运动疗法联合通络补心化瘀汤对冠心病合并急性心衰患者心率恢复和运动功能的影响

Effect of kinesiotherapy combined with Tongluo Buxin Decoction on heart rate recovery and motor function in patients with coronary heart disease complicated with acute heart failure

目的观察通络补心化瘀汤联合太极拳、运动康复训练对冠心病合并急性心衰患者心率恢复和运动功能的影响。方法将2013年5月至2015年5月在陕西省康复医院心内科住院治疗的62例冠心病合并急性心衰患者按照随机数字表法分为两组,每组31例,对照组单纯采用西医常规治疗,观察组在对照组治疗的基础上采用通络补心化瘀汤联合太极拳和运动康复治疗,观察并比较两组患者治疗前后的临床疗效、血脂水平变化[甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)及低密度脂蛋白(LDL)]、心率恢复情况、心脏彩超测定值[左心射血分数(LVEF),左室舒张末期容积(LVEDV)值,收缩末期容积(LVESV)值]、运动功能及并发症发生情况。结果观察组患者的治疗总有效率为90.32%,明显高于对照组的64.52%,两组比较差异有统计学意义(P<0.05);治疗前,两组患者的血脂水平和各心功能参数比较差异均无统计学意义(P>0.05);治疗后,对照组患者的TG、TC、HDL、LDL分别为(1.34±0.21)mmol/L、(4.15±0.63)mmol/L、(1.44±0.32)mmol/L、(2.75±0.52)mmol/L,观察组分别为(0.88±0.19)mmol/L、(2.82±0.54)mmol/L、(1.71±0.34)mmol/L、(2.03±0.48)mmol/L,两组血脂水平比较差异均有统计学意义(P<0.05);对照组患者的LVEF为(32.72±3.41)%,LVEDV为(176.23±34.91)m L/m2,LVESV为(126.42±28.51)m L/m2,观察组分别为(38.81±3.63)%、(150.15±37.12)m L/m2、(106.81±23.84)m L/m2,两组各心功能参数比较差异均有统计学意义(P<0.05);治疗14 d后,两组患者的心率均较治疗前降低[对照组:(112.20±41.52)次/min vs(93.15±36.92)次/min、观察组:(119.77±26.66)次/min vs(71.62±18.85)次/min],差异均有统计学意义(P<0.05);对照组患者的运动功能评分为(71.39±17.81)分,明显低于观察组的(82.53±18.58)分,差异有统计学意义(P<0.05);观察组患者治疗后并发症发生率为16.13%,对照组为19.35%,差异无统计学意义(P>0.05)。结论通络补心化瘀汤联合太极拳和运动康复训练对冠心病合并急性心衰患者疗效确切,能明显改善患者心功能水平,促进心率和运动功能恢复,不良反应少,值得临床推广使用。

Objective To observe the effect of kinesiotherapy combined with Tongluo Buxin decoction on heart rate recovery and motor function in patients with coronary heart disease（CHD） complicated with acute heart failure（AHF）. Methods A total of 62 patients with CHD complicated with AHF in Department of Cardiology in Shaanxi Province Comprehensive Rehabilitation Hospital from May 2013 to May 2015 were divided into two groups（control group and observation group） according to the random number table, with 31 patients in each group. The control group was treated with routine western medicine, and the observation group applied Tongluo Buxin decoction combined with taijiquan and kinesiotherapy based on the control group. The clinical efficacy, changes of blood lipid levels [triglyceride（TG）, total cholesterol（TC）, high density lipoprotein（HDL） and low density lipoprotein（LDL）], heart rate recovery,measured value of Cardiac color Doppler ultrasonography [left ventricular ejection fraction（LVEF）, left ventricular end diastolic volume（LVEDV）, left ventricular end-systolic volume（LVESV）], motor function and complications were observed before and after treatment between the two groups. Results The total effective rate in observation group（90.32%） was significantly higher than that in the control group（64.52%）, and the difference was statistically significant between the two groups（P〈0.05）. Before treatment, there was no statistically significant difference in blood lipid levels and the heart function parameters between the two groups（P〈0.05）. After treatment, the TG, TC, HDL, LDL in control group were respectively（1.34±0.21） mmol/L,（4.15±0.63） mmol/L,（1.44±0.32） mmol/L,（2.75±0.52） mmol/L, and in ob-servation group were respectively（0.88±0.19） mmol/L,（2.82±0.54） mmol/L,（1.71±0.34） mmol/L,（2.03±0.48） mmol/L.There were significant differences in blood lipid levels between the two groups（P〈0.05）. The LVEF, LVEDV, LVESV in control group were respectively（32.72±3.41）%,（176.23±34.91） m L/m2,（126.42±28.51） m L/m2, and in observation group were respectively（38.81±3.63）%,（150.15±37.12） m L/m2,（106.81±23.84） m L/m2. There were significant differences in cardiac function parameters between the two groups（P〈0.05）. 14 d after the treatment, the heart rate of the two groups were significantly lower than those before treatment： control group：（112.20 ± 41.52） beats/min vs（93.15 ±36.92） beats/min, observation group：（119.77±26.66） beats/min vs（71.62±18.85） beats/min, and the differences were statistically significant（P〈0.05）. The motor function score in control group was（71.39 ± 17.81）, which was significantly lower than that in observation group（82.53 ± 18.58）, and the difference was statistically significant（P〈0.05）. The incidence of complications after treatment in the observation group was 16.13%, which was significantly lower than that in control group（19.35%）, and the difference was statistically significant（P〈0.05）. Conclusion Tongluo Buxin decoction combined with Taijiquan and rehabilitation exercise training has good effect for patients with CHD complicated with AHF, which can significantly improve the heart function level, and promote heart rate and motor function recovery, with less side-effect. It is worthy of clinical popularization and application.