有氧运动和抗阻运动对心力衰竭患者心率变异性影响的观察性研究

Observational study of the effects of aerobic and resistance exercise on heart rate variability in patients with heart failure

目的探讨有氧运动和抗阻运动对心力衰竭患者心率变异性的影响。方法选取2021年2月至2022年4月在中山市小榄人民医院心血管内科就诊的心力衰竭患者,采用随机数表法随机分为有氧运动组、抗阻运动组、对照组,记录患者性别、年龄等一般资料。所有患者均给予常规药物治疗。有氧运动组、抗阻运动组参与为期12周的运动康复治疗,对照组不接受运动康复治疗。比较各组患者在治疗前、后的评价心率变异性的指标变化,评价指标选取每5 min窦性R-R间期均值的标准差(SDANN)、相邻心搏间期差值均方的平方根(RMSSD)。结果共纳入90例患者,年龄(65±8)岁,其中男48例(53.3%,48/90)。有氧运动组、抗阻运动组、对照组各30例。有氧运动组及抗阻运动组试验后RMSSD均有上升,有氧运动组的RMSSD显著上升,差异具有统计学意义(t=-4.70,P=0.001)。对照组、有氧运动组试验后SDANN值显著下降,差异具有统计学意义(t=2.82,P=0.009;t=3.81,P=0.001),而抗阻运动组的SDANN值较试验前有显著上升(t=-4.85,P=0.001)。结论有氧运动可以提高迷走神经活性,提高RMSSD;抗阻运动可以降低交感神经活性,提高SDANN;运动康复可在药物治疗的基础上改善自主神经系统对心脏的调控。

Objective To investigate the effects of aerobic exercise and resistance exercise on heart rate variability in patients with heart failure.Methods Patients with heart failure admitted to Xiaolan People's Hospital of Zhongshan from February 2021 to April 2022 were selected,and randomly divided into aerobic exercise group,resistance exercise group and control group by random number table method.All patients were given conventional drug therapy.Aerobic exercise group and resistance exercise group participated in exercise rehabilitation therapy for 12 weeks,while the control group did not receive exercise rehabilitation therapy.The changes of heart rate variability indexes were compared before and after treatment in each group.The evaluation indexes were the sequential five-minute R-R interval means(SDANN)and the root mean square of the successive differences(RMSSD).Results A total of 90 patients were included,aged(65±8)years,including 48 males(53.3%,48/90).Thirty patients in aerobic exercise group,resistance exercise group and control group respectively.The RMSSD of the aerobic exercise group and the resistance exercise group increased after the test,and the RMSSD of the aerobic exercise group increased significantly,and the difference was statistically significant(t=-4.70,P=0.001).The SDANN values of the control group and the aerobic exercise group decreased significantly after the test,and the difference was statistically significant(t=2.82,P=0.009;t=3.81,P=0.001),while the SDANN value of the resistance exercise group was significantly higher than that before the test(t=-4.85,P=0.001).Conclusion Aerobic exercise can increase vagus nerve activity and increase RMSSD value.Resistance exercise can decrease sympathetic nerve activity and increase SDANN value.Exercise rehabilitation can improve the regulation of autonomic nervous system on the basis of drug therapy.