心脏康复：历史和近50年概况课件.ppt

1、Although the concept of cardiac rehabilitation as a means by which a person can be restored to an optimal physical,medical,physiological,social,emotional,sexual,vocational and economic status prior to a cardiovascular event may have gained momentum ONLY in the late 1950s,As early as 250 years ago,He

2、berden already advocated physical activity for patients with angina claiming it to be beneficial.1912Herrickdescription of the clinical characteristics of myocardial infarction.Mallorypathologic studies showingit would take 6 weeks for themyocardial tissue to form a firm scar1933Lewis advocated 6-8

3、weeks of bed rest,the patient to be guarded day andnight,nursed and helped in every way to avoidvoluntary effort or movement.Activity as strenuous as climbing up a flight of stairswere deferred until after one year.Return to productive livingwas practically unknown.In the first half of the 1900s,the

4、 mainstays of treatment of acute myocardial infarction:1.Protracted bed rest2.Prolonged hospitalizationWHY?Physical activity would cause 1.Recurrence of MI 2.Ventricular aneurysm 3.Ventricular rupture 4.Serious arrhythmias 5.Sudden cardiac death 1930sRedwood,Rosing and Epstein:Physical activity 1.De

5、crease in HR 2.Decrease in systolic BP 3.Increase in O2 utilization 4.Increase in physical capacityProlonged immobilization 1.Decrease physical work capacity 2.Tachycardia on ambulation 3.Orthostatic hypotension 4.Thromboembolism 5.Decrease pulmonary ventilation 6.Negative nitrogen balance causing d

6、elay in the healing process1940Levine and Lownadvocated the“armchair treatment”after acute MI.Long continued bed rest 1.Saps morale 2.Provokes desperation 3.Unleashes anxiety 4.Ushers in feeling of hope-lessness in resuming a normal lifeSitting for 1-2 hours after MI:1.Increased venous pooling 2.Dec

7、reased venous return 3.Decreased cardiac workload 1944 DOCKExtended bed rest results:1.Thromboembolism 2.Bone demineralization 3.Muscular wasting 4.Gastrointestinal problems 5.Urinary complications 6.Vasomotor instabilityBedside commode 1.Less energy requirement 2.Cardiac output and myocardial work

8、less in sitting position 3.Avoids Valsalva maneuverBenefits of early ambulation:1.Prevents de-conditioning 2.Prevents anxiety and depression 3.Increases physical capacity 4.Improves self image 5.Shorter hospital stay 6.Early return to workROSE“the burden of proof now lies on the physician who advoca

9、tesextensive activity restriction asbeneficial for the patient withuncomplicated acute MI”1957the start of cardiac rehabilitationprograms in the U.S.Torkelsen,Tobias,HellerSkinner,Fox,McPherson,Hellerstein,Kaufman,Shaeffer,Bouyer and Cardus Their efforts became the foundation of modern cardiacrehabi

10、litation.Early 1960sfocus on In HospitalCardiac Rehabilitation Late 1960sOut patient cardiac rehabilitationprograms started to proliferate1960 1970advocacy for early institution of physical activities for MI patientsRationale for early ambulation and early exercise:1.Demonstrated safety 2.Shortened

11、hospital stay 3.Fewer complications related to bed rest 4.Psychological gains 5.Improved cardiac function 6.Earlier and higher frequency of return to workKey objective of most programs:1.Preparing the individual for return to work.Stipulations for early ambulation:1.Uncomplicated MI and stable 2.Abs

12、ence of any of the following:a.cardiac failure b.shock c.arrhythmias d.persistent angina e.non-cardiac complications f.over 65 years old1970 1980Establishment of outpatient cardiac rehabilitation programPatients referred 12-24 weeks post myocardial infarctionGraded exercise testing utilizedRisk stra

13、tification popularized In the 70s“For cardiac rehabilitation to be complete,it must include:1.Psychological rehabilitation2.Sociological rehabilitation3.Vocational rehabilitation1970scardiac rehabilitation to includesecondary prevention1970steam approach to better cardiac rehabilitation1980sChanging

14、 attitudes in regard tocardiac rehabilitation of patients previously excluded in rehabilitation of patients in the1960s and 1970s.Dramatic changes in the 1980s:1.earlier and more intensive diag-nostic procedures 2.earlier and more intensive medical management with more and sophisticated pharmaceutic

15、al preparations,coronary thrombolysis and myocardial revascularizationLessened the pathophysiologicconsequences and improvedsurvival from MI.FOCUS:1.CR on the elderly 2.CR on high risk patients -patients in CHF NYHA III&IV -patients with serious arrhythmias -patients with artificial pacemaker -post-

16、cardiac transplantation1990sphysiological rehabilitation:low level type of exerciseversushigh impact physical exercises1990sCardiac Rehabilitation with special emphasis on the developing countriesCONCLUDING REMAKRSAlthough,as early as 250 yearsago,physical activity wasthought to offer benefits to pa

17、tients with angina,works of some scientists in the early part of the 20th century precludedany form of physical activityclaiming it to cause disastrouseffects on the cardiovascularsystem.CONCLUDING REMARKSHowever,the attitudes and practices in regard to physical activities after a coronary event has

18、 dramatically changed since the“armchair”advocacy of Levine and Lown right one day one of an uncomplicated myocardial infarction.So that,today more and morepatients are taken out of bed soon after a cardiovascular event,enrolled in bothin patient and out patient for complete physical,physiological,p

19、sychological,emotional,social and economic re-habilitation.While,during the first decade of the establishment of formal CR programmany were excluded in the rehabilitationprocess,presently,enrolled in the CRPare a good number of the elderly and the disabled.It is therefore recommended that:Cardiac re

20、habilitation should be anintegral component of the long-term,comprehensive care of cardiac patients.It should be available to all patients with CV disease,both adults and children.CR should be integrated into theexisting health care system.THANK YOU!on the basis of the position paper of the American College of Cardiology that cardiac rehabilitation as“those exerciseand counselling services which will reduce symptoms to improve cardiac function”