SMART原则下原地踏步运动方案对老年 PCI术后患者院内Ⅰ期康复活动耐力的影响 [中文引用][英文引用]

目的 探讨基于 SMART 原则的原地踏步运动方案对老年急性心肌梗死（acute myocardial infarction，AMI）经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）术后患者院内Ⅰ期康复活动耐力及康复结局的影响，为老年 PCI 术后早期运动康复提供实用方案。方法 采用历史前后对照研究，采用便利抽样法，选取 2024 年 4 月— 11 月江苏省某三级甲等综合医院心血管内科收治的老年 AMI 行 PCI 术后患者 88 例作为研究对象。将 2024 年 4 月—7 月入院的 44 例患者作为对照组，2024 年 8 月— 11 月入院的 44 例患者作为观察组。对照组患者实施 PCI 术后常规护理与康复指导；观察组患者在对照组基础上实施基于 SMART 原则的院内Ⅰ期原地踏步运动康复方案，干预始于 PCI 术后第 2 天，止于出院。比较两组患者干预前后的活动耐力、生活自理能力、焦虑评分、心功能、术后住院时间及出院后 6 个月再入院率。结果 共 88 例患者均完成研究。干预后观察组患者 6min 步行试验距离（6-minute walking test distance，6MWT）长于对照组、干预前后 Barthel 指数差值、焦虑评分差值高于对照组，术后住院时间短于对照组，再入院率低于对照组，差异具有统计学意义（均 P<0.05）；两组患者左心室射血分数（left ventricular ejection fraction，LVEF）干预前后差值比较，差异无统计学意义（P>0.05）。结论 基于 SMART 原则的原地踏步运动院内 I 期康复方案，可改善老年 AMI 患者 PCI 术后院内Ⅰ期康复的活动耐力、生活自理能力及焦虑情绪，缩短住院时间，降低再入院率，但对 LVEF 的改善作用有限，其远期心功能获益尚需进一步验证。

Objective To investigate the effect of a stationary walking exercise rehabilitation program based on the SMART principle on in-hospital phase I rehabilitation endurance and recovery outcomes in elderly patients with acute myocardial infarction（AMI） following percutaneous coronary intervention（PCI）, and to provide a practical early rehabilitation strategy for elderly post-PCI patients. Methods A historical controlled before and after study was used, employing convenience sampling to select 88 elderly AMI patients who underwent PCI at a tertiary general hospital in our province from April to November 2024. The 44 patients admitted between April and July 2024 were assigned to the control group, while the 44 patients admitted between August and November 2024 formed the observation group. The control group received standard post-PCI nursing care and rehabilitation guidance；the observation group received, in addition, a phase I in-hospital stationary walking exercise rehabilitation program based on the SMART principle, starting on the second day after PCI and continuing until discharge. Pre-and post-intervention assessments included activity endurance, activities of daily living（ADL）, anxiety scores, cardiac function, length of hospital stay, and six-month readmission rates after discharge. Results All 88 patients completed the study. After intervention, the observation group showed significantly greater 6-minute walk test（6MWT）distance, higher differences in Barthel index and anxiety scores, shorter hospital stays, and lower readmission rates compared to those of the control group（all P<0.05）. However, there was no significant difference in changes in left ventricular ejection fraction（LVEF）between the two groups before and after intervention（P>0.05）. Conclusion A stationary walking exercise rehabilitation program based on the SMART principle is safe and effective in improving endurance, ADL capacity, and anxiety levels during in-hospital phase I rehabilitation in elderly AMI patients after PCI, reducing hospitalization duration and readmission rates. However, its impact on LVEF is limited, and long-term cardiac functional benefits require further validation.