运动康复改善老年慢性心衰患者心功能和生活质量的研究

Rehabilitating exercise improves heart function and quality of life in old patients with chronic heart failure

目的：观察老年慢性心衰患者运动康复后心功能和生活质量的改变。方法：对60例老年慢性心衰病人在常规药物治疗的基础上，实施运动康复疗法，并与58例非康复组进行对照比较；观察出院时病人6min步行距离、运动耐量、平均住院日和心功能变化，同时测定血浆脑钠肽（BNP）含量．对其生活质量进行评定；观察随访一年时病人的心功能、再住院率和死亡率。结果：出院时康复组运动贮量、生活质量明显提高，NYHA心功能级别显著改善（P〈0．05或〈0．01），BNP水平和心室重量指数（LVMI）则显著降低（P〈0.05）；较之对照组除上述指标显著改善（P〈0.05～〈0.01）外，6min步行距离增加非常显著（P〈0.01）平均住院日显著减少（P〈0．05）；随访一年时康复组病人的心功能、6min步行距离、运动贮量、生活质量、左室射血分数（LVEF）和E／A比值均明显增加，NYHA心功能级别显著改善（P〈0．01）．左房内径（LAd）、LVMI以及再入院率和死亡率明显低于对照组（P〈0．01或P〈0．05）。结论：运动康复可以改善心功能，提高运动耐量和生活质量，缩短住院时间，降低再入院率和死亡率；长期运动康复可能有改善心肌的重构的作用。

Objective： To evaluate effects of rehabilitating exercise on heart function and quality of life （QOL） in old patients with chronic heart failure （CHF）. Methods： On the basis of convention medicine. 60 old CHF patients received rehabilitating exercise plan for 2 weeks to one year and compared with 58 CHF control patients （no rehabilitating exercise）. Six-minute walking distance, exercise capacity,days in hospitalization were observed and heart function were assessed by clinic symptom as NYHA and by echocardiography before discharge. Meanwhile, plasma brain natriuretic peptide （BNP） levels were determined and QOL were assessed. Heart function, rehospitalization rate and mortality were also evaluated following one year. Results：NYHA heart function .the 6-minute walking distance, exercise capacity. QOL. and E/A ratio were significantly increased： Plasma BNP levels. Left ventricular mass index （LVMI） and days in hospitalization were lower in training group than those of control group （P〈0.05 or P〈0.01 ）. In addition to above, rehospitalization rate and mortality were lower, and LVEF increased （P〈0.05～0.01） in training group than those of control group following one year. Conclusion： Rehabilitating exercise can improve heart function, exercise capacity, QOL and shorten days of hospitalization. Long-term effects of exercise training may decrease rehospitalization rate and mortality and improve myocardial reconstruction.