Abstract: Background　At present，the participation rates of phaseⅡ outpatient cardiac rehabilitation both at home and abroad are low.Foreign studies have shown that the clinical benefits of home-based cardiac rehabilitation are equivalent to that of outpatient cardiac rehabilitation，and are reliable and safe.However，there are few researches on home-based cardiac rehabilitation in China.Objective　To explore the effect of intra-hospital+home-based continuous cardiac rehabilitation model on patients with acute myocardial infarction after percutaneous coronary intervention（PCI）.Methods　From June in 2018 to February in 2019，80 patients with acute myocardial infarction who were hospitalized in the Department of Cardiovascular Medicine of Daxing Teaching Hospital of Capital Medical University and underwent emergency PCI were selected as the study objects.The subjects were divided into observation group（n=40） and control group（n=40） according to the method of random number table.The observation group adopted intra-hospital+home-based continuous cardiac rehabilitation model for three months，and the control group was intervened by routine intervention for three months.The body mass index（BMI），blood pressure，total cholesterol（TC），low-density lipoprotein cholesterol（LDL-C），6-minute walk distance（6MWD），left ventricular ejection fraction（LVEF） and smoking status were compared between the two groups at admission and three months after intervention.According to the results of 6-min walk test before discharge，the patients in the observation group and the control group were divided into 6MWD≥400 m group and 6MWD<400 m group，and the 6MWD before and after the intervention was further compared between the two groups.Results　There was no significant difference in blood pressure，TC，LDL-C，LVEF and BMI between the two groups at admission（P>0.05）.There was no significant difference in 6MWD between the two groups before discharge（P>0.05）.The systolic blood pressure，diastolic blood pressure，TC，LDL-C and BMI in the observation group after three months of intervention were lower than those before the intervention，6MWD in the observation group after three months of intervention was higher than those before the intervention.The TC，BMI in the control group after three months of intervention were lower than those before the intervention，6MWD in the control group were longer than those before the intervention（P<0.05）.After three months of intervention，TC，LDL-C and 6MWD in the observation group were higher than those in the control group with a statistically significant difference（P<0.05）.The difference value of TC，LDL-C，BMI and 6MWD in the observation group before and after the intervention were higher than those in the control group（P<0.05）.The rate of quitting smoking was 70.6%（24/34） in the observation group and 39.4%（13/33） in the control group after three months of intervention，and the difference was statistically significant（P=0.010）.There was no significant difference in 6MWD between 6MWD≥400 m groups in the observation group and the control group at discharge and three months after intervention（P>0.05）.The 6MWD in the two groups increased significantly after three months of intervention（P<0.05）.The 6MWD between 6MWD<400 m groups in the observation group and the control group after three months of intervention was significantly longer than that at discharge（P<0.05）.The 6MWD in the observation group was significantly longer than that in the control group after three months of intervention（P<0.05）.Conclusion　The intra-hospital and home-based continuous cardiac rehabilitation model is beneficial for patients with acute myocardial infarction after PCI to control risk factors（blood pressure，blood lipid，smoking and BMI），change behavior and improve daily physical activity ability，especially for patients in the 6MWD<400 m groups.

Key words: Home rehabilitation；Acute myocardial infarction；Angioplasty, balloon, coronary；Cardiac rehabilitation；6-minute walk text

摘要： 背景　目前，国际与国内Ⅱ期门诊心脏康复的参与率偏低，国外研究显示以家庭为基础的心脏康复临床获益等同于医院门诊心脏康复，且可靠安全，但居家心脏康复在我国的研究较少。目的　探讨院内+居家续贯式心脏康复模式在急性心肌梗死急诊冠状动脉介入治疗术（PCI）后患者心脏康复中的应用效果。方法　选取2018年6月—2019年2月在首都医科大学大兴教学医院心内科住院且行急诊PCI的急性心肌梗死患者80例作为研究对象。按随机数字表法将研究对象分为观察组（n=40）和对照组（n=40），观察组采用院内+居家续贯式心脏康复模式干预3个月，对照组给予常规干预3个月。比较两组患者入院时及干预3个月后的体质指数（BMI）、血压、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、6 min步行距离、左室射血分数（LVEF）、吸烟情况。并根据出院前6 min步行试验结果将观察组和对照组患者细分为6 min步行距离≥400 m组和<400 m组，进一步比较两组干预前后6 min步行距离。结果　两组入院时血压、TC、LDL-C、LVEF、BMI比较，差异无统计学意义（P>0.05），两组出院前6 min步行距离比较，差异无统计学意义（P>0.05）。观察组干预3个月后收缩压、舒张压、TC、LDL-C、BMI低于干预前，6 min步行距离高于干预前，差异有统计学意义（P<0.05）；对照组干预3个月后TC、BMI低于干预前，6 min步行距离高于干预前，差异有统计学意义（P<0.05）。干预3个月后观察组TC、LDL-C低于对照组，6 min步行距离长于对照组，差异有统计学意义（P<0.05）。观察组TC、LDL-C、BMI及6 min步行距离干预前后差值高于对照组，差异有统计学意义（P<0.05）。观察组干预后3个月后戒烟率为70.6%（24/34），对照组戒烟率为39.4%（13/33），两组戒烟率比较，差异有统计学意义（P=0.010）。6 min步行距离≥400 m组观察组和对照组出院时、干预后3个月6 min步行距离比较，差异无统计学意义（P>0.05）；两组干预3个月后6 min步行距离均较出院时增加，差异有统计学意义（P<0.05）。6 min步行距离<400 m观察组和对照组干预3个月后6 min步行距离均较出院时增加，差异有统计学意义（P<0.05）；干预3个月后观察组6 min步行距离高于对照组，差异有统计学意义（P<0.05）。结论　院内+居家续贯式心脏康复模式利于急性心肌梗死急诊PCI后患者控制危险因素（血压、血脂、吸烟、BMI）、改变行为方式、改善日常体力活动能力（尤其对于6 min步行距离<400 m组）。

关键词: 居家康复, 急性心肌梗死, 血管成形术, 气囊, 冠状动脉, 心脏康复, 6分钟步行试验