运动康复在先天性心脏病术后患儿中的应用进展

doi:10.3761/j.issn.2096-7446.2024.03.006

摘要/Abstract

摘要： 运动康复是根据疾病特点和患儿自身功能状况,依据力学原理进行主被动运动以改善身体功能,提高身体素质的治疗性运动。先天性心脏病患儿的运动耐力及心肺功能都低于正常儿童,且术后会出现不同程度的下降。运动康复能够安全、有效地促进快速康复,增强患儿心肺功能,提高运动耐力,改善生活质量并促进快速康复。但运动耐力评价指标、个体化运动处方、患儿院外支持系统及随访管理仍有待进一步研究和完善。该文就运动康复对先天性心脏病术后患儿的意义、影响因素、实施过程等进行综述,以期为临床实践提供参考依据。

关键词: 心脏缺损, 先天性, 儿童, 运动疗法, 心脏康复, 综述文献（主题）

Abstract: Exercise rehabilitation is tailored to the characteristics of the disease and the child's functional status,it involves carrying out active and passive exercise guided by mechanical principles,to improve physical function and fitness. The exercise tolerance and cardiopulmonary function of children with congenital heart disease are lower than those of normal children,and there will be varying degrees of decline after surgery. Exercise rehabilitation is a safe and effective way to promote rapid recovery. This article reviews the implementation process and influencing factors of exercise rehabilitation in children with congenital heart disease,and the exercise rehabilitation can enhance the cardiopulmonary function,improve exercise endurance,improve the quality of life and promote rapid recovery. But the evaluation indicators of exercise tolerance,individualized exercise prescription,out-of-hospital support system and follow-up management of children still need to be further studied and improved.

Key words: Heart Defects, Congenital, Child, Exercise Therapy, Cardiac Rehabilitation, Literature Review as Topic

金泓丞, 诸纪华, 唐晓敏, 炊琳博, 蒋伟红. 运动康复在先天性心脏病术后患儿中的应用进展[J]. 中华急危重症护理杂志, 2024, 5(3): 230-234.

JIN Hongcheng, ZHU Jihua, TANG Xiaomin, CHUI Linbo, JIANG Weihong. Progress in the application of exercise rehabilitation in children with congenital heart disease after surgery[J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(3): 230-234.

