增强型体外反搏与冠心病患者运动耐量及血浆内皮功能

Enhanced external counterpulsation and exercise tolerance and plasm endothelial function in patients with coronary heart disease

目的:探讨增强型体外反搏对冠心病患者运动耐量及内皮功能恢复的作用。方法:实验于1999-05/2004-12在暨南大学医学院第四附属医院心内科完成。128例确诊冠心病的患者随机分为反搏组和药物治疗组,每组64例。反搏组在常规药物治疗的基础上接受体外反搏治疗36d(1h/d),药物组接受常规药物治疗相同天数;分别于治疗前后给患者行平板运动试验,检测运动耐量相关指标(总运动时间和做功当量),同时测定患者的血浆内皮素含量用放射免疫法,测定患者血浆一氧化氮浓度应用硝酸盐还原酶。并测定30名健康人的内皮素和一氧化氮值作为对照。结果:反搏组和药物组有121例进入结果分析,正常对照组30名进入结果分析。①患者运动耐量指标比较:治疗后做功当量反搏组显著高于药物组犤(7.9±2.4),(6.1±2.4)METs,P<0.05犦。②患者血浆内皮素含量:治疗后反搏组明显低于药物组犤(78.9±30.2),(148.0±36.5)mg/L,P<0.01犦;反搏组治疗后明显低于治疗前犤(78.9±30.2),(116.4±24.9)mg/L,P<0.01犦。③患者血浆一氧化氮水平:反搏组治疗后明显高于治疗前犤(89.6±18.3),(64.4±14.8)μmol/L,P<0.01犦;反搏组治疗后明显高于对照组和药物组犤(89.6±18.3),(70.1±13.9),(83.4±23.0)μmol/L,P<0.01犦。结论:体外反搏治疗可以在较短时间内增加冠心病患者的运动耐力,提高血浆一氧化氮水平并降低内皮素的含量,促进血管舒缩平衡功能的恢复。

AIM： To investigate the role of enhanced external counterpulsation （EECP） on exercise tolerance and endothelium functional restoration in patients with coronary heart disease. METHODS： The experiment was done in Department of Cardiology of Fourth Affiliated Hospital of Medical College of Jinan University between May 1999 and December 2004. 128 patients confirmed with coronary heart disease had been randomly divided into external counterpulsation group and drug treatment group with 64 in each group. The patients in external counterpulsation group were treated with external counterpulsation for 36 days （one hour per day） on the basis of routine drug treatment. The patients in drug group were treated with routine drug treatment for the same days. Treadmill test was performed before and after treatment respectively to check the related index of exercise tolerance （the general movement time and work equivalent ）. Meanwhile, the plasma of endothelins content by using radio-immunity test and concentrations of nitrogen monoxide by using nitrate reductase test were detected. The endothelins and nitrogen monoxide of the 30 health people was detected as control.RESULTS： 121 in counterpulsation group and drug group were involved in the result analysis, and 30 in control group were involved in the result analysis. ① Comparison among exercise tolerance index in patients：The equivalent of doing work post-treatment in counterpulsation group was significantly higher than that in drug group [（7.9±2.4）, （6.1±2.4） METs, P〈 0.05]; ② The content of plasm endothelins in patients： It was significantly lower in counterpulsation group post-treatment than that in drug group [（78.9±30.2）, （148.0±36.5） mg/L, P 〈 0.01]; It was significantly lower in counterpulsation group post-treatment than that pre-treatment [（78.9±30.2）, （116.4±24.9） mg/L, P 〈 0.01]. ③ The level of plasm nitrogen monoxide in patients： It was significantly higher in counterpulsation group posttreatment than that pre-treatment [（89.6±18.3）, （64.4±14.8） μmol/L, P 〈 0.01]; It was significantly higher in counterpulsation group posttreatment than that in control group and drug group [（89.6±18.3）, （70.1±13.9）, （83.4±23.0） μmol/L, P 〈 0.01]. CONCLUSION： The treatment of EECP can make the exercise tolerance of patients with coronary heart disease increase in a short time, enhance the level of plasm nitrogen monoxide and decrease the content of endothelins, and accelerate the recovery of vasomotion equilibrium function.