Efficacy and safety of home-based exercise rehabilitation in chronic heart failure with reduced ejection fraction patients under the guidance of remote cardiogram monitoring
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摘要: 目的 探讨远程心电监护指导下慢性射血分数降低型心力衰竭(HFrEF)患者进行家庭心脏康复的疗效及安全性。方法 100例HFrEF患者被随机分入基础对照组和家庭康复组。基础对照组维持标准抗心力衰竭药物治疗，家庭康复组患者在药物治疗基础上，同时接受远程心电监护指导下的家庭运动康复，随访时间6个月。比较2组患者治疗前后心功能、心肺运动能力和生活质量变化以及再住院率和安全性差异。结果 最终完成随访且资料完整者88例，其中基础对照组47例，家庭康复组41例。与治疗前比较，2组患者治疗后心功能、心肺运动能力及6 min步行距离显著提高，心率储备增加，明尼苏达心力衰竭生活质量表(MLHFQ)积分下降(P< 0.01)。与基础对照组相比，家庭康复组心功能和心肺运动能力、心率储备及MLHFQ积分均显著改善(P< 0.05)，6个月内再住院率显著降低(P=0.033)，2组主要不良心血管事件发生率差异无统计学意义(P=0.466)。结论 与单纯药物治疗相比，联合远程心电监护指导下的家庭运动康复在维护患者安全性的同时，能够进一步提高患者心功能和心肺运动能力，增加心率储备，改善患者生活质量，降低患者再住院率。Abstract: Objective To investigate the efficacy and safety of home-based cardiac rehabilitation in chronic heart failure with reduced ejection fraction (HFrEF) patients under the guidance of remote cardiogram monitoring.Methods One hundred HFrEF patients were randomly divided into the basic control group (Group C) and the home-based exercise rehabilitation group (Group R). Patients in the Group C maintained standard anti-heart failure drug treatment, while the patients in Group R received home-based exercise rehabilitation under the guidance of remote cardiogram monitoring on the basis of the drug treatment. The follow-up period was 6 months. The changes in cardiopulmonary exercise capacity, cardiac function, and life quality, as well as the differences in rehospitalization rate and safety between the two groups before and after treatment were compared.Results In the end, 88 cases with full data completed the follow-up, including 47 cases in Group C and 41 cases in the group R. The cardiac function, cardiopulmonary exercise capacity, and 6-min walking distance were all significantly increased compared with those before treatment (allP< 0.01).In addition, the heart rate reserves significantly increased and Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores decreased significantly in the two groups after treatment(allP< 0.01). The cardiac function, cardiopulmonary exercise capacity, heart rate reserve (HRR), and MLHFQ scores of patients in the Group R were further significantly improved compared with those in Group C(P< 0.05,P< 0.01). The rehospitalization rate within 6 months in the Group R was significantly lower than that in Group C(P=0.033), and there was no significant difference in the incidence of major adverse cardiovascular events between the two groups(P=0.466).Conclusion Compared with medication therapy alone, combination treatment with home-based exercise rehabilitation under the guidance of remote cardiogram monitoring can further improve the patients' heart function and cardiopulmonary exercise capacity, increase HRR, improve life quality, and reduce readmission rates while maintaining the safety of the patients.
