老年慢性心衰患者运动康复的效果

Effects of exercise rehabilitation in aged patients with chronic heart failure

目的:探讨老年慢性心衰患者实施运动康复的安全性及效果。方法:83例老年慢性心衰患者被随机分为常规护理组(41例,常规护理)和运动康复组(42例,在常规护理基础上接受运动训练)。疗程均为8周,随访12个月。患者心功能以纽约心脏病协会(NYHA)分级表示,以超声心动图测定左室射血分数(LVEF)和左室舒张末期内径(LVEDd),同时测定6min步行距离(6MWD),血浆脑钠肽(BNP)水平,代谢当量(METs),明尼苏达心力衰竭生活质量量表(MLHFQ)评分表示健康相关生活质量,记录12个月内的再入院率和死亡率。结果:两组治疗8周时LVEF、LVEDd、NYHA分级均显著改善(P均<0.05),且与常规护理组相比,运动康复组LVEF[(54.7±6.2)%比(65.4±8.7)%]、LVEDd[(49.6±8.3)mm比(40.2±9.3)mm]、NYHA分级[(2.7±0.8)级比(1.9±0.9)级]改善更显著(P<0.05);6MWD[(122.7±9.2)m比(175.6±8.7)m]和METs[(5.8±1.8)比(8.4±2.4)]也明显增加(P<0.01),血浆BNP水平[(43.4±9.8)pg/ml比(31.7±8.9)pg/ml]明显降低(P<0.05);运动康复组康复训练中未发生严重不良事件。12个月时,运动康复组MLH-FQ评分明显高于常规护理组[(68.9±7.9)分比(45.6±8.2)分,P<0.05],因心衰再入院率明显低于常规护理组(9.5%比24.4%,P<0.05)。结论:对老年慢性心衰患者实施运动康复安全有效,可明显改善心功能,增强运动耐力,提高生活质量。

Objective： To explore safety and effects of exercise rehabilitation in aged patients with chronic heart failure （CHF）. Methods： A total of 83 aged CHF patients were randomly divided into exercise rehabilitation group （n= 42, received exercise training based on usual care） and usual care group （n=41, received usual care）. Period of treatment was eight weeks and patients were followed up for 12 months. New York heart association （NYHA） clas- sification was used to represent cardiac function. Left ventricular ejection fraction （LVEF）, left ventricular end-- diastolic dimension （LVEDd） were determined by ultrasound cardiography, 6min walking distance （6MWD） and oxygen metabolic equivalent （METs） also were determined, plasma level of brain natriuretic peptide （BNP） was examined. Minnesota living with heart failure questionnaire （MLHFQ） was used to represent quality of life. Rehospitalization rate and mortality rate within 12 months were recorded in all patients. Results： On 8 th weeks after treatment, the LVEF, LVEDd and NYHA class of two groups all significantly improved （P〈0.05 all）, compared with usual care group, there were significant improvement in LVEF [- （54.7 ± 6.2）% vs. 65.4 ± 8.7）%], LVEDd [ （49.6±8.3） mm vs. （40.2±9.3） mm] and NYHA class [（2.7±0.8） classes vs. （1.9±0.9） classes], P〈0.05 all; 6MWD [ （122.7±9.2） m vs. （175.6±8.7） m] and METs [ （5.8±1.8） vs. （8.4±2.4）] also significantly increased （P〈0.01）, and plasma level of BNP [ （43.4±9.8） pg/ml vs. （31.7±8.9） pg/ml, P〈0.05] significantly decreased in exercise rehabilitation group. No severe adverse events occurred in exercise rehabilitation group. After 12 months, compared with usual care group, there were significant increase in MLHFQ score [ （45.6±8.2） scores vs. （68.9±7.9） scores], significant decrease in rehospitalization rate caused by heart failure （24.4% vs. 9.5%）, P 〈0.05 all in exercise rehabilitation group. Conclusion： Exercise rehabilitation is safe and effective in aged patients with chronic heart failure, which can significantly improve cardiac function, enhance exercise capacity and increase quality of life.