参考文献

[1] 朱耀斌,李志强,丁楠,等. 先天性心脏病患儿术后心脏康复研究进展[J]. 中华实用诊断与治疗杂志,2019,33(4):410-413.
Zhu YB,Li ZQ,Ding N,et al.Postoperative cardiac rehabilitation for children with congenital heart disease[J]. J Chin Pract Diagn Ther,2019,33(4):410-413.
[2] 蔡小满,徐卓明,徐毅超,等. 先天性心脏病患儿心脏矫正术后心肺运动功能评估的初步实践[J]. 中华心血管病杂志,2022,50(5):471-479.
Cai XM,Xu ZM,Xu YC,et al.Preliminary practice in the postoperative cardiopulmonary exercise testing for children with congenital heart disease[J]. Chin J Cardiol,2022,50(5):471-479.
[3] European Association of Cardiovascular Prevention and Rehabilitation Committee for Science Guidelines,Eacpr,Corrà U,et al. Secondary prevention through cardiac rehabilitation:physical activity counselling and exercise training:key components of the position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation[J]. Eur Heart J,2010,31(16):1967-1974.
[4] Balady GJ,Williams MA,Ades PA,et al.Core components of cardiac rehabilitation/secondary prevention programs:2007 update:a scientific statement from the American Heart Association Exercise,Cardiac Rehabilitation,and Prevention Committee,the Council on Clinical Cardiology;the Councils on Cardiovascular Nursing,Epidemiology and Prevention,and Nutrition,Physical Activity,and Metabolism;and the American Association of Cardiovascular and Pulmonary Rehabilitation[J]. Circulation,2007
115(20):2675-2682.
[5] 中华医学会心血管病学分会,中国康复医学会心血管病专业委员会,中国老年学学会心脑血管病专业委员会. 冠心病康复与二级预防中国专家共识[J]. 中华心血管病杂志,2013,41(4):267-275.
Cardiology Branch of Chinese Medical Association,Cardiovascular Disease Committee of Chinese Rehabilitation Medicine Association,Cardiovascular and Cerebrovascular Diseases Committee of Chinese Geriatrics Society. China expert consensus on rehabilitation and secondary prevention of coronary heart disease[J]. Chin J Cardiol,2013,41(4):267-275.
[6] Longmuir PE,Brothers JA,de Ferranti SD,et al. Promotion of physical activity for children and adults with congenital heart disease:a scientific statement from the American Heart Association[J]. Circulation,2013,127(21):2147-2159.
[7] 季涧琳,陆群峰,杨利灵,等. 先天性心脏病患儿出院后延续护理的研究进展[J]. 中国护理管理,2021,21(12):1910-1914.
Ji JL,Lu QF,Yang LL,et al.Continued care among discharged children with congenital heart disease:a literature review[J]. Chin Nurs Manag,2021,21(12):1910-1914.
[8] 范菲菲,苏丹. 运动疗法提高维持性血液透析患者体力活动水平的研究进展[J]. 中国康复理论与实践,2017,23(9):1068-1071.
Fan FF,Su D.Advances of exercise for physical activity in maintenance hemodialysis patients(review)[J]. Chin J Rehabil Theory Pract,2017,23(9):1068-1071.
[9] 徐芳,黄珊珊,郑洋. 早期心脏康复对先心病患儿介入术后心功能及运动耐力的影响[J]. 中国校医,2021,35(11):820-823.
Xu F,Huang SS,Zheng Y.Effect of early cardiac rehabilitation on cardiac function and exercise endurance in children with congenital heart disease after interventional surgery[J]. Chin J Sch Dr,2021,35(11):820-823.
[10] 陈龙,李运飞,覃璐. 出院后早期运动康复对先天性心脏病患儿术后心功能、运动耐力及肌肉力量的影响[J]. 齐鲁护理杂志,2020,26(20):26-29.
Chen L,Li YF,Qin L.Effects of early exercise rehabilitation after discharge on postoperative cardiac function,exercise tolerance and muscle strength in children with congenital heart disease[J]. J Qilu Nurs,2020,26(20):26-29.
[11] Stuart G,Forsythe L.Exercise prescription in young children with congenital heart disease:time for a change in culture[J]. Open Heart,2021,8(1):e001669.
[12] van Deutekom AW,Lewandowski AJ. Physical activity modification in youth with congenital heart disease:a comprehensive narrative review[J]. Pediatr Res,2021,89(7):1650-1658.
[13] Kwon SJ,Choi EK,Lee K,et al.Factors influencing physical activity in adolescents with complex congenital heart disease[J]. Child Health Nurs Res,2019,25:262-272.
[14] 李依霖,陈京立. 先天性心脏病患儿运动康复的研究进展[J]. 中华现代护理杂志,2018,24(12):1482-1485.
Li YL,Chen JL.Research progress of exercise rehabilitation in children with congenital heart disease[J]. Chin J Mod Nurs,2018,24(12):1482-1485.
