急性冠脉综合征患者心脏康复治疗的基本概念与进展

1、HM734 Exercise Testing and Prescription: Cardiorespiratory 1 急性冠脉综合征患者心脏康复治疗 的基本概念与进展 The Basic Concepts of and Progress in Cardiac Rehabilitation in Patients with Acute Coronary Syndrome HM734 Exercise Testing and Prescription: Cardiorespiratory 2 Acute Coronary Syndromes(ACS) Anderson, J. L. et al

2、. J Am Coll Cardiol 2007;50:e1-e157 HM734 Exercise Testing and Prescription: Cardiorespiratory 3 HM734 Exercise Testing and Prescription: Cardiorespiratory 4 = HM734 Exercise Testing and Prescription: Cardiorespiratory 5 CR的定义的定义 J. Am. Coll. Cardiol. doi:10.1016/j.jacc.2007.04.033 published online

3、Sep 20, 2007; HM734 Exercise Testing and Prescription: Cardiorespiratory 6 针对ACS的CR纲要 HM734 Exercise Testing and Prescription: Cardiorespiratory 7 针对ACS的CR目标 www.capitalhealth.ca HM734 Exercise Testing and Prescription: Cardiorespiratory 8 CR涉及的人员 Who should be involved? Can J Cardiol 2006, 22(11):

4、905-11 药剂师（Pharmacist） 护士（Nurse） 咨询医师（Consultant） 全科医师（GP） 营养学家（Dietician） 运动教练（Exercise instructor） 戒烟顾问 （Smoking cessation advisor） 社会服务 （Social Services） 心理学家（Psychologist） 社区护士 （District Nurses） 实习护士（Practice nurses） 保健随访人员 （Health Visitor） 二级预防保健（Secondary care） HM734 Exercise Testing and Presc

5、ription: Cardiorespiratory 9 ACS后CR的核心要素 European Journal of Cardiovascular Prevention 17:1-17 Copyright by European Society of Cardiology HM734 Exercise Testing and Prescription: Cardiorespiratory 10 患者评估（Patient assessment） 平板运动最大负荷 European Journal of Cardiovascular Prevention 17:1-17 HM734 Exerc

6、ise Testing and Prescription: Cardiorespiratory 11 患者评估（Patient assessment） 11 HM734 Exercise Testing and Prescription: Cardiorespiratory 12 体力活动咨询 （Physical activity counselling） European Journal of Cardiovascular Prevention 17:1-17 HM734 Exercise Testing and Prescription: Cardiorespiratory 13 运动训练

7、 （Exercise training） u抗阻训练 European Journal of Cardiovascular Prevention 17:1-17 HM734 Exercise Testing and Prescription: Cardiorespiratory 14 有氧和抗阻运动训练禁忌症 HM734 Exercise Testing and Prescription: Cardiorespiratory 15 饮食/营养咨询 （Diet/nutritional counselling） European Journal of Cardiovascular Preventi

8、on 17:1-17 HM734 Exercise Testing and Prescription: Cardiorespiratory 16 血脂管理 （Lipid management） European Journal of Cardiovascular Prevention 17:1-17 HM734 Exercise Testing and Prescription: Cardiorespiratory 17 体重管理 (Weight control management) European Journal of Cardiovascular Prevention 17:1-17

9、HM734 Exercise Testing and Prescription: Cardiorespiratory 18 血压管理（Blood pressure monitoring） European Journal of Cardiovascular Prevention 17:1-17 HM734 Exercise Testing and Prescription: Cardiorespiratory 19 戒烟（Smoking cessation） European Journal of Cardiovascular Prevention 17:1-17 HM734 Exercise

10、 Testing and Prescription: Cardiorespiratory 20 心理管理（Psychosocial management） European Journal of Cardiovascular Prevention 17:1-17 HM734 Exercise Testing and Prescription: Cardiorespiratory 21 European Journal of Cardiovascular Prevention 17:1-17 心理管理（Psychosocial management） HM734 Exercise Testing

11、 and Prescription: Cardiorespiratory 22 CR时段分配（时段分配（Structure of CR） JACC Vol. 50, No. 14, 2007:140033 HM734 Exercise Testing and Prescription: Cardiorespiratory 23 第第1阶段（阶段（住院期间） J Am Coll Cardiol 2007;50:140033. HM734 Exercise Testing and Prescription: Cardiorespiratory 24 J Am Coll Cardiol 2007;5

12、0:140033. 第第2阶段（阶段（开始于ACS后13周） HM734 Exercise Testing and Prescription: Cardiorespiratory 25 第第3阶段阶段(ACS后3-4 周) J Am Coll Cardiol 2007;50:140033. HM734 Exercise Testing and Prescription: Cardiorespiratory 26 第第4阶段阶段(长期而坚持不懈) J Am Coll Cardiol 2007;50:140033. HM734 Exercise Testing and Prescription:

13、Cardiorespiratory 27 J Am Coll Cardiol 2007;50:140033. 对患者及其家庭的挑战对患者及其家庭的挑战 HM734 Exercise Testing and Prescription: Cardiorespiratory 28 J Am Coll Cardiol 2007;50:140033. CR的的实施途径实施途径 HM734 Exercise Testing and Prescription: Cardiorespiratory 29 ACS后CR获益的证据 HM734 Exercise Testing and Prescription:

14、Cardiorespiratory 30 Arch Intern Med. 2008;168(20):2194-2204. doi:10.1001/archinte.168.20.2194 HM734 Exercise Testing and Prescription: Cardiorespiratory 31 The ENRICHD Intervention Did Improve Late Survival (6 Months) Late survival depended on whether depression improved over the course of the inte

15、rvention. Carney et al., Psychosom Med 2004;66(4):466-474. HM734 Exercise Testing and Prescription: Cardiorespiratory 32 Actuarial cumulative hazard plot for survival time based on depression status upon completion of cardiac rehabilitation 0 0.05 0.10 0.15 0.20 0.25 0.30 0.35 012345 Depression is Associated with Decreased Survival Milani RV, Am J Med 2007 HM734 Exercise Testin