基于电子健康的冠心病患者心脏康复效果的系统评价

doi:10.3761/j.issn.1672-9234.2021.03.014

摘要/Abstract

摘要：

目的系统评价基于电子健康的冠心病患者心脏康复的效果,以期为心血管护理实践提供依据。方法计算机检索PubMed、Embase、Web of Science、Cochrane、Springer、ScienceDirect、Ovid、EBSCO循证医学数据库、中国生物医学文献数据库、中国知网、万方、中文科技期刊全文数据库并辅以手工检索,检索建库至2020年4月发表的基于电子健康的冠心病患者心脏康复研究,进行文献的筛选、提取并质量评价,采用Stata 14.0进行数据分析。结果共纳入14项研究,基于电子健康的心脏康复研究中,试验组较对照组增加了体育活动时间（SMD=0.24,95%CI=0.04~0.45,P=0.02）、每日步数（SMD=0.41,95%CI=0.22~0.60,P<0.001）,改善了患者的生活质量（SMD=0.97,95%CI=0.12~1.81,P=0.02）,降低了再入院率（RR=0.49,95%CI=0.27~0.89,P=0.02）。敏感性分析发现,基于电子健康的心脏康复可有效改善冠心病患者饮食习惯（SMD=0.49,95%CI=0.15~0.83,P=0.005）、总胆固醇水平（SMD=-0.23,95%CI=-0.41~-0.04,P=0.02）、低密度脂蛋白（SMD=-0.36,95%CI=-0.55~-0.17,P<0.001）。结论基于电子健康的心脏康复可有效提高患者参与良好生活方式的积极性,改善患者的饮食习惯,改善患者总胆固醇及低密度脂蛋白水平,患者的生活质量得以提高并降低再入院率。

关键词: 冠心病, 康复护理, 电子健康, 系统评价

Abstract:

Objective To systematically evaluate the effects of electronic health cardiac rehabilitation program on patients with coronary heart disease. Methods Comprehensive search was conducted in PubMed,Embase,Web of Science,Cochrane,Springer,ScienceDirect,Ovid,EBSCO,CBM,CNKI,Wanfang,and VIP,supplemented by manual search. The search time limit was form inception to April 2020. The effects of heart rehabilitation was determined by mata-analysis with Stata 14.0 after data extraction and quality appraisal. Results A total of 14 studies were included. Compared with the control group,the electronic health-based cardiac rehabilitation program could improve the time of physical activity（SMD=0.24,95%CI=0.04~0.45,P=0.02）,daily steps（SMD=0.41,95%CI=0.22~0.60,P<0.001）,the quality of life（SMD=0.97,95%CI=0.12~1.81,P=0.02）,and reduce the readmission rate（RR=0.49,95%CI=0.27~0.89,P=0.02）. Sensitivity analysis found that cardiac rehabilitation based on electronic health could effectively improve eating habits（SMD=0.49,95%CI=0.15~0.83,P=0.005）,total cholesterol level（SMD=-0.23,95%CI=-0.41~-0.04,P=0.02）,and low-density lipoprotein（SMD=-0.36,95%CI=-0.55~-0.17,P<0.001）. Conclusion Cardiac rehabilitation based on electronic health can effectively improve patients’ enthusiasm for sustaining a good lifestyle,improving their eating habits,and quality of life,reducing their total cholesterol and low-density lipoprotein levels,and the readmission rate.

Key words: Coronary Disease, Rehabilitation Nursing, Electronic health, Systematic review

周丽娜,付明月,孙琳,万映雪,葛星. 基于电子健康的冠心病患者心脏康复效果的系统评价[J]. 中华护理教育, 2021, 18(3): 260-265.

ZHOU Li-na,FU Ming-yue,SUN Lin,WAN Ying-xue,GE Xing. The effects of heart rehabilitation program based on electronic health on patients with coronary heart disease：a systematic review[J]. Chinese Journal of Nursing Education, 2021, 18(3): 260-265.