[15] 中国康复医学会心血管病专业委员会. 中国心脏康复与二级预防指南:2018版[M]. 北京:北京大学医学出版社,2018.
Cardiovascular Disease Committee of Chinese Association of Rehabilitation Medicine. Chinese guideline for cardiac rehabilitation and secondary prevention[M]. Beijing:Peking University Medical Press,2018.
[16] Haykowsky M,Scott J,Esch B,et al.A meta-analysis of the effects of exercise training on left ventricular remodeling following myocardial infarction:start early and go longer for greatest exercise benefits on remodeling[J]. Trials,2011,12:92.
[17] Guazzi M,Arena R,Halle M,et al.2016 focused update:clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations[J]. Eur Heart J,2018,39(14):1144-1161.
[18] Levett DZH,Jack S,Swart M,et al.Perioperative cardiopulmonary exercise testing(CPET):consensus clinical guidelines on indications,organization,conduct,and physiological interpretation[J]. Br J Anaesth,2018,120(3):484-500.
[19] Blanchard J,Blais S,Chetaille P,et al.New reference values for cardiopulmonary exercise testing in children[J]. Med Sci Sports Exerc,2018,50(6):1125-1133.
[20] Agarwala P,Salzman SH.Six-minute walk test:clinical role,technique,coding,and reimbursement[J]. Chest,2020,157(3):603-611.
[21] 田宏,朱雪梅,叶明,等. 六分钟步行试验对先天性心脏病术后患儿心功能评估的作用[J]. 中国循证儿科杂志,2012,7(6):440-444.
Tian H,Zhu XM,Ye M,et al.The role of the 6-minute walk test on evaluating cardiac function in children withoostoperative congenital heart disease during follow-up[J]. Chin J Evid Based Pediatr,2012,7(6):440-444.
[22] Qu JB,Shi H,Guo YG,et al.Is the six-minute walk test still reliable compared to cardiopulmonary exercise test for exercise capacity in children with congenital heart disease?[J]. Front Pediatr,2022,10.
[23] Mylius CF,Paap D,Takken T.Reference value for the 6-minute walk test in children and adolescents:a systematic review[J]. Expert Rev Respir Med,2016,10(12):1335-1352.
[24] Ross R,Blair SN,Arena R,et al.Importance of assessing cardiorespiratory fitness in clinical practice:a case for fitness as a clinical vital sign:a scientific statement from the American heart association[J]. Circulation,2016,134(24):e653-e699.
[25] 张云婷,马生霞,陈畅,等. 中国儿童青少年身体活动指南[J]. 中国循证儿科杂志,2017,12(6):401-409.
Zhang YT,Ma SX,Chen C,et al.Physical Activity Guide for Chinese Children and Adolescents[J]. Chin J Evid Based Pediatr,2017,12(6):401-409.
[26] Scottish Intercollegiate Guidelines Network(SIGN). Cardiac rehabilitation[EB/OL]. (2017-07-01)[2023-12-13]. http://www.sign.ac.uk.
[27] Meyer M,Brudy L,García-Cuenllas L,et al.Current state of home-based exercise interventions in patients with congenital heart disease:a systematic review[J]. Heart Br Cardiac Soc,2020,106(5):333-341.
[28] 冯瑞玲,王瑞玲,陈洁,等. 远程照护模式对先天性心脏病患儿术后父母照护能力影响的研究[J]. 中华现代护理杂志,2020,26(30):4270-4273.
Feng RL,Wang RL,Chen J,et al.Effects of telecare model on parental care ability of children with congenital heart disease after surgery[J]. Chin J Mod Nurs,2020,26(30):4270-4273.
[29] Jackson JL,Fox KR,Swenski TN,et al.Gender differences in physical activity engagement among adolescents with congenital heart disease[J]. J Pediatr Psychol,2022,47(8):859-869.
[30] Ponikowski P,Voors AA,Anker SD,et al.2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Rev Esp Cardiol(Engl Ed),2016,69(12):1167.
[31] Neunhaeuserer D,Battista F,Mazzucato B,et al.Exercise capacity and cardiorespiratory fitness in children with congenital heart diseases:a proposal for an adapted NYHA classification[J]. Int J Environ Res Public Health,2022,19(10):5907.
[32] Hedlund ER,Lundell B,Söderström L,et al.Can endurance training improve physical capacity and quality of life in young Fontan patients?[J]. Cardiol Young,2018,28(3):438-446.
[33] Scheffers LE,Berg LEMV,Ismailova G,et al.Physical exercise training in patients with a Fontan circulation:A systematic review[J]. Eur J Prev Cardiol. 2021,28(11):1269-1278.