欧洲心脏病学会心血管康复手册

本书旨在作为一本实用手册，在临床实践中实施心血管患者的康复。欧洲预防心脏病学协会（eapc）和欧洲心脏病学会（esc）的部分使命是促进医疗保健专业人员对这一主题的教育，这本书将帮助人们克服许多障碍。心血管疾病潜在的病理生理机制、预防干预和策略已经从心脏延伸到整个心血管系统，也延伸到其他系统。此外，康复的范围也在快速扩大，包括越来越复杂的患者。本书旨在介绍心血管疾病的康复内容。

张兆国，主任医师，现任北京市第一中西医结合医院康复医学科主任，北京清华长庚医院心内科兼职专家，意大利安科纳医院访问学者，中国医师协会“心电学技术规范化培训项目”特约培训专家，国家心血管病中心—— 心电技术培训中心客座教授，曾获得等“中国杰出心电工作者奖”。　　擅长冠心病、高血压、心房颤动和心功能不 全等诊治和重症心血管疾病患者康复，熟练脑卒中康复。　　长期担任康复医学科带头人，主导冠心病支架和搭桥术后以及心脏瓣膜置换术后康复评估与训练 3500 多例，脑卒中 康复 2000 多例，骨关节术后康复 1500 多例。　　社会兼职:世界中医药联合会学会心脏康复专业委员会常务委员，中国中医药促进会中西 医结合心血管预防与康复专业委员会常务委员，基层心脏康复专家委员会主任委员，中国 康复医学会心血管预防与康复委员会委员，中国生物医学工程学会心律分会委员，北京康复 医学会理事。

