文章摘要

中老年冠心病患者经皮冠状动脉介入治疗术后开展心脏运动训练的康复效果

作者: 1叶燕华, 1陈瑞娟, 1熊玲, 1艾丹, 1左露露
1 中国人民解放军陆军第七十三集团军医院干部病房心血管/全科医学病区,福建 厦门 361003
通讯: 左露露 Email: 276336297@qq.com
DOI: 10.3978/j.issn.2095-6959.2021.03.019

摘要

目的:探讨中老年冠心病(coronary heart disease,CHD)患者经皮冠状动脉介入术(percutaneous coronary intervention,PCI)出院后开展心脏运动训练的康复效果。方法:前瞻性选取2017年6月至2019年6月期间在中国人民解放军陆军第七十三集团军医院接受PCI术的80例CHD患者,纽约心脏病协会(New York Heart Association,NYHA)心功能分级I~II级,患者均对研究知情同意。采用计算机随机分组法分为常规组(n=40)和康复组(n=40),常规组患者PCI术后给予常规心内科治疗和护理,康复组在对照组基础上开展心脏运动训练,由专业康复医护人员负责指导和跟踪,均持续随访观察3个月,比较2组治疗前后超声心动图心功能指标、血清N端B型脑钠肽前体(N-terminal pro brain natriuretic peptide,NT-proBNP)、6 min步行试验(6 min walking test,6MWT)、心肺运动试验中峰值摄氧量(peak or maximum oxygen uptake,VO2peak)和西雅图心绞痛调查量表(Seattle Angina Questionnaire,SAQ)变化情况。结果:2组治疗3个月后LVEF、6MWT、VO2peak较治疗前均明显提高,LVEDD均显著下降,差异有统计学意义(P<0.05),2组治疗前后血清NT-proBNP水平无明显变化(P>0.05),康复组治疗3个月后LVEF、6MWT、VO2peak明显高于常规组,LVEDD显著低于常规组,差异有统计学意义(P<0.05)。2组治疗3个月后SAQ量表“躯体活动受限程度”“心绞痛稳定程度”“心绞痛发作频率”“治疗满意程度”和“疾病认知程度”评分均较治疗前显著升高,差异有统计学意义(P<0.05),且康复组治疗3个月SAQ量表上述5个维度评分均显著高于常规组,差异有统计学意义(P<0.05)。结论:中老年CHD患者PCI术后开展心脏运动训练康复效果显著,能有效改善心功能和提高运动耐力,改善患者术后生活质量,值得推广应用。
关键词: 冠心病;经皮冠状动脉介入术;心脏运动训练;心功能;生活质量

Rehabilitation effect of cardiac exercise training after percutaneous coronary intervention in elderly patients with coronary heart disease

Authors: 1YE Yanhua, 1CHEN Ruijuan, 1XIONG Ling, 1AI Dan, 1ZUO Lulu
1 Department of Cardiology/General Practice Ward, the 73th Hospital of the PLA, Xiamen Fujian 361003, China

CorrespondingAuthor: ZUO Lulu Email: 276336297@qq.com

Abstract

Objective: To investigate the rehabilitation effect of cardiac exercise training after percutaneous coronary intervention (PCI) in elderly patients with chronic heart disease (CHD). Methods: Eighty patients with CHD who underwent PCI in the 73th Hospital of the PLA from June 2017 to June 2019 were prospectively selected. NYHA heart function grades I to II were used in the study, and all of patients were informed and agreed with the study. The patients in the routine group were treated and nursed in the cardiology department after PCI. Using the computer random grouping method, it is divided into the regular group (n=40) and the rehabilitation group (n=40). The professional rehabilitation medical staff were responsible for the relevant guidance and follow-up for three months respectively. The changes of cardiac ultrasound heart function indicator before and after the treatment, NT-proBNP, 6MWT, VO2peak and SAQ between two groupes are compared with each other. Results: It’s statistically significant that the LVEF, 6MWT and VO2peak of the 2 groups were significantly higher than those before the treatment, and the LVEDd was significantly lower after three months (P<0.05). There was no significant change in NT-proBNP level before and after the treatment in the two groups (P>0.05). LVEF, 6MWT and VO2peak in the rehabilitation group were significantly higher than those in the routine group, but LVED was significantly lower than that in the conventional group (P<0.05). After 3 months of treatment, SAQ scores of “limitation of physical activity” “stability of angina pectoris” “frequency of angina pectoris attack” “satisfaction of treatment” and “cognition of disease” in the 2 groups were significantly higher than those before the treatment (P<0.05). The scores of the above five dimensions of SAQ in the rehabilitation group were significantly higher than those in the routine group (P<0.05). All of the above changes are statisticly significant. Conclusion: The rehabilitation effect of cardiac exercise training after PCI in the elderly patients with CHD is significant. It can effectively improve the cardiac function, exercise endurance, the quality of life of patients after PCI, so it is worth popularizing.
Keywords: coronary heart disease; percutaneous coronary intervention (PCI); cardiac exercise training; cardiac function; quality of life