Evaluation of the efficacy of Tian dan shu gan rehabilitation exercise in improving the short-term quality of life of patients with acute myocardial infarction after percutaneous coronary intervention

The number of patients with acute myocardial infarction in China has been increasing rapidly every year, and the success rate of rescue of acute myocardial infarction in China has been increasing year by year. However, literature reports^1,2 show that the quality of life of patients after acute myocardial infarction is uneven, affecting their physiological, psychological, and even social adaptation functions. Lack of exercise rehabilitation after percutaneous coronary intervention (PCI) directly affects the short-term quality of life of patients and gradually causes serious complications such as recurrence of myocardial infarction and sudden death. Therefore, this study focused on the relationship between early exercise rehabilitation and the short-term quality of life of patients after PCI and combined the Tian dan shu gan rehabilitation exercise³ in the Department of Cardiology of our hospital to provide nursing guidance for early postoperative rehabilitation exercise with traditional Chinese medicine. This exercise has evolved from the “deer play” of Wuqinxi, which reduces the difficulty of the deer play itself. Deer play follows the principle of “the safety and comfort of the deer”. The deer group is leisurely and comfortable, sometimes playing with their heads and sometimes running with their feet. They can be static and dynamic and adjust the overall state of the body with the music of the Five Elements.

A total of 110 patients with acute myocardial infarction who met the inclusion criteria and were admitted to Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine from August 2020 to November 2020 were included in the study. Convenience sampling was adopted to examine the 110 subjects, while 3 cases were lost in the process for the following reasons: patients being “do not want to continue” and “make last-minute plans to travel”. Finally, 107 patients finished the whole exercises on request, and the data on the 107 patients were analyzed. The 52 subjects in the control group (32 males and 20 females) were 56.21 ± 9.77 years old and had body mass index (BMI) of 27.01 ± 3.98; 42 patients had experienced a first heart attack and 10 had had a second attack. The experimental group consisted of 55 patients, including 30 males and 25 females with the following characteristics: 56.27 ± 9.44 years old and BMI of 27.15 ± 3.51; 43 patients had had a first heart attack and 12 had experienced a second heart attack. There were no significant differences between the two groups in terms of age, BMI, gender, educational background, whether the heart attack in the patients was the first onset, the severity of the disease, and the original quality of life of the patients (P > 0.05). The baseline characteristics of the two groups was consistent, and the experimental results were comparable.

Excel 2017 was used for data collection, and Statistical Package for the Social Sciences (SPSS) 24.0 statistical software was used for analysis. Measurement data were expressed as mean ± standard deviation (x̄ ± s. Categorical data were tested by the chi-square test. Analysis of variance was used for comparison between groups, and P < 0.05 was considered as a statistically significant difference.

Huangdi Neijing, a classic work on theories of traditional Chinese medicine, explains the critical symptoms of chest pain and heartburn (coronary heart disease) as “evil heart, the heart pain is happy and sad, when dizzy”, “with chest pain, the patient can not lie down”.^8,9 Modern studies have shown that the incidence of chest pain and recurrence of myocardial infarction after stenting are still very high, which directly affects the quality of life of patients.¹⁰ Therefore, early rehabilitation exercise after PCI has been advocated by experts in various countries and recommended in the guidelines.^11-14 In this study, traditional Chinese medicine rehabilitation exercise and conventional nursing measures were organically combined, so that patients could achieve “pulling the waist and moving the joints” by imitating “shaking the muscles and bones, moving the limbs”, and achieve “relaxing and natural breathing” by coordinating the movements, and finally achieve “physical and mental preparation with external guidance and internal guidance, and internal and external unity”. Postoperative adverse symptoms, such as chest tightness, chest pain, palpitation, and fatigue, were relieved, and the physical function recovered quickly and effectively, which was consistent with the research results of Li et al.¹⁵

This study shows that in PCI postoperative patients with acute myocardial infarction, liver function is good after rehabilitation using traditional Chinese medicine after operation, the short-term quality of life is significantly higher than in the conventional nursing group, the difference was statistically significant (P < 0.001). Tian dan shu gan rehabilitation exercise can enhance the patient’s physical function, cognitive function, psychosocial function, and so on to accelerate the postoperative recovery process. The symptom score of patients with a bachelor’s degree was the highest (28.80 ± 4.21), which was higher than that of patients with other education level (26.10 ± 3.31). The reason may be related to the fact that higher the degree of education, the better is the perception and understanding of disease symptoms, and the better is the sensitivity and acceptance of knowledge and information in the WeChat group. This is consistent with the research results of Liu et al.¹⁶ In addition, the statistical results of physical function items in the scale showed that patients with BMI in the range of “overweight” had the highest score (18.40 ± 2.41 to 21.21 ± 1.23), while patients classified as “obese” had the lowest score (18.91 ± 1.51). The analytical reasons may be similar to “Locke’s Law” in management. “Tian dan shu gan rehabilitation exercise” can be regarded as a small goal. Patients with a BMI slightly higher than the normal value believe that with a little effort, their body shape management can reach the normal standard, and such patients will work harder in exercise. However, “obese” patients who were far from the normal BMI value thought that functional exercise could not change the current situation; so, their attitude was more negative and the improvement of physical function was poor.

In this study, none of the patients fell and no other adverse nursing events occurred in the process of Tian dan shu gan rehabilitation exercise. Through online communication with patients and nurses through the WeChat group, patients had a deeper cognition of the disease and a higher adaptability of psychosocial function. After 3 wk, the satisfaction of patients in the experimental group reached 96.3%, which was higher than that in the conventional nursing group. In recent years, early postoperative exercise rehabilitation and quality of life of patients have gradually received attention.¹⁷ Tian dan shu gan rehabilitation exercise movements are simple and short, patients’ acceptance and compliance are high, and this exercise could be applied for more diseases in the future, but attention should be paid to the different characteristics of the population; when promoting nursing instruction, attention should be paid to more individualized regimens, attention should be given to the patients in the form of feedback in a timely manner to improve their involvement,¹⁸ make them feel respected, provide care and understanding, and finally promote the rapid and comprehensive recovery from the disease.