间歇性高强度训练-耐力运动联合前列地尔对冠心病合并糖尿病患者心肺康复的影响

Effects of intermittent high-intensity training endurance exercise combined with alprostadil on cardiopulmonary rehabilitation in patients with coronary heart disease and diabetes

目的探讨间歇性高强度训练-耐力运动联合前列地尔对冠心病合并糖尿病患者心肺康复的影响。方法前瞻性选取2020年1月至2023年1月南京脑科医院收治的冠心病并糖尿病患者104例,按随机数字表法分成常规组与间歇高强度组,每组各52例。两组均给予前列地尔治疗,用药2周,常规组进行常规康复指导,间歇高强度组采用间歇性高强度训练-耐力运动模式,康复训练干预12周。比较两组干预前后的心功能指标[左室射血分数(LVEF)、左室收缩末内径(LVESD)、左室舒张末内径(LVEDD)、心输出量(CO)]、肺功能指标[第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC、最大自主通气量(MVV)]、运动耐力指标[运动持续时间(ED)、无氧阈值(AT)、峰值摄氧量(VO 2peak)],记录两组再发心绞痛、心力衰竭、恶性心律失常发生率与再住院率。结果干预后,两组LVEF、CO均高于干预前,LVESD、LVEDD均低于干预前,差异均有统计学意义(P<0.05);干预后间歇高强度组LVEF、CO分别为(65.32±2.87)%、(4.67±0.17)L/min,均高于常规组[(61.29±3.55)%、(4.44±0.24)L/min],差异均有统计学意义(P<0.05),但两组LVESD、LVEDD比较,差异均无统计学意义(P>0.05)。干预后,两组FEV1、FVC、FEV1/FVC、MVV均高于干预前,差异均有统计学意义(P<0.05);干预后间歇高强度组FEV1、FEV1/FVC、MVV水平分别为(1.73±0.31)L、0.70±0.09、(75.31±1.18)L/min,均高于常规组[(1.59±0.24)L、0.65±0.07、(73.67±1.65)L/min],差异均有统计学意义(P<0.05),但两组FVC比较,差异无统计学意义(P>0.05)。干预后,两组ED、AT、VO 2peak均高于干预前,且间歇高强度组ED、AT、VO 2peak分别为(439.65±15.59)s、(14.91±0.87)mL·min^(-1)·kg^(-1)、(20.05±1.37)mL·min^(-1)·kg^(-1),均高于常规组[(411.08±12.88)s、(14.60±0.62)mL·min^(-1)·kg^(-1)、(18.64±1.05)mL·min^(-1)·kg^(-1)],差异均有统计学意义(P<0.05)。间歇高强度组不良事件发生率及住院率均为3.85%,与常规组(9.62%、11.54%)比较,差异无统计学意义(P>0.05)。结论间歇性高强度训练-耐力运动联合前列地尔能提高冠心病并糖尿病患者的心肺功能与运动耐力,但对近期不良事件发生率与再住院率未见明显影响。

Objective To explore the effect of intermittent high-intensity training endurance exercise combined with alprostadil on cardiopulmonary rehabilitation in patients with coronary heart disease and diabetes.Methods A total of 104 patients with coronary heart disease and diabetes mellitus admitted to Nanjing Brain Hospital from January 2020 to January 2023 were divided into the routine group and the intermittent high intensity group according to random number table method,with 52 patients in each group.Both groups were treated with alprostadil for 2 weeks.The routine group received routine rehabilitation guidance,while the intermittent high-intensity group received intermittent high-intensity training endurance exercise mode,with rehabilitation training intervention for 12 weeks.The cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end-systolic internal diameter(LVESD),left ventricular end-diastolic internal diameter(LVEDD),cardiac output(CO)],lung function indicators[forced expiratory volume in the first second(FEV1),forced vital capacity(FVC),FEV1/FVC,maximum spontaneous ventilation(MVV)],and sports endurance indicators[duration of exercise(ED),anaerobic threshold(AT),peak oxygen uptake(VO 2peak)]before and after intervention were compared between the two groups,the incidence of recurrent angina pectoris,heart failure,malignant arrhythmia and readmission rate of the two groups were recorded.Results After intervention,LVEF and CO in two groups were higher than before intervention,while LVESD and LVEDD were lower than before intervention,the differences were statistically significant(P<0.05);after intermittent high-intensity intervention,LVEF and CO in intermittent high-intensity group were(65.32±2.87)%and(4.67±0.17)L/min,respectively,which were higher than those in the routine group(61.29±3.55)%and(4.44±0.24)L/min),the differences were statistically significant(P<0.05);however,there was no statistically significant difference in LVESD and LVEDD(P>0.05).After intervention,FEV1,FVC,FEV1/FVC and MVV in two groups were higher than those before intervention,and FEV1,FEV1/FVC and MVV in intermittent high-intensity group were(1.73±0.31)L,0.70±0.09,and(75.31±1.18)L/min,respectively,which were higher than those in the routine group[(1.59±0.24)L,0.65±0.07,and(73.67±1.65)L/min],the differences were statistically significant(P<0.05),but there was no statistically significant difference in FVC between the two groups(P>0.05).After intervention,the ED,AT,and VO 2peak levels in two groups were higher than those before intervention,and the ED,AT,and VO 2peak levels in the intermittent high-intensity group were(439.65±15.59)s,(14.91±0.87)mL·min^(-1)·kg^(-1),and(20.05±1.37)mL·min^(-1)·kg^(-1),respectively,which were higher than those in the routine group[(411.08±12.88)s,(14.60±0.62)mL·min^(-1)·kg^(-1),and(18.64±1.05)mL·min^(-1)·kg^(-1)],the differences were statistically significant(P<0.05).The incidence of adverse events and hospitalization in intermittent high-intensity group were 3.85%,which had no difference compared with the routine group(9.62%,11.54%)(P>0.05).Conclusion Intermittent high-intensity training endurance exercise combined with alprostadil can improve the cardiopulmonary function and exercise endurance of patients with coronary heart disease and diabetes,but has no significant impact on the incidence of recent adverse events and rehospitalization rate.