中国全科医学 ›› 2023, Vol. 26 ›› Issue (19): 2323-2331.DOI: 10.12114/j.issn.1007-9572.2022.0700

所属专题: 指南/共识最新文章合集 心血管最新文章合集

• 从指南到实践 • 上一篇    下一篇

冠心病患者心脏康复相关指南的系统评价

刘晶涛1, 苏荷2, 秦小金1, 兰云霞3, 张金枝2,*()   

  1. 1.450000 河南省郑州市,河南省胸科医院(郑州大学附属胸科医院)介入手术室1
    2.450000 河南省郑州市,河南省胸科医院(郑州大学附属胸科医院)综合重症监护病房(GICU)
    3.450000 河南省郑州市,河南省胸科医院(郑州大学附属胸科医院)护理部
  • 收稿日期:2022-10-12 修回日期:2023-02-03 出版日期:2023-07-05 发布日期:2023-03-02
  • 通讯作者: 张金枝

  • 作者贡献:刘晶涛提出选题方向,负责文章的撰写;刘晶涛、苏荷、秦小金负责资料的收集、指南的评价及推荐意见的提取;兰云霞负责部分资料的收集和对文章进行润色;张金枝负责文章的质量控制及审校,并对文章整体负责;所有作者确认了论文的最终稿。
  • 基金资助:
    河南省卫健委联合共建项目(LHGJ20190729)

Guidelines on Cardiac Rehabilitation in Patients with Coronary Heart Disease: a Systematic Review

LIU Jingtao1, SU He2, QIN Xiaojin1, LAN Yunxia3, ZHANG Jinzhi2,*()   

  1. 1. Interventional Operating Room 1, Henan Provincial Chest Hospital (Affiliated Chest Hospital of Zhengzhou University), Zhengzhou 450000, China
    2. General Intensive Care Unit, Henan Provincial Chest Hospital (Affiliated Chest Hospital of Zhengzhou University), Zhengzhou 450000, China
    3. Department of Nursing, Henan Provincial Chest Hospital (Affiliated Chest Hospital of Zhengzhou University), Zhengzhou 450000, China
  • Received:2022-10-12 Revised:2023-02-03 Published:2023-07-05 Online:2023-03-02
  • Contact: ZHANG Jinzhi

摘要: 背景 心脏康复作为冠心病患者康复的有效干预措施已达成共识,但国内外制定的心脏康复相关指南的质量尚不明确,相关的推荐意见有待整合。 目的 系统评价冠心病患者心脏康复的相关指南,为临床实践提供参考。 方法 于2022年6月,计算机检索the Cochrane Library、Web of Science、PubMed、中国知网、维普网及万方数据知识服务平台,以及国内外指南网和相关学会网,获取冠心病患者心脏康复相关指南,检索时限均为建库至2022-06-30。2名研究者按照纳入与排除标准独立筛选文献并提取资料。采用临床指南研究与评估系统Ⅱ(AGREE Ⅱ)对纳入指南进行质量评价,并汇总冠心病患者心脏康复的推荐意见。 结果 最终纳入10部指南,8部来源于国外,指南发布时间为2011—2020年。纳入指南AGREE Ⅱ各领域平均得分为:范围和目的71%、参与人员65%、严谨性58%、清晰性80%、应用性64%、独立性45%。4部指南推荐级别为A级,6部指南推荐级别为B级。主要推荐意见汇总为心脏康复的基本要求、健康教育、危险因素控制、心理支持、运动训练及促进患者参与心脏康复6个方面。 结论 纳入指南的质量处于中等至较高水平,在参与人员、严谨性、应用性、独立性领域仍需提高;各指南推荐意见趋于一致,但在促进患者参与心脏康复方面意见仍显不足;我国心脏康复指南质量水平与国外相比仍存差距,应构建适用于我国冠心病患者的高质量心脏康复循证指南。

关键词: 冠心病, 心脏康复, 降低风险行为, 指南, 系统评价, 循证医学

Abstract:

Background

It has been a consensus that cardiac rehabilitation is an effective comprehensive intervention for patients with coronary heart disease (CHD), but the quality of relevant guidelines is still unclear, and recommendations from the guidelines need to be integrated.

Objective

To systematically review the guidelines on cardiac rehabilitation in patients with CHD, providing evidence to inform clinical practice.

Methods

In June 2022, guidelines on cardiac rehabilitation in patients with CHD were searched in electronic databases of the Cochrane Library, Web of Science, PubMed, CNKI, CQVIP and Wanfang Data, relevant guideline repositories and association websites from inception to 30 June 2022. Literature screening and data extraction were performed by two researchers separately according to the inclusion and exclusion criteria. The quality of included guidelines was assessed using the Appraisal of Guidelines for Research & EvaluationⅡ (AGREEⅡ), and recommendations from which were summarized.

Results

Ten guidelines (eight of them are foreign guidelines) with publication time ranging from 2011 to 2020 were eventually included. The average score of every AGREEⅡ domain was 71% for scope and purpose, 65% for stakeholder involvement, 58% for rigor of development, 80% for clarity of presentation, 64% for applicability, and 45% for editorial independence. Four guidelines were rated as grade A and the remaining six as grade B. Six aspects are involved in recommendations, including basic requirements of cardiac rehabilitation, heath education, risk factors control, psychological support, exercise training, and improvement of cardiac rehabilitation participation.

Conclusion

The quality of included guidelines is at a moderate to high level. More efforts are needed to improve the domains in stakeholder involvement, rigor of development, applicability, and editorial independence. Recommendations of the 10 guidelines tend to be consistent, but there are still insufficient recommendations on improving cardiac rehabilitation participation. There is a gap in the quality between domestic and foreign guidelines, so it is necessary to develop a high-quality guideline on cardiac rehabilitation for patients with CHD in China.

Key words: Coronary disease, Cardiac rehabilitation, Risk reduction behavior, Guidelines, Systematic review, Evidence-based medicine