有氧运动联合抗阻运动对急性心肌梗死患者微循环及梗死面积的影响

Effects of aerobic exercise plus resistance training on myocardial microcirculation and infarct size in patients after acute myocardial infarction

目的：探讨急性心肌梗死（AMI）患者应用有氧运动联合抗阻运动对心肌微循环及梗死面积的影响，为临床上治疗AMI提供更广泛的治疗手段。方法选择2013年1月至2014年12月首发入住哈尔滨市第一医院的AMI患者86例，随机分为治疗组（n＝43）及对照组（n＝43）。两组患者均给予药物治疗，治疗组在药物治疗的基础上进行为期12周的有氧运动？抗阻运动治疗。于治疗前和治疗12周后对两组患者的峰值氧耗量（VO2max）、相对最大摄氧量（VO2max/kg）、峰值氧脉搏（VO2max/HR）、最大心率（HRmax）、最大通气量（VEmax）、心肌声学造影（MCE）结果进行评价和比较。结果治疗前，两组间VO2max、VO2max/kg、VO2max/HR、HRmax、VEmax各项指标比较，差异均无统计学意义（P＞0.05）。治疗12周后，两组的VO2max、VO2max/kg、VO2max/HR、HRmax、VEmax比较，差异均有统计学意义（P＜0.05）。治疗前，心肌声学造影显示两组间的A（平台期强度）、κ（再充盈平均速度）、及A·κ值无明显差异（P＞0.05）。12周后，治疗组的3项指标较对照组明显增加（P＜0.05）。结论在急性心肌梗死患者的心脏康复方案中采用有氧运动与抗阻训练相结合的训练方法，可以使患者心肌微循环及梗死面积得到不同程度的改善，该方法为临床上治疗AMI提供一种新的思路及更广泛的治疗手段。

Objective To investigate the effect of aerobic exercise plus resistance exercise training on myocardial microcirculation and infarct size in the patients with acute myocardial infarction （AMI） so as to provide wider range of treatment options for the disease. Methods A total of 86 patients with initial AMI admitted in our department from January 2013 to December 2014 were enrolled in this study. They were randomly divided into treatment group （n=43） and control group （n=43）. The patients of both groups were treated with drug therapy, and those from the treatment group underwent a 12-week aerobic exercise plus resistance training. Myocardial microcirculation and infarct size, including maximal oxygen consumption （VO2max）, maximal oxygen consumption/kg （VO2max/kg）, maximal oxygen consumption /heart rate （VO2max/HR）, maximal heart rate （HRmax）, maximal voluntary ventilation （VEmax） and the results of myocardial contrast echocardiography （MCE） were measured before and at the end of treatment and compared between the 2 groups. Results There as no significant demographic difference between the 2 groups before treatment （P〉0.05）. Aerobic exercise plus resistance training significantly improved VO2max, VO2max/kg, VO2max/HR, HRmax and VEmax, compared with those of control group （P〈0.05）. The A,κand A·κlevels had no significant demographic difference between the 2 groups before treatment （P〉0.05）, but the levels were significantly higher in the treatment group than in control group in 12 weeks after treatment （P〈0.05）. Conclusion The aerobic exercise plus resistance training is effective intervention to improve microcirculation and infarct size in patients with AMI. This intervention may provide a new option and wider measures for further treatment of patients with AMI.