【摘要】 目的:通过对中老年冠心病患者经皮冠脉介入术(PCI)术后制定科学、个体化,以运动训练为核心的心脏康复,结合揿针疗法,观察患者运动能力、心肺功能以及生存质量改善情况。方法:60例中老年冠心病PCI术后患者按随机数表法分为三组各20例,三组患者均接受常规药物治疗。A组患者于心脏康复门诊接受每周3次,共12周的运动训练,包括有氧运动和抗阻运动;B组患者采用揿针,选择双侧内关、郄门、足三里、心俞、肺俞、膈俞、三阴交留针后进行运动训练。C组患者接受常规药物治疗和健康宣教。12周前后评估患者的心肺功能包括:1秒用力呼气量(FEV1),用力呼气量占用力肺活量比值(FEV1/FVC%),最大通气量(MVV),左心室射血分数(LVEF),心肺运动试验1min后心率恢复(HRR1);相关运动能力包括最大摄氧量(VO2max),无氧阈(AT),最大运动负荷(MWL);生存质量评估采用健康调查简表(SF-36),对患者生理机能、躯体疼痛等8个维度进行评估。结果:①C组12周后心肺功能、运动能力及生存质量均出现不同程度下降。②A组患者心肺功能、运动能力指标均有显著改善(P<0.01);SF-36量表评估中,生理机制、社会功能、生理职能、一般健康状况四个方面有所改善(P<0.01),其余四项无明显改善(P>0.05)。③B组患者心肺功能、运动能力指标均有显著改善(P<0.01),且HRR1、LVEF、VO2max、AT优于A组(P<0.05)。SF-36量表评估8个维度均显著改善(P<0.01),其中躯体疼痛、精力、情感职能、精神健康优于A组(P<0.05)。结论:①中老年冠心病PCI术后患者仅给予常规药物治疗,其心肺功能、运动能力及生存质量将会不同程度下降,不利于预后;②揿针治疗结合运动训练相比于单纯运动训练,能够更好地改善中老年冠心病PCI术后患者的心肺功能和运动能力,对患者躯体疼痛、精力、情感职能、精神健康等方面的改善也优于单纯运动训练。更多还原

【Abstract】 Objective: To observe effects of exercise training and press-needle on exercise performance, cardiopulmonary function and living quality of middle aged and elderly PCI postoperative CHD patients Method: Sixty middle aged and elderly PCI postoperative CHD patients were randomly assigned to exercise training group A(n=20), exercise training and press-needle group B(n=20) and control group C(n=20) by random number table. All the patients adopted the routine medication management and health education. Group A adopted the exercise training including aerobic training and resistance training 3 times a week for 12 weeks.Group B firstly adopted the press-needle treatment on double Nei Guan(PC6), Xi Men(PC4), Zu Sanli (ST36), Xin Shu(BL15), Fei Shu(BL13), Ge Shu(BL17), San Yinjiao(SP6) and then had the same exercise training with group A. Group C has regular medicine treatment and health education. All patients were evaluated with cardiopulmonary function including FEV1, FEV1/FVC%, MVV, LVEF, HRR1 and exercise performance including VO2 max, AT, MWL. The living quality is assessed by SF-36 questionnaire from 8 aspects before and after 12 weeks.Result:(1)Varying degrees of decline in exercise performance, cardiopulmonary function and living quality existed in group C.(2) Group A had significant improvements in FEV1, FEV1/FVC%, MVV, LVEF, HRR1,VO2 max, AT, MWL(P<0.01). Group A also had improvement in Physical Functioning(PF), Role-Physical(RP), Social Functioning(SF), General Health(GH) among SF-36(P<0.01) and the last 4 aspects had no significant change(P>0.05).(3) Group B had significant improvements in FEV1, FEV1/FVC%, MVV, LVEF,HRR1, VO2 max, AT, MWL(P<0.01) and better than group A in HRR1, LVEF, VO2 max, AT(P<0.05). All the 8 aspects of SF-36 had remarkable improvements in group B(P<0.01) which were better than group A in Body Pain(BP), Vitality(VT), Role-Emotional(RE) and Mental Health(MH)(P<0.05).Conclusion:(1)Middle aged and elderly PCI postoperative CHD patients’ exercise performance, cardiopulmonary function and living quality have varying degrees of decline if they accept conventional drug treatment only and will have a bad for prognosis;(2)Exercise training combined with press-needle treatment have better improvements than single exercise training in exercise performance, cardiopulmonary function and living quality.更多还原