运动治疗对慢性心力衰竭患者的影响

Effect of exercise training in patients with chronic heart failure

目的观察运动治疗对慢性心力衰竭患者的影响,评估运动治疗的安全性,探寻合理的运动方式。方法将40例慢性心力衰竭患者分为运动组(20例)和对照组(20例)。在规范药物治疗心力衰竭症状稳定至少4周的基础上,两组患者均进行健康教育和心理疏导,运动组同时进行规范的运动治疗,分别于入组前和治疗12周后评估两组的左心室射血分数(left ventricular ejection fraction,LVEF),6分钟步行试验(6-minute walk test,6MWT)距离,踏车运动试验,同时观察运动治疗过程中不良事件的发生率。结果两组患者入组时LVEF、6MWT距离、踏车试验最大运动负荷和运动时间比较,差异无统计学意义(P>0.05)。治疗12周后,运动组与对照组LVEF、6MWT距离、踏车试验最大运动负荷和运动测试时间比治疗前明显改善,差异有统计学意义(P<0.05或0.01);且运动组比对照组改善更明显,差异有统计学意义(P<0.05或0.01)。随访期间运动组患者未发生任何不良事件。结论在常规药物治疗基础上对慢性心力衰竭患者进行踏车和步行结合的运动治疗是可行有效的,可以提高患者的心功能,改善其运动耐量,而且安全性高。

Objectives To evaluate the safety and effects of exercise training on heart function and functional capacity in patients with chronic heart failure （CHF）. Methods We studied 40 CHF out-patients whose cardiac status remained stable after receiving regular drug treatment according to guidelines of CHF for at least 4 weeks. After initial measurements of left ventricular ejection fraction （LVEF）, 6-minute walk test （6MWT） and bicycle exercise test, patients were divided into two groups： trained group （n=20） and control group （n=20）. Patients in the two groups all received health education, counseling on CHF and psychological counseling. Patients in trained group participated in a cardiac rehabilitation program with exercise training （cycling once or twice a week and walking twice a week for 12 weeks）, while patients in control group had no training program. After the training program completed, all the measurements above were reexamed in both groups. At the same time we compared the differences in the measurements before and after training between the two groups and observed the incidence rate of adverse events （arrhythmia, angina, aggravated heart failure, sudden death and so on） during exercise training. Results No significant differences in initial measurements were found between the two groups at baseline （P〉0.05）. After 12 weeks, LVEF, 6MWT and bicycle exercise testing time in the two groups all improved significantly compared with those at baseline （P〈0.05 or 0.01 ） ; and these improved more significantly in trained group than in control group （P〈0.05 or 0.01 ）. Work load on bicycle exercise test improved significantly in trained group （P〈0.01）, but not in control group （P〉O.05）. No training related adverse events occurred. Conclusions The exercise training in this study is safe and feasible for patients with CHF who has received regular pharmacotherapy. Exercise training can significantly improve heart function and functional capacity.