运动锻炼改善急性心肌梗死患者运动能力及心率恢复能力

Cardiac Rehabilitation Improving Exercise Ability and Heart Rate Recovery in Patients With Acute Myocardial Infarction

目的:探讨运动锻炼对急性心肌梗死患者运动能力及心率恢复能力的影响。方法:60例无严重并发症首次发生急性ST段抬高型心肌梗死的患者,随机分为康复运动组(n=30)和对照组(n=30),给予康复运动组有指导的家庭运动锻炼,共随访6个月,于发病后第10～14天(康复运动前)及第6个月(康复运动后)分别进行运动心肺功能测定,测定运动后第一分钟心率恢复能力(HRR)及两组患者HRR降低(sHRR)的比例。结果:①康复运动组和对照组无氧阈时代谢当量和峰值代谢当量基线值差异无统计学意义,随访6个月时两组上述运动指标均较基线值明显增加,差异有统计学意义(P<0.01),但康复运动组较对照组增加显著,差异有统计学意义(P<0.01)。②两组患者的基线值运动第一分钟HRR及sHRR的比例差异无统计学意义,随访6个月时,康复运动组HRR较基线值明显提高,差异有统计学意义[(29±11)次/分比(22±10)次/分,P<0.05];康复运动组sHRR的比例较基线值明显下降,差异有统计学意义[0%比75%,P<0.05],与对照组比较差异也有统计学意义[0%比45%,P<0.05]。结论:有指导的运动锻炼可以改善急性心肌梗死患者的运动能力及运动后心率恢复能力。

Objective：To investigate the influence of cardiac rehabilitation on exercise ability and heart rate recovery in patients with acute myocardial infarction（AMI）. Methods ：A total of 60 patients with the first ST segment elevation myocardial infarction（STEMI） underwent direct percutaneous coronary intervention（PCI） from February to October 2008 were studied. The subjects were randomly assigned to Exercise group（ n = 30）, the patients were trained for cardiac rehabilitation, and Control group, patients were not trained （n = 30）. Cardiopulmonary exercise test were performed in both groups at 10-14 days before the training and 6 months after the training, the heart rate recovery（HRR） and the ratio of slow heart rate recovery（sHRR） were evaluated. Results：There was no significant difference in cardiopulmonary exercise test at the baseline between two groups. While 6 months after, the peak and the anaerobic threshold values of metabolic equivalents was significantly increased in Exercise group than in Control group（P 〈0. 01 ）. There was no significant difference in HRR and sHRR during hospitalization between two groups（ P 〉 0. 05）. 6 months later,HRR was improved in Exercise group but not in Control group（29 ±11bpm vs. 22 ± 10bpm,P 〈0. 05）. Compared with the baseline,the ratio of sHRR was decreased in Exercise group than in Control group（75% vs. 45% ,P 〈 0. 05 ）. Conclusion ：The cardiac rehabilitation in the early and recovery stage of AMI could improve the exercise ability, HRR and the ratio of sHRR in patients with AMI.