| Objectives1.To investigate the frailty status of elderly patients with coronary heart disease at home in Zhengzhou and analyze the influencing factors;2.Based on the preliminary investigation,a cardiopulmonary exercise rehabilitation program was constructed for elderly patients with CHD and frailty at home,and its effect was verified.Methods1.Inventory SurveyFrom September 2018 to June 2019,a total of 821 elderly patients with CHD were selected from two communities of Hanghai east road and High-tech zone in Zhengzhou city by convenient sampling.General data questionnaire,Tilburg frailty scale and geriatric depression scale were used to collect data.The objective indexes of the patients were measured by electronic grip strength instrument,human body composition measuring instrument and laboratory examination.IBM SPSS Statistics 21.0 software was used for data analysis α=0.05.2.Build scheme phaseGuided by evidence-based medicine,Literature review and analysis in the last 10 years(from 2010 to 2020),The quality of the literature was evaluated by using the method of GRADE evidence and the recommendation strength of evidence,and the evidence with the recommendation strength of GRADE A was included,Based on the preliminary survey results,the first draft of cardiopulmonary exercise rehabilitation program was constructed,and the intervention program was revised and improved through expert consultation and preliminary experiment.3.Intervention StudyExperimental study was adopted to construct cardiopulmonary exercise rehabilitation program based on preliminary investigation,literature research and expert consultation.In July 2019,106 patients from the community health service center of Hanghai east road were selected as the study object.The patients were divided into two groups according to the residential grouping method.The intervention group consisted of 54 patients living in two communities north of Hanghai east road,while the control group consisted of 52 patients living in two communities south of Hanghai east road.The intervention group received cardiopulmonary rehabilitation on the basis of health education and routine nursing intervention,while the control group received health education and routine nursing intervention.The changes of frailty,cardiopulmonary function,physical function and quality of life were compared before and after the intervention.Results1.Inventory SurveyIn this survey,a total of 850 questionnaires were issued,of which 821 were valid.The effective recovery rate was 96.6%.(1)Among the 821 patients included in this study,197(24.0%)were frailty,389(47.4%)were male,432(52.6%)were female,47.9%were aged 60～69,37.0%were 70～79.and 15.1%were 80～89.(2)Single factor analysis results,different gender,age,educational level,personal income,living conditions,movement,heart function grading,course of the disease,medication compliance,multiple slow disease,history of PCI therapy,genetic history,cognitive function,depression,BMI,fasting glucose,heart rate,TC,TG,HDL and LDL of the community elderly patients with CHD frailty condition,statistically significant difference(P<0.05).(3)Logistic regression analysis results showed that personal monthly income(≥ 3000RMB),medication,cognitively normal,depression and high BMI in elderly patients with coronary heart disease frailty risk that at home showed a trend of gradual decline(P<0.05),the female,don’t exercise,the heart function classification is higher,and heart rate(HR≥100 times/min),TC(≥5.2mmol/L),TG(≥1.7mmol/L)and fasting plasma glucose(6.1～11.1mmol/L)of in elderly patients with coronary heart disease frailty risk that at home is gradually rising trend(P<0.05).2.Build scheme phaseBased on literature review,preliminary investigation,expert consultation and preliminary experiment,the final draft of cardiopulmonary exercise rehabilitation program was formed.3.Intervention StudyIn this study,a total of 8 patients were lost in the intervention process,and 98 patients finally completed the study(49 in the intervention group and 49 in the control group).(1)The effect of intervention on each index of two groups of patients at different time points① The total frailty scores and psychological frailty scores of the two groups were statistically significant in terms of time effect and interaction effect.The scores of physical function frailty had significant statistical significance in time effect and interaction effect(P<0.05),but no significant intergroup effect(P>0.05).The intergroup effect and interaction effect of social decline were statistically significant(P<0.05),but the time effect was not statistically significant(P>0.05).② In the two groups,systolic blood pressure(SBP),diastolic blood pressure(DBP),myocardial oxygen consumption(RPP),FVC and FEV1 had significant statistical significance in time effect and interaction effect(P<0.05),but there was no significant intergroup effect(P>0.05).FEV1(G)time effect had significant statistical significance(P<0.05),but no significant intergroup effect and interaction effect(P>0.05).The interaction effect of HR was statistically significant(P<0.05),but the intergroup effect and time effect were not statistically significant(P>0.05).③ There was significant statistical significance in the time effect and interaction effect of grip strength in the two groups(P<0.05),but there was no significant intergroup effect(P>0.05),and there were significant statistical significance in the intergroup effect,time effect and interaction effect of step speed,timing,standing up and walking time and six-minute walking distance(P<0.05).④ The total score of quality of life and scores of each dimension of the two groups were statistically significant in terms of intergroup effect,time effect and interaction effect(P<0.05).(2)Intergroup comparison of various indicators at different time points in the intervention group①The comparison results at 1 month after the intervention and before the intervention showed that the total score of frailty,psychological frailty score.SBP,DBP,RPP and timing standing and walking time were significantly reduced,with statistically significant differences(P<0.05).FVC,FEV1,grip strength,pace,and 6-minute walking distance were significantly increased,with statistically significant differences(P<0.05).There was no statistically significant difference between social frailty score,HR and FEV1(G)(P>0.05).②The comparison results at 3 months after intervention and before intervention showed that the total scores of frailties,scores of each dimension.SBP,DBP,RPP,HR and timing of standing up and walking time were significantly reduced,with statistically significant differences(P<0.05).FVC,FEV1,grip strength,pace,and 6-minute walking distance were significantly increased,and the differences were statistically significant(P<0.05).There was no significant difference in FEV1(G)(P>0.05).③ The results of 3 months of intervention and 1 month of intervention showed that the total frailty score,psychological frailty score,somatic frailty score,SBP,DBP,RPP,HR and timing of standing up and walking time were significantly reduced,with statistically significant differences(P<0.05).FVC,FEV1,grip strength,walking speed and six-minute walking distance were significantly increased,and the difference was statistically significant.There was no statistically significant difference in social frailty score and FEV1(G)(P>0.05).Conclusions1.In this study,elderly patients with CHD and frailty at home were affected by economic level,medication,cognition,depression,BMI,gender,exercise,cardiac function classification,fasting blood glucose,heart rate,TC and TG.2.In this study,cardiopulmonary exercise rehabilitation program can effectively improve patients’ frailty,enhance their cardiopulmonary and physical functions,and improve their quality of life.It can be popularized and applied in elderly patients with CHD at home in the community. |
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