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参考文献 27

[1]	Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke Statistics-2019 update a report from the American Heart Association[J]. Circulation, 2019,139(10):e56-e528. doi: 10.1161/CIR.0000000000000659 pmid: 30700139
[2]	Thomas H, Diamond J, Vieco A, et al. Global atlas of cardiovascular disease 2000-2016:the path to prevention and control[J]. Glob Heart, 2018,13(3):143-163. pmid: 30301680
[3]	刘雨, 黄蔚萍. 国内外心脏康复的研究进展[J]. 中华现代护理杂志, 2020,26(7):841-845.
	Liu Y, Huang WP. Research progress on cardiac rehabilitation at home and abroad[J]. Chin J Mod Nurs, 2020,26(7):841-845.
[4]	Ruano-Ravina A, Pena-Gil C, Abu-Assi E, et al. Participation and adherence to cardiac rehabilitation programs. A systematic review[J]. Int J Cardiol, 2016,223:436-443. doi: 10.1016/j.ijcard.2016.08.120 pmid: 27557484
[5]	厉锦巧, 冯国和, 张伟, 等. 电子健康素养理论及干预的研究进展[J]. 中华护理教育, 2019,16(4):279-283.
	Li JQ, Feng GH, Zhang W, et al. Research progress of electronic health literacy theory and intervention[J]. Chin J Nurs Educ, 2019,16(4):279-283.
[6]	Widmer RJ, Collins NM, Collins CS, et al. Digital health interventions for the prevention of cardiovascular disease:a systematic review and meta-analysis[J]. Mayo Clin Proc, 2015,90(4):469-480. doi: 10.1016/j.mayocp.2014.12.026 pmid: 25841251
[7]	Yardley L, Choudhury T, Patrick K, et al. Current issues and future directions for research into digital behavior change interventions[J]. Am J Prev Med, 2016,51(5):814-815. doi: 10.1016/j.amepre.2016.07.019 pmid: 27745680
[8]	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary?[J]. Control Clin Trials, 1996,17(1):1-12. doi: 10.1016/0197-2456(95)00134-4 pmid: 8721797
[9]	Widmer RJ, Allison TG, Lennon R, et al. Digital health intervention during cardiac rehabilitation:a randomized controlled trial[J]. Am Heart J, 2017,188:65-72. doi: 10.1016/j.ahj.2017.02.016 pmid: 28577682
[10]	Johnston N, Bodegard J, Jerström S, et al. Effects of interactive patient smartphone support app on drug adherence and lifestyle changes in myocardial infarction patients:a randomized study[J]. Am Heart J, 2016,178:85-94. doi: 10.1016/j.ahj.2016.05.005 pmid: 27502855
[11]	Dale LP, Whittaker R, Jiang Y, et al. Text message and Internet support for coronary heart disease self-management:results from the Text4Heart randomized controlled trial[J]. J Med Internet Res, 2015,17(10):e237. doi: 10.2196/jmir.4944 pmid: 26490012
[12]	Frederix I, Hansen D, Coninx K, et al. Medium-term effectiveness of a comprehensive Internet-based and patient-specific telerehabilitation program with text messaging support for cardiac patients:randomized controlled trial[J]. J Med Internet Res, 2015,17(7):e185. DOI: 10.2196/jmir.4799. doi: 10.2196/jmir.4799 pmid: 26206311
[13]	Maddison R, Pfaeffli L, Whittaker R, et al. A mobile phone intervention increases physical activity in people with cardiovascular disease:results from the heart randomized controlled trial[J]. Eur J Prev Cardiol, 2015,22(6):701-709. doi: 10.1177/2047487314535076 pmid: 24817694
[14]	Antypas K, Wangberg SC. An Internet-and mobile-based tailored intervention to enhance maintenance of physical activity after cardiac rehabilitation:short-term results of a randomized controlled trial[J]. J Med Internet Res, 2014,16(3):e77. doi: 10.2196/jmir.3132 pmid: 24618349
