摘要
目的:观察心脏康复运动在急性心肌梗死(AMI)行经皮冠状动脉介入(PCI)后患者康复中的应用效果。方法:选择温州市中心医院2018年6月至2019年6月收治的AMI行PCI术后患者100例为观察对象,采用随机数字表法分为康复组和常规组,每组50例。常规组行常规术后康复宣教,康复组实施针对性心脏康复运动计划,术后随访12个月,采用实时三维超声心动图(RT-3DE)评价术前、术后3、6、12个月心室重构[左室射血分数(LVEF)、舒张末期容积(LVEDV)、收缩末容积(LVESV)、重构指数(LVRI)]及心室同步性(Tmsv-16dif、Tmsv-16sd、Tmsv16-dif%、Tmsv16-sd%),检测血清心室重构指标[成纤维细胞生长因子23(FGF23)、Ⅰ型C端胶原前肽(PⅠCP)、Ⅲ型N端胶原前肽(PⅢNP)],统计12个月内心血管终点事件发生率。结果:康复组术后3、6、12个月LVEF分别为(51.81±5.43)%、(55.88±5.46)%、(55.63±5.57)%,均高于常规组的(47.16±5.38)%、(52.31±5.44)%、(51.84±5.59)%(t=4.302、3.275、3.396,均P<0.05);LVEDV分别为(124.65±15.56)mL、(98.54±14.54)mL、(99.82±13.18)mL,均低于常规组的(132.64±16.58)mL、(112.55±15.61)mL、(114.84±17.35)mL(t=2.485、4.644、4.874,均P<0.05);术后6、12个月LVESV分别为(52.26±5.48)mL、(52.15±5.32)mL,均低于常规组的(57.92±5.46)mL、(58.51±5.72)mL(t=5.174、5.757,均P<0.05);LVRI分别为(1.75±0.42)g/mL、(1.74±0.35)g/mL,均高于常规组的(1.52±0.37)g/mL、(1.50±0.32)g/mL(t=2.906、3.579,均P<0.05)。康复组术后3、6、12个月Tmsv-16dif(t=2.753、4.283、4.088,均P<0.05)、Tmsv-16sd(t=5.134、4.326、4.670,均P<0.05)、Tmsv16-dif%(t=7.714、8.587、7.800,均P<0.05)、Tmsv16-sd%(t=9.004、14.061、10.305,均P<0.05)水平均低于常规组。康复组术后3、6、12个月FGF23(t=6.303、5.053、4.619,均P<0.05)、PⅠCP(t=3.772、2.798、3.788,均P<0.05)、PⅢNP(t=3.110、5.912、4.294,均P<0.05)水平均低于常规组。随访12个月内,康复组心血管终点事件总发生率[12.00%(6/50)]明显较常规组[32.00%(16/50)]低(χ^(2)=5.828,P<0.05)。结论:心脏康复运动对改善AMI行PCI术后患者心室重构、心室同步性有积极意义,且有利于减少心血管终点事件发生。
Objective To investigate the therapeutic effect of cardiac rehabilitation exercise on ventricular remodeling in patients with acute myocardial infarction undergoing percutaneous coronary intervention.Methods A total of 100 patients with acute myocardial infarction undergoing percutaneous coronary intervention who received treatment in Wenzhou Central Hospital from June 2018 to June 2019 were included in this study.They were randomly divided into a rehabilitation group and a conventional treatment group(n=50/group).Patients in the conventional treatment group underwent conventional postoperative rehabilitation education while those in the rehabilitation group received targeted cardiac rehabilitation exercise.After surgery,all patients were followed up for 12 months.Real time three-dimensional echocardiography was used to evaluate ventricular remodeling(left ventricular ejection fraction,left ventricular end-diastolic volume,left ventricular end-systolic volume,left ventricular remodeling index)and ventricular synchrony(Tmsv-16dif,Tmsv-16sd,Tmsv16-dif%,Tmsv16-sd%)before and 3,6 and 12 months after surgery.In addition,serum levels of ventricular remodeling indexes(fibroblast growth factor 23,PICP and PIIINP)were measured.The incidence of cardiovascular end-point events within 12 months was calculated.Results At 3,6 and 12 months after surgery,left ventricular ejection fraction was(51.81±5.43)%,(55.88±5.46)%,(55.63±5.57)%in the rehabilitation group,which was significantly higher than(47.16±5.38)%,(52.31±5.44)%,(51.84±5.59)%respectively in the conventional treatment group(t=4.302,3.275,3.396,all P<0.05).At 3,6 and 12 months after surgery,left ventricular end-diastolic volume was(124.65±15.56)mL,(98.54±14.54)mL,(99.82±13.18)mL,respectively in the rehabilitation group,which was lower than(132.64±16.58)mL,(112.55±15.61)mL and(114.84±17.35)mL,respectively in the conventional treatment group(t=2.485,4.644,4.874,all P<0.05).At 6 and 12 months after surgery,left ventricular end-systolic volume was(52.26±5.48)mL and(52.15±5.32)mL respectively in the rehabilitation group,which was significantly lower than(57.92±5.46)mL and(58.51±5.72)mL in the conventional treatment group(t=5.174,5.757,both P<0.05).At 6 and 12 months after surgery,left ventricular remodeling index was(1.75±0.42)g/mL and(1.74±0.35)g/mL respectively in the rehabilitation group,which was significantly higher than(1.52±0.37)g/mL and(1.50±0.32)g/mL,respectively in the conventional treatment group(t=2.906,3.579,both P<0.05).At 3,6 and 12 months after surgery,Tmsv-16dif(t=2.753,4.283,4.088,all P<0.05),Tmsv-16sd(t=5.134,4.326,4.670,all P<0.05),Tmsv-16dif%(t=7.714,8.587,7.800,all P<0.05)and Tmsv16-sd%(t=9.004,14.061,10.305,all P<0.05)respectively in the rehabilitation group,were significantly lower than those in the conventional treatment group.At 3,6 and 12 months after surgery,fibroblast growth factor 23(t=6.303,5.053,4.619,all P<0.05).PICP(t=3.772,2.798,3.788,all P<0.05)and PIIINP(t=3.110,5.912,4.294,all P<0.05)in the rehabilitation group were significantly lower than those in the conventional treatment group.Within 12 months,the total incidence of cardiovascular end-point events in the rehabilitation group[12.00%(6/50)]was significantly lower than that in the conventional treatment[32.00%(16/50)](χ^(2)=5.828,P<0.05).Conclusion Cardiac rehabilitation exercise can improve ventricular remodeling and synchrony in patients with acute myocardial infarction undergoing percutaneous coronary intervention and reduce the incidence of cardiovascular end-point events.
作者
施中平
黄旭梅
陈颖
Shi Zhongping;Huang Xumei;Chen Ying(Department of Cardiology,Wenzhou Central Hospital,Wenzhou 325000,Zhejiang Province,China)
出处
《中国基层医药》
CAS
2021年第4期548-553,共6页
Chinese Journal of Primary Medicine and Pharmacy
基金
浙江省温州市科技计划经费自筹项目(Y20180654)。
关键词
心肌梗死
经皮冠状动脉介入
心脏康复运动
超声心动描记术
三维
心脏功能
心室重构
心室同步性
心血管终点事件
Myocardial infarction
Percutaneous coronary intervention
Cardiac rehabilitation exercise
Echocardiography,Three-Dimensional
Heart function
Ventricular remodeling
Ventricular synchrony
Cardiovascular end points
