目的：评估远程监护指导慢性心力衰竭患者康复训练的临床应用价值。方法将100例慢性心力衰竭患者随机分为试验组(50例)和对照组(50例),对照组在常规药物治疗的基础上于家中或社区实施康复训练；试验组在对照组的基础上根据心脏远程监护结果指导康复训练。试验组和对照组分别应用心脏远程监护和常规心电图检查检测心肌缺血,记录检出率,并比较两组患者治疗32 w 后的6 min 步行距离、生活质量评分和再入院率、死亡率。结果随访32 w,试验组发现无症状性心肌缺血34例,检出率为68%；对照组发现无症状性心肌缺血12例,检出率为26%,试验组检出率明显高于对照组(X2=3.581,P =0.023)；试验组在心脏远程监护指导下进行康复训练,出现胸闷、憋气、呼吸急促症状患者15例(30.0%),对照组出现胸闷、憋气、呼吸急促症状患者27例(54.0%),试验组明显少于对照组(X2=4.303,P =0.031)。康复训练治疗32 w 后,试验组与对照组比较,平均6 min 步行距离[(441.75±39.02)m 比(391.25±63.31)m,t =4.721,P =0.032]、生活质量评分(43.26±9.61比55.83±6.42,t =8.132,P =0.043)、再入院率(18%比32%,t =6.412,P =0.020),差异均有统计学意义,但死亡率差异无统计学意义(0比4%,P =0.893)。结论心脏远程监护指导慢性心力衰竭患者的康复训练能够增加康复训练的安全性,明显改善患者运动耐力,减少再入院,提高生活质量,具有较高的临床应用价值。%Objective To explore the application value of cardiac remote monitoring in rehabilitation training with chronic heart failure patients. Methods A total of 100 chronic heart failure patients who came from Jinan luo-yuan, er-qi, and other eight communities from January 2011 to January 2012 were randomly divided into two groups, the experimental group ( n = 50, received usual exercise training) and the control group ( n = 50, received cardiac remote monitoring based on usual exercise training). Period of treatment was 32 weeks. The experimental group and the control group respectively applying cardiac remote monitoring and normal ECG examination to detect myocardial ischemia, and record the detection rate. The 6 minutes walking distance ( 6MWD), quality of life score, readmission and mortality rate were compared between the two groups after 32 weeks. Results During the follow-up period, the experimental group found 34 cases of asymptomatic myocardial ischemia, the detection rate was 68% , and the control group found 12 cases of asymptomatic myocardial ischemia, the detection rate was 26% (X2= 3. 581, P = 0. 023). There were 15 patients with symptoms of chest tightness, suffocation and shortness of breath in experimental group, and 27 patients in control group (30% vs. 54% , X2 = 4. 303, P = 0. 031). After 32 weeks of treatment, compared with control group, the 6MWD was significantly increased [(441. 75 ± 39. 02) m vs. (391. 25 ± 63. 31) m, t = 4. 721, P = 0. 032], quality of life score was significantly decreased (43. 26 ± 9. 61 vs. 55. 83 ± 6. 42, t = 8. 132, P = 0. 043) and readmission rate was significantly decreased (18% vs. 32% , t = 6. 412, P = 0. 020) in experimental group. There was no significant difference in mortality rate between the two groups (0 vs. 4% , P = 0. 893). Conclusions The guidance of remote monitoring can increase the security of rehabilitation training for the patients with chronic heart failure, and improve the exercise endurance, reduce readmission rate, improve the quality of life significantly, it has a high value in clinical application.
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