等长收缩运动促进急性冠状动脉闭塞时侧支血流募集

Facilitating coronary collateral recruitment by isometric exercise during acute coronary occlusion

目的观察等长收缩运动对冠心病患者急性冠状动脉闭塞时缺血心肌侧支血流募集的影响。方法65例单支血管病变的患者按随机数字表法分为等长收缩运动（IME）组和对照组，其中IME组33例，对照组32例。所有患者在经皮冠状动脉介入治疗（PCI）术中病变血管接受1min的冠脉球囊阻塞，IME组患者在球囊阻塞同时行等长握拳收缩（50％最大自主收缩力），而对照组不做任何运动。所有患者均在球囊阻塞前及阻塞终未时测定侧支血流指数（CFI）、心率（HR）、收缩压（SBP）和舒张压（DBP）。结果IME组冠脉血管阻塞终未时与冠脉阻塞前的CFI差值（0．04±O．05）较对照组的CFI差值（0．01±0．03）显著增加，且2组比较，差异有统计学意义（P〈0．01）；IME组的HR、SBP和DBP治疗后与治疗前的差值分别为（7．84±8．20）次／rain、（3．25±7．17）mmHg和（5．884±6．40）mmHg，而对照组的HR、SBP和DBP治疗后与治疗前的差值分别为（0．88±3．96）次／min、（-1．88±6．21）mrnHg和（-1．5±6．22）mmHg，可见IME组有显著增加，且2组间差异均有统计学意义（P〈0．01）。结论冠心病患者急性冠脉闭塞时等长收缩运动可促进缺血心肌侧支【ffl流募集。

Objective To determine whether isometric handgrip exercise can increase collateral flow to the ischemic myocardium in acute coronary occlusion patients with coronary artery disease （CAD）. Methods Sixty five patients with one-vessel CAD were randomly assigned to either an isometric exercise （IME） group or no-exercise （NE） group. Patients in the IME group performed isometric handgrip exercises （50% of the maximum voluntary con- traction） during 1 min of coronary balloon occlusion. Patients in the NE group remained sedentary during the proce- dure. The collateral flow index （CFI） , heart rate （HR） , systolic blood pressure （SBP） and diastolic blood pressure （DBP） were determined prior to and at the end of 1 min of coronary occlusion. Results In the IME group the av erage CFI improved significantly more during the occlusion than in the NE group. The differences in HR, SBP and DBP were also significantly greater in the CFI group than in the NE group controls. Conclusion Isometric exercise can induce significantly increased coronary collateral flow in CAD patients during acute vessel occlusion.