等长收缩运动治疗冠心病患者作用机理探讨

Mechanism of Isometric Exereise in Rehabilitation of Patients with Coronary Arlery Disease

等长收缩运动是日 常生活中不可缺少的运动形式之一,由于该运动训练效应的特异性,停止训练即可产生不适应性。过去等长收缩运动被认为强度较难掌握,又可能同时存在Valsalva效应而产生过强的心血管反应,可能对心脏病患者不利,因而在康复治疗中未得到应有的重视。本文通过对18名健康青年(平均23.7岁)进行等长收缩运动的观察,应用β阻滞剂和阿片肽拮抗剂模拟特定的神经调控环境,发现等长收缩运动时的心血管反应受交感神经和阿片肽双重调节。我们还对20名冠心病患者(冠脉造影有1支以上血管病变的有13例,其余为陈旧性心肌梗塞或稳定性心绞痛患者)和10名年龄相似的健康者进行短暂最大强度等长收缩运动、持续3分钟等长收缩运动和动力性运动,观察运动对阿片肽、血流动力学和心功能的影响。结果表明:等长收缩运动如不同时伴有Valsalva动作,则不但对冠心病患者无害,反可因舒张压升高而起到提高冠脉灌注量的效果。等长收缩运动时的血流动力学反应和心功能变化较动力性运动弱,它与运动绝对负荷无关,而可能与中枢命令强弱有关。研究表明,等长收缩运动,特别是主观极量持续等长收缩运动时中枢命令较强,内源性阿片肽释放较多,可能有助于降低交感神经兴奋性,减少冠心病患者的运动风险。

isometricexeuisel(IE)is an essential cornponent of dairy living activ-ties Lack of IE may result in decondruoning of IE capacity IE has not been used in cardiac rehabilitation because of poor onderstanding in cardiovascular response to it and the Val-salva maneuver associated witn IE Eighteen healthy young subjects aged 23 7 years old on average was studied after admimstration of beta -biocker and antagonist of opioids during IE The resolt demonstrated that the regulation of cardiovascular response during IE is attributed to both sympathetic system and opioids activity Twenty patients with coronary artery disease(CAD) were also studied during briet maxinial IE, susiained maximal IE and dynamic exercise(DE) The patients included 13 cases with more than one vessei tesions and 7 post myocardial in-farction and/or angina Ten age-matched appaient healthy suojects were examined as the control group. The result showed that IE without the Vaisaiva Maneuver in patients with CAD might increase coronary artery per fusion by enhancing diastolic pressure and proionging diastolic penod, which had ne harmful effect on CAD. Hemodynamic re-sponses and cardiac function were weaker during IE than DE The intensity of the re-sponses to IE was correiated to the central command but not to the dbsolute workioad It is concluded that signiticant release of en dogenous opioids due to strong central command dunng IE especialiy perceived maximal sustained IE. may help to attenuate activity of sympathetic system, thus redacing risk of exercise in patients with CAD.