摘要
目的探讨Ⅱ期心脏康复治疗对急性心肌梗死经皮冠状动脉介入治疗(PCI)后患者的作用。方法选取确诊急性心肌梗死并已行PCI治疗的患者共60例作为研究对象,其中男42例,女18例。采用随机数字表法按性别随机将其分为康复组(n=30)和对照组(n=30)。对所有入组的患者常规进行一般情况评估、健康教育及规范冠心病二级预防用药。康复组在以上基础上进行危险评估和运动康复程序,以在跑步机或平地上慢跑为主要运动方式。运动强度为最大运动强度的50%～80%或自我感知劳累程度Borg评分达到12分,从低强度开始逐渐适应递增。频率为每周3～5次。随访时间为6个月,两组患者定期门诊复查心电图、心脏彩超、生化指标、血压、血脂、B型脑钠肽(BNP)、了解生活方式(有无吸烟、饮食、用药依从性等)、对运动耐力[6 min步行距离(6MWD)]进行测定和评价。结果两组患者性别、年龄、饮酒率、体质量、吸烟率、高血压、糖尿病、血脂指标、6MWD、心脏彩超指标等进行比较,差异无统计学意义(P>0.05)。干预后康复组总胆固醇、三酰甘油、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇改善均优于对照组(P<0.05);康复组体质指数和6MWD与对照组相比均较前明显改善(P<0.01)。干预后两组患者吸烟率较干预前有改善(P<0.01),但干预后两组对比无差异(P>0.05)。干预后两组左室射血分数均较干预前有所升高(P<0.05),干预后康复组左室射血分数较对照组更优(P<0.05)。康复组左室收缩末期容积、左室舒张末期容积经干预后也明显改善(P<0.05)。结论对急性心肌梗死患者PCI术后进行心脏康复治疗可获得良好的治疗效果,对患者运动耐力、体质指数、生活方式及心脏功能等方面均有明显改善。
Objective To study the effect of Stage II cardiac rehabilitation therapy on patients with acute myocar- dial infarction after PCI treatment. Methods Sixty patients with acute myocardial infarction and treated with PCI in Cha- ozhou people＇s hospital were chosen as the research subjects from January 2016 to January 2017, including 42 males and 18 females. The patients were randomly divided into rehabilitation group and control group using random number table （n = 30）. Routine assessment, health education and standardized secondary preventive medications were given in all pa- tients. Besides that, a risk assessment and rehabilitation program to jog on the treadmill or the ground floor as the main movement mode were carried out in the rehabilitation group. Exercise intensity was 50% - 80% of the maximum intensity or when Borg score of self - perceived fatigue reached 12 points, and the intensity increased gradually from the minimum as the patient adapted. The frequency is 3 - 5 times a week. The follow - up time was 6 months. Regular outpatient elec- trocardiogram, echocardiography, biochemical workup, blood pressure, blood lipid, BNP, lifestyle check（ smoking, diet, medication compliance, etc. ） and exercise endurance （6 minutes walking distance） were measured and evaluated in both groups. Results There were no significant differences in gender, age, rate of patients who drink, weight, rate of smok- ers, hypertension, diabetes, blood lipid profile, 6 minute walk distance （6MWD） and color Doppler index between the two groups （P 〉 0. 05 ）. After intervention, the improvement of TC, TG, LDL - C and HDL - C in the rehabilitation group was better than those in the control group （ P 〈 0. 05 ）. BMI and 6MWD in the rehabilitation group were significantly improved compared with those in the control group （P 〈 0.01 ）. After the intervention, the smoking rate in the 2 groups was lower than that before the intervention in both groups （ P 〈 0. 01 ）, but there was no difference between the two groupsafter intervention （ P 〉 O. 05 ）. After intervention, the LVEF in both groups were higher than that before intervention （ P 〈 0. 05 ）, and the LVEF of the rehabilitation group was better than that of the control group （ P 〈 0. 05 ）. The LVESV and LVEDV in the rehabilitation group were significantly improved （ P 〈 0. 05 ）. Conclusion Cardiac rehabilitation for pa- tients with acute myocardial infarction after PCI can achieve good toucomes with improved exercise tolerance, body mass, life style and cardiac function.
作者
陈培锦
刘映霞
孙华锋
陈秋通
江文益
张展渠
CHEN Pei - jin;LIU Ying-xia;SUN Hua-feng;CHEN Qiu- tong;JIANG Wen-yi;ZHANG Zhan- qu(Internal Medicine- Cardiovascular Department, Chaozhou People＇s Hospital, Chaozhou 521011, Guangdong , China)
出处
《广东医学》
CAS
2018年第7期1017-1021,共5页
Guangdong Medical Journal
基金
潮州市科技计划项目(编号:2016 GY25)
关键词
心脏康复
急性心肌梗死
冠状动脉介入
cardiac rehabilitation
acute myocardial infarction
coronary intervention