[15]	Devi R, Powell J, Singh S. A web-based program improves physical activity outcomes in a primary care angina population:randomized controlled trial[J]. J Med Internet Res, 2014,16(9):e186. doi: 10.2196/jmir.3340 pmid: 25217464
[16]	Lear SA, Singer J, Banner-Lukaris D, et al. Randomized trial of a virtual cardiac rehabilitation program delivered at a distance via the Internet[J]. Circ Cardiovasc Qual Outcomes, 2014,7(6):952-959. doi: 10.1161/CIRCOUTCOMES.114.001230 pmid: 25271050
[17]	Varnfield M, Karunanithi M, Lee CK, et al. Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients:results from a randomised controlled trial[J]. Heart, 2014,100(22):1770-1779. doi: 10.1136/heartjnl-2014-305783
[18]	Reid RD, Morrin LI, Beaton LJ, et al. Randomized trial of an Internet-based computer-tailored expert system for physical activity in patients with heart disease[J]. Eur J Prev Cardiolog, 2012,19(6):1357-1364. doi: 10.1177/1741826711422988
[19]	Vernooij JW, Kaasjager HA, van der Graaf Y, et al. Internet based vascular risk factor management for patients with clinically manifest vascular disease:randomised controlled trial[J]. BMJ, 2012,344:e3750. DOI: 10.1136/bmj.e3750. doi: 10.1136/bmj.e3750 pmid: 22692651
[20]	Lindsay S, Smith S, Bellaby P, et al. The health impact of an online heart disease support group:a comparison of moderated versus unmoderated support[J]. Health Educ Res, 2009,24(4):646-654. doi: 10.1093/her/cyp001 pmid: 19251770
[21]	Southard BH, Southard DR, Nuckolls J. Clinical trial of an Internet-based case management system for secondary prevention of heart disease[J]. J Cardiopulm Rehabil, 2003,23(5):341-348. doi: 10.1097/00008483-200309000-00003 pmid: 14512778
[22]	Zutz A, Ignaszewski A, Bates J, et al. Utilization of the Internet to deliver cardiac rehabilitation at a distance:a pilot study[J]. Telemedicine J E Heal, 2007,13(3):323-330.
[23]	Su JJ, Yu DSF, Paguio JT. Effect of eHealth cardiac rehabilitation on health outcomes of coronary heart disease patients:a systematic review and meta-analysis[J]. J Adv Nurs, 2020,76(3):754-772. doi: 10.1111/jan.14272 pmid: 31769527
[24]	Hamilton SJ, Mills B, Birch EM, et al. Smartphones in the secondary prevention of cardiovascular disease:a systematic review[J]. BMC Cardiovasc Disord, 2018,18(1):25. doi: 10.1186/s12872-018-0764-x pmid: 29415680
[25]	Duff OM, Walsh DM, Furlong BA, et al. Behavior change techniques in physical activity eHealth interventions for people with cardiovascular disease:systematic review[J]. J Med Internet Res, 2017,19(8):e281. DOI: 10.2196/jmir.7782. doi: 10.2196/jmir.7782 pmid: 28768610
[26]	Chauvet-Gelinier JC, Bonin B. Stress,anxiety and depression in heart disease patients:a major challenge for cardiac rehabilitation[J]. Ann Phys Rehabil Med, 2017,60(1):6-12. doi: 10.1016/j.rehab.2016.09.002 pmid: 27771272
[27]	林绚丽, 徐楚君. 独居老年高血压患者负性情绪与自我护理能力、血压控制的相关性研究[J]. 中华护理教育, 2019,16(3):193-195.
	Lin XL, Xu CJ. Correlations between negative emotion,self-care ability and blood pressure control in older adults living alone with hypertension[J]. Chin J Nurs Educ, 2019,16(3):193-195.