Ⅱ期和Ⅲ期心脏康复治疗对急性冠状动脉综合征患者经皮冠状动脉介入治疗后预后的影响

Effect of stage Ⅱ and Ⅲ cardiac rehabilitation on prognosis of patients with acute coronary syndrome after percutaneous coronary intervention

目的探讨Ⅱ期和Ⅲ期心脏康复治疗对急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后生活质量、心功能和远期预后的影响。方法采用随机数字表法将150例行PCI的ACS患者分为试验组和对照组,每组各75例,对照组患者PCI后常规进行一般情况评估、健康教育、心理干预、运动干预及规范冠心病用药;试验组患者在以上基础上进行Ⅱ期和Ⅲ期心脏运动康复治疗,两组均治疗6个月。比较干预前后两组患者生活质量评价量表(SF-36量表)评分、BMI、6 min步行距离(6MWD)、血脂水平及心功能指标。采用Cox回归模型评价Ⅱ期和Ⅲ期心脏康复对ACS患者PCI后3年内发生主要心脑血管不良事件(MACCE)的影响,Kaplan-Meier生存分析比较两组患者PCI后累计无终点事件的生存率。结果干预前两组患者SF-36量表各项评分、BMI、6MWD、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)水平、左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)及室壁运动积分指数(WMSI)比较差异均无统计学意义(P>0.05)。干预后两组患者SF-36量表中心理健康、活力、社会功能、情感角色、疼痛、躯体功能、躯体角色、整体健康评分、6MWD及LVEF均高于同组干预前,BMI、TC、TG及LDL-C水平均低于同组干预前,且干预后试验组SF-36量表各项评分、6MWD及LVEF均高于对照组,LDL-C水平低于对照组(P<0.05)。Cox回归模型分析结果显示,Ⅱ期和Ⅲ期心脏康复治疗显著降低ACS患者PCI后3年内发生MACCE的风险(HR=0.58,95%CI 0.39~0.98,P<0.05)。试验组患者PCI后3年内MACCE总发生率和总死亡率为17.6%、5.5%,对照组为26.9%、6.8%。试验组PCI后1年、2年、3年无MACCE终点事件发生的生存率显著高于对照组(P<0.05)。试验组与对照组PCI后1年、2年、3年总生存率比较差异均无统计学意义(P>0.05)。结论Ⅱ期和Ⅲ期心脏康复治疗对ACS患者PCI后生活质量、运动耐力、血脂水平及心功能均有明显改善,且显著降低PCI后发生MACCE的风险。

Objective To investigate the effect of stageⅡandⅢcardiac rehabilitation on quality of life,cardiac function and long-term prognosis of patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods A total of 150 patients with ACS undergoing PCI were randomly divided into experimental group and control group,with 75 cases in each group.Patients in control group were routinely evaluated for general situation,health education,psychological intervention,exercise intervention and standardized medication for coronary heart disease after PCI.On basis of the above,patients in experimental group received stageⅡandⅢcardiac exercise rehabilitation treatment.Patients in two groups were treated for 6 months.Before and after the intervention,SF-36 scale score,BMI,6 minutes walking distance(6 MWD),blood lipid level and cardiac function indexes between two groups were compared.Cox regression model was used to evaluate the effect of stageⅡandⅢcardiac rehabilitation on major adverse cardiovascular and cerebrovascular events(MACCE)in patients with ACS within 3 years after PCI.Kaplan-Meier survival analysis was used to compare non-end-point events cumulative survival rate between two groups after PCI.Results Before the intervention,there were no significant differences of each score of SF-36 scale,BMI,6 MWD,total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C)levels,left ventricular ejection fraction(LVEF),left ventricular end diastolic volume(LVEDV)and wall motion integral index(WMSI)between two groups(P>0.05).After intervention,mental health,vitality,social function,emotional role,pain,physical function,physical role,overall health score of SF-36 scale,6 MWD and LVEF in two groups were higher than those in the same group before the intervention,and BMI,TC,TG,LDL-C levels were lower than those in the same group before the intervention(P<0.05).After the intervention,each score of SF-36 scale,6 MWD and LVEF in experimental group were higher than those in control group,LDL-C level was lower than that in control group(P<0.05).Cox regression model analysis showed that risk of MACCE within 3 years after PCI in patients with ACS was significantly reduced by stageⅡandⅢcardiac rehabilitation therapy(HR=0.58,95%CI 0.39~0.98,P<0.05).Total incidence and mortality of MACCE within 3 years after PCI were 17.6%,5.5%in experimental group and 26.9%,6.8%in the control group.Survival rates without MACCE endpoint at 1,2 and 3 years after PCI in experimental group were significantly higher than those in control group(P<0.05).There were no significant differences of overall survival rates of 1,2 and 3 years after PCI between experimental group and the control group(P>0.05).Conclusion StageⅡandⅢcardiac rehabilitation therapy can significantly improve quality of life,exercise endurance,blood lipid level and cardiac function of patients with ACS after PCI,and significantly reduce risk of MACCE after PCI.