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表 1 2组治疗前基础资料比较
Table 1. Comparison of the basic data between the two groups before treatment
例(%), X±S 项目 基础对照组
(47例)家庭康复组
(41例)χ2/t P 男/女 31/16 27/14 0.046 0.830 年龄/岁 59.9±11.9 60.7±11.7 0.321 0.749 疾病构成 0.599 0.897 扩张型心肌病 20(42.6) 18(43.9) 冠心病 18(38.3) 14(34.1) 瓣膜性心脏病 7(14.9) 8(19.5) 酒精性心肌病 2(4.3) 1(2.4) NYHA分级 0.014 0.906 NYHAⅡ级 19(40.4) 17(41.5) NYHAⅢ级 28(59.6) 24(58.5) 基础用药 ARNI 44(93.6) 37(90.2) 0.036 0.851 β受体阻滞剂 42(89.4) 36(87.8) 0.012 0.915 地高辛 21(44.7) 19(46.3) 0.003 0.953 排钾利尿剂 41(87.2) 37(90.2) 0.012 0.915 螺内酯 41(87.2) 37(90.2) 0.012 0.915 ARNI：血管紧张素受体脑啡肽酶抑制剂。 
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表 2 2组治疗前后心功能指标比较
Table 2. Comparison of the cardiac function indexes between the two groups before and after treatment
X±S 指标 基础对照组(47例) 家庭康复组(41例) t P LVEF/% 治疗前 32.72±4.24 31.95±5.39 0.751 0.455 治疗后 35.77±4.84 39.29±5.12 3.322 0.001 t -11.554 -18.120 P < 0.001 < 0.001 LVESD/mm 治疗前 50.62±5.50 49.63±5.94 0.806 0.422 治疗后 47.92±5.54 43.44±5.70 3.729 < 0.001 t 21.602 32.271 P < 0.001 < 0.001 LVEDD/mm 治疗前 61.17±6.04 60.73±5.64 0.350 0.727 治疗后 58.32±6.30 55.51±5.13 2.270 0.026 t 16.081 22.659 P < 0.001 < 0.001 NT-proBNP/(μg·L-1) 治疗前 2957.09±756.98 3030.07±824.32 0.433 0.666 治疗后 1830.23±636.61 1223.46±520.16 4.851 < 0.001 t 22.619 24.883 P < 0.001 < 0.001
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表 3 2组治疗前后心肺运动指标比较
Table 3. Comparison of the cardiopulmonary exercise capacity indicators between the two groups before and after treatment
X±S 指标 基础对照组(29例) 家庭康复组(27例) t P VO2at AT /(mL·min-1·kg-1) 治疗前 11.37±2.21 10.87±2.08 0.882 0.382 治疗后 12.64±2.27 14.12±2.36 2.170 0.034 t 3.527 9.729 P 0.001 < 0.001 VO2peak/(mL·min-1·kg-1) 治疗前 19.06±2.41 18.66±2.96 0.560 0.578 治疗后 22.10±3.26 24.17±2.58 2.625 0.011 t 6.014 17.730 P < 0.001 < 0.001 无氧阈值功率/W 治疗前 62.31±13.89 63.59±13.14 0.354 0.725 治疗后 71.86±13.05 79.67±14.64 2.109 0.040 t 10.553 18.679 P < 0.001 < 0.001 最大功率/W 治疗前 89.86±16.34 88.85±11.61 0.265 0.792 治疗后 94.52±15.53 102.26±10.49 2.169 0.034 t 9.720 20.56 P < 0.001 < 0.001 力竭时间/min 治疗前 14.11±3.60 13.41±3.25 0.756 0.453 治疗后 16.49±4.20 18.55±3.27 2.037 0.047 t 11.203 27.362 P < 0.001 < 0.001
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表 4 2组治疗前后6 min步行距离、HRR及MLHFQ评分比较
Table 4. Comparison of the 6-min walking distance, heart rate reserve and MLHFQ scores between the two groups before and after treatment
X±S 指标 基础对照组(47例) 家庭康复组(41例) t P 6 min步行距离/m 治疗前 284.36±65.76 281.34±70.33 0.208 0.836 治疗后 344.55±64.59 387.39±65.70 3.079 0.003 t 18.384 37.457 P < 0.001 < 0.001 HRR/(次·min-1) 治疗前 44.51±13.76 45.95±13.46 0.495 0.622 治疗后 51.09±13.47 57.27±13.24 2.165 0.033 t 12.864 25.427 P < 0.001 < 0.001 MLHFQ评分/分 治疗前 48.36±10.84 49.32±10.07 0.426 0.671 治疗后 39.53±9.94 31.85±8.98 3.780 < 0.001 t 18.766 44.533 P < 0.001 < 0.001
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