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急性ST節段升高之心肌梗塞患者第一期心臟復健

Phase I Cardiac Rehabilitation among Patients with Acute ST-Elevation Myocardial Infarction

摘要


急性心肌梗塞病人接受經皮冠狀動脈介入性治療(percutaneous coronary interventions)後,在住院中所接受之復健,屬第一期心臟復健(phase I cardiac rehabilitation)。本研究之目的是想了解並探討急性ST節段升高性心肌梗塞(ST-elevation myocardial infarction)患者接受第一期心臟復健之現況,做為日後發展及改進此類病患第一期心臟復健之參考。本研究以回溯性病歷回顧方式分析2009年12月至2010年3月於臺大醫院心臟內科加護病房住院之30位ST節段升高性心肌梗塞病患之資料,分析其接受經皮冠狀動脈介入性治療後,接受第一期心臟復健及後續追蹤之情況。結果發現在30位ST節段升高性心肌梗塞患者中,共28位(93.3%)照會復健部並接受第一期心臟復健,其總住院日數平均為5.2±2.0天。患者住入加護病房至照會復健部平均為20.7±17.9小時,照會復健部至復健部醫師評估平均為7.1±13.9小時,復健部醫師評估完成至病患接受第一次物理治療平均為20.6±17.3小時,患者接受物理治療總次數平均為2.0±1.1次,治療次數與一般病房及總住院天數成正相關(相關係數0.559及0.461)。治療頻率為0.4±0.2次/天,扣除週末後之治療頻率增加為0.5±0.2次/天。所有病患在接受心臟復健時沒有發生不適症狀。患者出院後有27人(90%)於心臟內科門診接受追蹤治療,但接受第二期門診心臟復健者僅有2人(6.7%)。本研究呈現ST節段升高性心肌梗塞患者於經皮冠狀動脈介入性治療後接受第一期心臟復健比率超過九成,患者住入心臟加護病房至接受第一次心臟復健治療之時間間距較長,患者出院後之第二期心臟復健參與率不高。建議未來應改善照會流程、假日提供心臟復健服務、並加強宣導出院後第二期心臟復健之重要性。(台灣復健醫誌2012;40(1):25-33)

並列摘要


Background and Purpose: Phase I cardiac rehabilitation (CR) programs have been shown to be effective and beneficial for patients with acute myocardial infarction. However, only few studies have evaluated the determinants of treatment frequency in phase I CR. The aim of this study was to investigate the current administration of phase I CR for patients who have acute ST-elevation myocardial infarction (STEMI) and have undergone percutaneous coronary intervention (PCI) in a medical center in Taiwan.Methods: We retrospectively reviewed the medical records of 30 patients with STEMI who were admitted to the coronary care unit (CCU) between December 2009 and March 2010 in order to examine details about the consultation process and these patient's participation in phase I and phase II CR.Results: Twenty-eight patients (93.3%) with STEMI participated in phase I CR after PCI. The mean duration of hospital stay was 5.2 days. The mean durations from admission to consultation, for completing consultation, and for initiating therapy after exercise prescription were 20.7 hours, 7.1 hours, and 20.6 hours, respectively. The mean total treatment time was 2 times (range: 0-5 times), and it correlated with the patient's duration of stay in the general ward and the total duration of hospitalization (R = 0.559 and 0.461, respectively). The treatment frequency was 0.4 times/day inclusive of holidays and increased to 0.52 times/day after the exclusion of holidays. The prolonged waiting period for the first CR treatment negatively correlated with the total treatment times and treatment frequency in the cardiac intensive care unit and with the total duration of hospitalization. None of the patients in our study presented with cardiac complications during phase I CR. Twenty-seven (90%) patients continued regular follow-ups at clinics of cardiology; however, only 2 patients (6.7%) entered phase II CR.Conclusions: Most STEMI patients who underwent primary PCI participated in the phase I CR program. The frequency of attending phase I CR program correlated with the duration of hospitalization but not with the Killip classification or left ventricular ejection fraction. The participation rate in phase II CR was very low. To improve treatment frequency, facilitation of the consultation process and provision of treatment even on holidays must be considered. It is important that STEMI patients and cardiologists are made aware of the benefits of outpatient CR in order to increase participation in phase II CR programs. ( Tw J Phys Med Rehabil 2012; 40(1): 25 - 33 )

被引用紀錄


洪慧霞、陳淑華、馬瑞菊(2019)。一位心衰竭第三期病人之照護經驗領導護理20(3),52-64。https://doi.org/10.29494%2fLN.201909_20(3).0005
蘇淑貞(2016)。執行經皮冠狀動脈介入治療的中年男性患者之運動健康信念與身體活動之相關性〔碩士論文,長榮大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0015-2301201615213500

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