【摘要】 目的:探讨运动康复治疗对慢性稳定性心力衰竭(心衰)患者运动耐力、心肺功能和生活质量的影响。方法:入选的96例纽约心脏协会(NYHA)心功能Ⅱ~Ⅲ级、左心室射血分数(LVEF)<40%的慢性稳定性心衰患者在药物治疗基础上,随机分为运动康复组(n=46)和对照组(n=50)。运动康复组采用踏车运动康复,训练强度为基线水平症状限制性心肺运动试验测得的峰值氧耗量(peak VO2)50%~80%;每周运动3次,每次25~40 min。在基线及12周随访结束时通过心肺运动试验测peak VO2、二氧化碳通气当量斜率(VE/VCO2 slop)、无氧阈氧耗量(VO2 AT)、最大运动功率和最大运动时间;超声心动图检查左心房内径(LAD)、左心室舒张末期内径(LVEDD)、心脏指数(CI)、LVEF;测6 min步行距离;检测血浆N末端B型利钠肽原(NT-pro BNP);通过明尼苏达心衰生活质量问卷表(MLWHFQ)评估生活质量。对上述指标进行组内及组间比较。结果:运动康复组患者通过12周的规律有氧运动训练,与基线水平比较,peak VO2[(19.8±2.7)ml/(min·kg)vs(17.4±2.1)ml/(min·kg)]、VO2 AT[(11.6±2.5)ml/(min·kg)vs(9.5±1.8)ml/(min·kg)]、最大运动功率[(120±20)W vs(102±21)W]、最大运动时间[(8.2±1.7)min vs(6.4±1.5)min]、CI[(2.2±0.5)L/(min·m2)vs(1.9±0.4)L/(min·m2)]、LVEF[(42±5)%vs(35±4)%]和6 min步行距离[(406±58)m vs(345±79)m]均增加(P均<0.05),VE/VCO2 slop[(31.7±4.6)vs(34.2±5.8)]、LAD[(38.6±5.5)mm vs(41.5±3.6)mm]、LVEDD[(58.4±6.3)mm vs(62.9±5.4)mm]、NT-pro BNP[(235±69)ng/ml vs(387±57)ng/ml]和MLWHFQ总评分[(30.8±12.0)分vs(42.3±8.5)分]下降(P均<0.05);运动康复组与对照组比较,上述指标之间的差异也均有统计学意义(P均<0.05)。而对照组随访12周后,上述指标与基线水平比较,差异无统计学意义(P均<0.05)。结论:运动康复治疗能安全、有效地改善慢性稳定性心衰患者的运动耐力、心肺功能和生活质量。更多还原

【Abstract】 Objective:To evaluate the impact of rehabilitation on exercise capacity,cardiopulmonary function and quality of life(Qo L) in patients with chronic heart failure(CHF).Methods:A total of 96 CHF patients with NYHA II-III and left ventricular ejection fraction(LVEF)<40% were enrolled.Based on routine drug therapy,the patients were randomly assigned into 2 groups:Control group,n =50 and Rehabilitation group,n=46,the patients performed treadmill exercise,the training intensity was tailored by(50-80) % of peak oxygen uptake(peak VO2) of baseline cardiopulmonary exercise test(CPET) at(25-40) min/session,3 sessions/week for 12 weeks.The peak VO2,VE/VCO2 slop,anaerobic threshold(VO2 AT),maximum workload and maximum exercise time were measured by CPET;left atrial diameter(LAD),left ventricular end diastolic diameter(LVEDD),cardiac index(CI) and LVEF were examined by echocardiography;6 min walking distance(6 MWD) and plasma NT-pro BNP level were recorded;Qo Lwas assessed by Minnesota living with heart failure questionnaire(MLWHFQ).The above indexes were compared within Rehabilitation group and between 2 groups.Results:In Rehabilitation group,compared to baseline condition,the following indexes were increased by 12 weeks training:peak VO2(19.8±2.7) ml/min·kg vs(17.4±2.1) ml/min·kg,VO2 AT(11.6±2.5) ml/min·kg vs(9.5±1.8) ml/min·kg,maximum workload(120±20) w vs(102±21) w,maximum exercise time(8.2±1.7) min vs(6.4±1.5) min,CI(2.2±0.5) L/(min·m2) vs(1.9±0.4) L/(min·m2),LVEF(42±5) % vs(35±4) % and 6 MWD(406±58) m vs(345±79) m,all P<0.05;while the following parameters were decreased:VE/VCO2 slop(31.7±4.6) vs(34.2±5.8),LAD(38.6±5.5) mm vs(41.5±3.6) mm,LVEDD(58.4±6.3) mm vs(62.9±5.4) mm,NT-pro BNP(235±69) ng/ml vs(387±57) ng/ml and MLWHFQ(30.8±12.0) vs(42.3±8.5),all P<0.05.The above indexes were different between Control group and Rehabilitation group,all P<0.05.Conclusion:Rehabilitation may safely and effectively improve cardiopulmonary function and quality of life in CHF patients.更多还原