康复运动对冠心病PTCA术后再狭窄影响的实验研究和临床观察

The experimental research and clinical observation on the coronary artery restenosis post PTCA in patients with CHD following rehabilitation exercise

目的:从动物实验和临床观察研究康复运动对冠心病PTCA术后再狭窄的影响。方法:建立大鼠胸主动脉损伤后细胞增殖的动物模型,随机分为3组。31例冠心病人进行PTCA术和支架术,术后15例进行规律的康复运动(康复组),运动强度为2.4～7.5METs,6个月到1年后随访复查冠脉造影。结果:(1)运动可增加被损伤动脉内皮和平滑肌细胞一氧化氮合成酶的生成,并可抑制细胞增殖;(2)康复组15例在运动训练后左冠状动脉阻塞>80％者有l例,右冠状动脉阻塞>75％有1例。16例未坚持康复运动者,左冠状动脉阻塞≥80％有8例,右冠状动脉阻塞≥75％有7例,另有1例左回旋支阻塞>75％。结论:实验结果提示运动有助于预防动脉壁损伤后再狭窄;临床观察结果提示冠心病人PTCA术后进行规律的康复运动有助于减轻术后再狭窄的程度。

Objective: In order to explore the influence of insistent rehabilitation exercise on coronary artery restenosis in patients with CHD post PTCA. Methods; The cellular proliferation model of injured thoracic aorta in rats was founded, the rats were divided into 3 groups randomly. Thirty-one patients with CHD post PTCA and stent were observed. Fifteen patients participated the regular exercise training program (rehabilitation group), the range of exercise intensity was 2. 4 - 7. 5 METs, the follow up study of coronary artery angiography was performed in 31 patients after 6 months to 1 year. Results: The experiment showed that exercise training could increase endothelium and smooth muscle cells nitric oxide (NO) synthetase and inhibit cellular proliferation in injured artery. The clinic observation showed that after exercise training the obstructive degree of LAD was >80% for 1 patient and the obstructive degree of RCA was >75% for 1 patient respectively in rehabilitation group. The obstructive degree of LAD was ≥80% for 8 patients and the obstructive degree of RCA ≥75% for 7 patients as well as the obstructive degree of LCX was>75% for I patient in control group (16 cases, did not insist the rehabilitation exercise). Conclusion: The results indicate exercise may be helpful to prevent the restenosis of injured artery. The clinical observation indicates that insistent regular rehabilitation exercise in patients with CHD may reduce the degree of restenosis post PTCA.