【摘要】 目的探讨有指导的运动康复对急性心肌梗死(AMI)患者左室重构和收缩功能的影响。方法64例无并发症首发AMI患者随机分为运动组与对照组,对运动组患者进行个体化的运动锻炼指导。采用超声心动图、血N-末端脑钠肽前体(NT-proBNP)及心肺运动试验检测。结果两组患者随访终点时运动组NTpro-BNP水平较基线值下降[(335.64±246.14)ng/L比(845.29±93.48)ng/L,P<0.05],并显著低于对照组[(1099.83±168.75)ng/L];左室射血分数(LVEF)增加[(60.0±8.0)%比(55.0±8.6)%,P<0.05],对照组NT-proBNP及LVEF与基线值比较无统计学意义(P>0.05);运动组患者心室舒张末径(LVDd)无明显变化[(50.3±3.9)mm比(50.7±4.5)mm,P>0.05],而对照组LVDd则较心肌梗死早期增大[(52.6±5.4)mm比(50.9±5.8)mm,P<0.05]。结论运动康复锻炼可改善无并发症AMI患者心脏收缩功能,限制左室的异常重构。更多还原

【Abstract】 Objective To investigate the influence of rehabilitation on left ventricular remodeling and systolic function in acute myocardial infarction patients.Methods Patients meeting the inclusion criteria with uneventful clinical course after a first myocardial infarction were randomly assigned to a 3-month exercise training period(exercise group,n=35)or a control group(n=29).Before randomization,all patients underwent NT-proBNP test,2-dimensional echocardiography,and submaximal exercise test.Results(1)At baseline,there were no significant differences in NT-proBNP,left ventricular end-diastolic diameter(LVDd)and left ventricular ejection fraction(LVEF)between the exercise and control groups.After 3 months,a significant decrease in NT-proBNP was observed only in the exercise group [from(845.29±93.48)ng/L to(335.64±246.14)ng/L,P<0.05],but not in the control group [from(1091.62±101.78)ng/L to(1099.83±168.75)ng/L,P>0.05)and there was significant difference in NT-proBNP level between the two groups after 3 months(P<0.01).The LVDd increased in the control group [from(50.9 ±5.8)to(52.6±5.4)mm,P<0.05] but not in the exercise group [from(50.7 ±4.5)to(50.3 ±3.9)mm,P>0.05] and there was significant difference in LVDd between the two groupsafter 3 months(P<0.05).Conversely,LVEF improved in the exercise group[from(55.0±8.6)% to(60.0±8.0)%,P<0.05] but not in the control group(P>0.05)and there was significant difference in LVEF between the two groups after 3 months(P<0.05).(2)NT-proBNP was inversely correlated with LVEF.Conclusions Rehabilitation exercise training under instructions based on family condition in the early and recovery stage of AMI can lower the NT-proBNP level,improve ejection fraction,and prevent the increase of left ventricular end-diastolic diameter.Therefore,it may reduce unfavorable remodeling response and improve cardiac systolic function hereafter.更多还原