）。结论：实施运动康复及心理干预能有效降低扩张型心肌病患者心力衰竭的发生率，提高患者生活质量，降低病死率。

[关键词] 扩张型心肌病；运动康复；心理干预；扩张型心肌病；心力衰竭

[中图分类号] R541.6[文献标识码]A [文章编号]1673-7210（2011）11（c）-126-03

Exercise rehabilitation and psychological intervention on heart failure patients with dilated cardiomyopathy impact

SUN Fengyuan, FENG Dongqing, WANG Xuemei, WANG Dongmei, SHI Yanhui

Department of Prehospital Emergency, the Second Hospital of Qinhuangdao, Hebei Province, Qinhuangdao 066600, China

[Abstract] Objective: To investigate the exercise rehabilitation and psychological intervention on heart failure patients with dilated cardiomyopathy impact. Methods: The clinical dataes of 100 cases dilated cardiomyopathy in our hospital from January 2005 to January 2010 were analysed retrospectively. 100 cases dilated cardiomyopathy were randomly divided into experiment group and control group, each group had 50 cases. The experiment group were implemented exercise rehabilitation and psychological intervention, the control group were implemented conventional treatment and health education, the incidence of complications in two groups were assessed. Results: After the follow-up of 1 year, 50 cases of the experiment group completed the 6 min walk test, 42 cases of the control group completed the 6 min walk test, the difference was significant (χ2=6.54, P<0.05). The average distance of 6 min walk test in experiment group was (207.66±36.48) m, the average distance of 6 min walk test in control group was (178.25±27.41) m, the experiment group was significantly higher, and the difference was significant (χ2=1.65, P<0.01); two groups of patients with LVEDD, LVEF and other heart indicators of improvement had significant differences compared with before intervention (P<0.05), the cardiac function LVEDD, LVEF and other indicators in the experiment group after the intervention respectively were (55.08±5.71) mm, (45.68±4.57)%, the cardiac function LVEDD, LVEF and other indicators in the control group after the intervention respectively were (62.68±6.82) mm, (32.42±3.28)%, the differences were statistically significant (t=3.67, 3.092, all P<0.05). The re-hospitalization cases were 5 cases in the experiment group, with no death case, the re-hospitalization cases were 20 cases in the control group, with 2 deaths (χ2=8.16, 4.35, P<0.05). Conclusion: The implementation of the exercise rehabilitation and psychological intervention can reduce the dilated cardiomyopathy patients′heart failure rate, improve the quality of life of patients and reduce the mortality.

[Key words] Dilated cardiomyopathy; Family nursing intervention; Dilated cardiomyopathy; Heart failure

扩张型心肌病（dilated cardiomyopathy，DC）是原发性心肌病中最常见的类型，占原发性心肌病的70%~80%，其主要特征是以一侧或双侧的心室腔扩大，心肌收缩功能减低，心排血量降低，导致心力衰竭。常伴有心脏扩大、心力衰竭、心律失常和动脉栓塞等，严重者可引起猝死[1-2]。该病病死率较高，预后极差，严重危害人类健康。张晓伟等[3]报道，美国每年有上万人死于扩张型心肌病。因此积极进行预防、治疗和护理，能降低患者的病死率。研究表明，运动康复治疗及心理干预可以减少患者的发病，提高生存能力和生命质量。现将我院收治的扩张型心肌病患者实施运动康复治疗及心理干预取得的效果报道如下：

1 资料与方法

1.1 一般资料

选取我院2005年1月～2010年1月收治的扩张型心肌病患者100例，主要症状以心力衰竭为主，均符合扩张型心肌病心力衰竭的诊断标准[4]，心功能符合纽约心脏病协会（NYHA）分级Ⅱ~Ⅳ级[4]，并排除严重肝肾功能不全、完全性房室传导阻滞、急性心肌梗死、严重心律失常者。……