标题：术前心脏康复干预联合动机访谈对重症瓣膜病患者心肌功能、生活质量及WIC的影响

      作者：李碧波，朱韦霞，卜雪莉    上海市瑞金医院北院重症医学科，上海 201801

      卷次： 2020年31卷6期

      【摘要】 目的 分析在重症瓣膜病患者中应用术前心脏康复干预联合动机访谈对患者心肌功能、生活质量及查尔森基础疾病权重指数(WIC)的影响。方法 将2018年9月至2019年9月在上海市瑞金医院北院重症医学科接受治疗的80例重症瓣膜病患者纳入研究，并通过数字随机表法分为对照组和观察组各40例，对照组患者给予常规护理，观察组患者给予术前心脏康复干预联合动机访谈。比较两组患者术后的临床指标，检测左室射血分数(LVEF)、左房容积指数(LAVI)、舒张前期二尖瓣血流速度与舒张前期二尖瓣环运动速度比(E/e′)；通过Barthel指数评估患者术后日常生活能力及6 min步行实验(6MWT)情况；通过SF-36量表评价患者术后生活质量；采用查尔森基础疾病权重指数(WIC)评估患者预后效果。结果 两组患者在机械通气时间、ICU停留时间、住院时间和并发症方面比较，差异均无统计学意义(P>0.05)；观察组患者术后LVEF、LAVI、E/e′分别为(60.64±5.51)%、(28.24±4.57) mL/m2、(9.57±3.28)，对照组分别为(51.68±6.54)%、(31.64±6.23) mL/m2、(912.28±3.16)，观察组明显优于对照组，差异均具有统计学意义(P<0.05)；观察组患者术后Barthel指数和 6WMT分别为(80.14±6.83)分、(319.11±48.86) m，明显高于对照组的(75.24±7.43)分、(287.34±62.71) m，差异均具有统计学意义(P<0.05)；观察组患者的术后生活质量各项评分明显高于对照组，差异均具有统计学意义(P<0.05)；观察组患者术后WIC评分为(0.81±1.21)分，明显低于对照组的(1.83±1.36)分，差异均具有统计学意义(P<0.05)。结论 术前心脏康复干预联合动机访应用于重症瓣膜病患者中，能够有效增强患者的心肌功能，加强运动耐量，提升生活自理能力，明显改善预后，具有较高的应用价值。
      【关键词】 心脏康复干预；心肌功能；重症瓣膜病；动机访谈；生活质量
      【中图分类号】 R473.6 【文献标识码】 A 【文章编号】 1003—6350（2020）06—0813—04

Effect of preoperative cardiac rehabilitation intervention combined with motivational interviewing on myocardialfunction, quality of life and Charlson's weighted index of comorbidities in patients with severe valvular disease.LI Bi-bo, ZHU Wei-xia，PU Xue-li.
Department of Critical Medicine, the North Hospital of Shanghai Ruijin Hospital,Shanghai 201801, CHINA
【Abstract】 Objective To analyze the effect of preoperative cardiac rehabilitation intervention combined withmotivational interviewings on myocardial function, quality of life, and Charlson's weighted index of comorbidities(WIC) in patients with severe valvular disease. Methods Eighty patients with severe valvular disease, who admitted toDepartment of Critical Medicine of the North Hospital of Shanghai Ruijin Hospital from September 2018 to September2019, were selected and divided into the control group and the observation group according to random number tablemethod, with 40 cases in each group. The patients in the control group were given routine care, and the patients in the ob-servation group were given preoperative cardiac rehabilitation interventions combined with motivational interviewings.The clinical indicators, including left ventricular ejection fraction (LVEF), left atrial volume index (LAVI), pre-diastolicmitral valve blood flow velocity and pre-diastolic mitral annulus motion velocity ratio (E/e') of the two groups were com-pared and investigated; Barthel index was used to evaluate patients' postoperative daily living ability and 6-minute walk-ing test (6MWT); SF-36 was used to evaluate and observe patients' postoperative quality of life; Charlson's weighted in-dex of comorbidities was used to evaluate the patients' prognosis. Results The results of the two groups of patientsshowed that there was no significant difference between the two groups in terms of mechanical ventilation time, ICUstay time, length of hospital stay, and complications (all P>0.05); After the treatment, LVEF, LAVI, E/e' of the observa-tion group were (60.64±5.51)%, (28.24±4.57) mL/m2, 9.57±3.28, respectively, which were significantly better than corre-sponding (51.68±6.54)%, (31.64±6.23) mL/m2, 912.28±3.16 of the control group (all P<0.05). Barthel index and 6WMTin the observation group were (80.14±6.83) points and (319.11±48.86) m, which were significantly higher than corre-sponding (75.24±7.43) points and (287.34±62.71) m in the control group (P<0.05). The scores of postoperative qualityof life in the observation group were significantly higher than those in the control group (P<0.05); the postoperative WICscore of the observation group was (0.81±1.21) points, which was significantly lower than (1.83±1.36) points in the con-·护理·doi:10.3969/j.issn.1003-6350.2020.06.039