第一章　现代心脏康复的证据............................................................................ 1摘要 .................................................................................................................................3介绍 .................................................................................................................................3证据 .................................................................................................................................3结论 .................................................................................................................................6参考文献 .......................................................................................................................11拓展阅读 .......................................................................................................................13第二章　心脏康复的不同方案.......................................................................... 15摘要 ...............................................................................................................................17 介绍 ...............................................................................................................................17心脏康复组织...............................................................................................................18心脏康复的备选模型...................................................................................................18家庭心脏康复的核心组成部分...................................................................................21结论 ...............................................................................................................................22参考文献 .......................................................................................................................22拓展阅读 .......................................................................................................................23第三章　心脏康复：转诊和阻碍 ...................................................................... 25摘要 ...............................................................................................................................27介绍 ...............................................................................................................................27CR施行阻碍.................................................................................................................28结论 ...............................................................................................................................31参考文献 .......................................................................................................................32拓展阅读 .......................................................................................................................35第四章　人力资源、物质资源、结构和组织方面的建议 .................................. 37摘要 ...............................................................................................................................39介绍 ...............................................................................................................................39人力资源和组织问题...................................................................................................39组织方面、基础设施和物质资源...............................................................................42结论 ...............................................................................................................................45参考文献 .......................................................................................................................45拓展阅读 .......................................................................................................................46第五章　从急性心脏事件中康复 ...................................................................... 47摘要 ...............................................................................................................................49介绍 ...............................................................................................................................49急性心脏事件后的心脏康复.......................................................................................49结论 ...............................................................................................................................52参考文献 .......................................................................................................................52拓展阅读 .......................................................................................................................54第六章　早期评估和风险分层.......................................................................... 55摘要 ...............................................................................................................................57介绍 ...............................................................................................................................57早期评估 .......................................................................................................................57风险概况 .......................................................................................................................59结论 ...............................................................................................................................62参考文献 .......................................................................................................................62拓展阅读 .......................................................................................................................63第七章　在心血管健康管理中具有风险因素患者的体育活动和锻炼方式......... 65摘要 ...............................................................................................................................67介绍 ...............................................................................................................................67体力活动和运动训练对心血管疾病危险因素的影响..............................................68如何制订控制心血管疾病风险因素的运动处方 ......................................................70结论 ...............................................................................................................................73参考文献 .......................................................................................................................74拓展阅读 .......................................................................................................................76第八章　冠心病低危患者的运动训练摘要........................................................ 77摘要 ...............................................................................................................................79介绍 ...............................................................................................................................79低危患者的评估...........................................................................................................80有氧耐力训练处方.......................................................................................................81有氧耐力训练方案.......................................................................................................83动态抗阻训练的处方...................................................................................................85低危患者运动训练的注意事项和安全性 ..................................................................87结论 ...............................................................................................................................88参考文献 .......................................................................................................................89第九章　针对高危和特殊患者群体的运动训练计划摘要 .................................. 91摘要 ...............................................................................................................................93介绍 ...............................................................................................................................93“高危”患者的定义.....................................................................................................93高危患者评估...............................................................................................................94运动强度的确定...........................................................................................................98运动方式 .......................................................................................................................99特定人群（使用植入式心律转复除颤器、心脏再同步化治疗和心室辅助装置的患者）..............................102结论 .............................................................................................................................105参考文献 ..........................106拓展阅读 ...................108第十章　心脏康复的饮食和营养方面............................................................. 109摘要 .............................................................................................................................111介绍 .............................................................................................................................111心血管疾病患者的饮食和营养方面 ........................................................................112考虑到合并症、糖尿病和高血压.............................................................................114心血管疾病患者的营养问题.....................................................................................114体重管理与消瘦和虚弱的风险.................................................................................115结论 .............................................................................................................................118参考文献 .....................................................................................................................118第十一章　教育干预 ...................................................................................... 123摘要 .............................................................................................................................125介绍 .............................................................................................................................125一般考虑 .....................................................................................................................125结论 .............................................................................................................................129参考文献 .....................................................................................................................129拓展阅读 .....................................................................................................................130第十二章　心血管病患者中抑郁、焦虑和压力的干预.................................... 131摘要 .............................................................................................................................133介绍 .............................................................................................................................133抑郁如何增加心脏死亡率？.....................................................................................134我们如何诊断心脏病患者中的抑郁 ? .....................................................................134我们如何治疗抑郁 ? ..................................................................................................135心脏病患者的抑郁症治疗能够降低死亡率吗 ? .....................................................138结论 .............................................................................................................................139参考文献 .....................................................................................................................139拓展阅读 .....................................................................................................................142第十三章　非常规危险因素的管理 ................................................................ 143 摘要 .............................................................................................................................145介绍 .............................................................................................................................145尿酸 .............................................................................................................................145血循环和尿液生物标志物.........................................................................................146基因标志 .....................................................................................................................147血管损伤 .....................................................................................................................147肾功能障碍 .................................................................................................................148总结 .............................................................................................................................148参考文献 .....................................................................................................................148第十四章　如何提高药物治疗和生活方式措施的依从性 ................................ 151摘要 .............................................................................................................................153介绍 .............................................................................................................................153影响不坚持治疗的因素、不坚持治疗的风险群体，以及促进坚持治疗的因素.......................................154如何衡量依从性.........................................................................................................155促进药物依从性的具体策略.....................................................................................156促进非药物治疗依从性的具体策略 ........................................................................157心脏康复：二级预防计划和依从性 ........................................................................158改变和坚持的模式与理论.........................................................................................159行为改变的技巧.........................................................................................................159新型电子技术 .............................................................................................................160总结 .............................................................................................................................160参考文献 .....................................................................................................................161拓展阅读 .....................................................................................................................164第十五章　老年病人和体弱病人的心脏康复治疗........................................... 165摘要 .............................................................................................................................167介绍 .............................................................................................................................167老年人的心脏康复.....................................................................................................167虚弱的定义和评估.....................................................................................................169年老体弱患者的心脏康复.........................................................................................170对体弱患者进行运动干预.........................................................................................171老年患者心脏康复干预的其他措施 ........................................................................173总结 .............................................................................................................................173病例 1 ..........................................................................................................................173病例 2 ..........................................................................................................................175参考文献 .....................................................................................................................177拓展阅读 .....................................................................................................................180第十六章　重返工作 ...................................................................................... 181摘要 .............................................................................................................................183介绍 .............................................................................................................................183重返工作岗位的预测指标.........................................................................................183 F -36简短健康调查问卷 ..........................................................................................186结论 .............................................................................................................................187参考文献 .....................................................................................................................188拓展阅读 .....................................................................................................................188第十七章　心脏康复后体力活动的具体问题 .................................................. 189摘要 .............................................................................................................................191介绍 .............................................................................................................................191如何在Ⅱ期心脏康复后促进规律的 PA ..................................................................192Ⅱ期心脏康复后如何开具处方和（或）建议定期 PA ..........................................193结论 .............................................................................................................................194 参考文献 .....................................................................................................................195拓展阅读 .....................................................................................................................195第十八章　心肺运动试验............................................................................... 197摘要 .............................................................................................................................199介绍 .............................................................................................................................199如何进行心肺运动测试.............................................................................................202心肺运动测试结果的解释.........................................................................................204总结 .............................................................................................................................208参考文献 .....................................................................................................................210拓展阅读 .....................................................................................................................212第十九章　技术问题概要............................................................................... 213摘要 .............................................................................................................................215介绍 .............................................................................................................................215心脏康复中的监测.....................................................................................................215数字医疗 .....................................................................................................................218未来的发展方向.........................................................................................................219参考文献 .....................................................................................................................220拓展阅读 .....................................................................................................................225第二十章　心脏康复中的远程医疗概要 ......................................................... 227 摘要 .............................................................................................................................229介绍 .............................................................................................................................229如何实施心脏远程康复：组织方面 ........................................................................230如何实施心脏远程康复：实践方面 ........................................................................231如何应对法律框架和不断变化的技术 ....................................................................232小结 .............................................................................................................................233参考文献 .....................................................................................................................233拓展阅读 .....................................................................................................................235第二十一章　EXPERT工具：如何让运动处方变得简单概要........................237摘要 .............................................................................................................................239介绍 .............................................................................................................................239EXPERT工具：特征和功能 .....................................................................................241EXPERT培训中心 .....................................................................................................246小结 .............................................................................................................................247致谢 .............................................................................................................................247参考文献 .....................................................................................................................247拓展阅读 .....................................................................................................................248