广西医学

目的探讨节拍式呼吸疗法在老年急性心肌梗死（AMI）患者经皮冠状动脉介入（PCI）术后家庭心脏康复中的应用效果。方法纳入46例PCI术后老年AMI患者，其中观察组26例、对照组20例。两组患者在病情稳定出院后接受家庭心脏康复干预，其中观察组患者采取节拍式呼吸疗法，对照组患者采取常规腹式呼吸训练。在出院当天（干预前）和干预3个月后检测两组患者的血流动力学指标［每搏输出量（SV）、每搏输出量指数（SVI）、心排血量（CO）、心排血量指数（CI）、左心室做功（LVSW）、左心室做功指数（LVSWI）、加速指数（ACI）、速度指数（VI）、全身血管阻力（SVR）、全身血管阻力指数（SVRI）、心率及收缩压、舒张压］，采用36项健康调查简表（SF⁃36）评定两组患者的生活质量。通过康复记录评估患者的家庭心脏康复干预依从性。结果（1）干预3个月后，观察组的SV、SVI、CO、CI、VI、LVSW、LVSWI高于干预前水平，SVR、SVRI低于干预前（P<0.05）；观察组的 SV、SVI、CO、CI和VI高于对照组，SVR、SVRI和收缩压低于对照组（P<0.05）。（2）干预3个月后，观察组SF⁃36原始总分和生理功能维度、躯体疼痛维度、总体健康维度、活力维度、社会功能维度、情感职能维度、精神健康维度得分高于干预前（P<0.05）；观察组SF⁃36原始总分和生理功能维度、躯体疼痛维度、总体健康维度和精神健康维度的得分高于对照组（P<0.05）。（3）观察组患者的家庭心脏康复干预依从性优于对照组（P<0.05）。结论与常规腹式呼吸训练相比，应用节拍式呼吸疗法进行PCI术后家庭心脏康复，可以在短期内有效地降低老年AMI患者的体循环血管阻力，增强患者的左心室射血功能，提高其家庭心脏康复依从性，改善其生活质量，值得临床应用推广。

Objective To explore the application effect of metronomic breathing therapy in home cardiac rehabilitation of elderly patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods A total of 46 elderly AMI patients after PCI were enrolled, therein there were 26 cases in the observation group and 20 cases in the control group. Patients of both groups received home cardiac rehabilitation for intervention after discharge of being in stable condition, therein the observation group received metronomic breathing therapy, whereas the control group received routine abdominal breathing exercise. The hemodynamic indices with respect to stroke volume (SV), stroke volume index (SVI), cardiac output (CO), cardiac output index (CI), left ventricular stroke work (LVSW), left ventricular stroke work index (LVSWI), acceleration index (ACI), velocity index (VI), systemic vascular resistance (SVR), systemic vascular resistance index (SVRI), heart rate, systolic blood pressure, and diastolic blood pressure of patients in both groups were detected on the day of discharge (before intervention) and 3 months after intervention. The 36⁃Item Short Form Health Survey (SF⁃36) was used to evaluate quality of life in patients of the two groups. Compliance with home cardiac rehabilitation intervention of patients was evaluated through rehabilitation records. Results (1) After 3 months of intervention, the observation group exhibited higher SV, SVI, CO, CI, VI, LVSW, LVSWI, whereas lower SVR and SVRI as compared with before intervention (P<0.05); furthermore, the observation group yielded higher SV, SVI, CO, CI, and VI, while lower SVR, SVRI, and systolic blood pressure as compared with the control group (P<0.05). (2) After 3 months of intervention, the observation group interpreted a higher original total score of SF⁃36, and higher scores of physiological function dimension, somatic pain dimension, overall health dimension, vitality dimension, social function dimension, emotional function dimension, and mental health dimension of SF⁃36 as compared with before intervention (P<0.05); in addition, the observation group depicted a higher SF⁃36 original total score, and higher scores of physiological function dimension, somatic pain dimension, overall health dimension, and mental health dimension of SF⁃36 as compared with the control group (P<0.05). (3) Compliance with home cardiac rehabilitation intervention of patients in the observation group was superior to that in the control group (P<0.05). Conclusion Compared with routine abdominal breathing exercise, applying metronomic breathing therapy to home cardiac rehabilitation after PCI can effectively reduce systemic vascular resistance in elderly AMI patients in the short term, enhance patients’ left ventricular ejection function, elevate their compliance with home cardiac rehabilitation, and ameliorate their quality of life, which is worthy to clinical application and promotion.