心脏康复运动在老年慢性心力衰竭患者治疗中的应用

Application of cardiac rehabilitation training program in the treatment of elderly patients with chronicheart failure

目的观察心脏康复运动治疗老年慢性心力衰竭（CHF）的疗效。方法将2012年1月至2015年12月首都医科大学附属北京安贞医院收治的88例老年CHF患者按随机数字表法分为对照组和观察组，各44例。对照组予常规治疗，观察组加用心脏康复运动治疗，6个月为1个疗程，2组均治疗1个疗程。比较2组心功能、6min步行距离（6MWT）、明尼苏达心力衰竭生活质量量表（MLHFQ）评分，测定血浆中N末端B型脑钠肽（NT-proBNP）和心肌肌钙蛋白T（cThT），随访统计因心力衰竭加重再入院及病死人数。结果治疗后，观察组6MWT长于对照组，左心室射血分数高于对照组，MLHFQ的身体领域、情绪领域评分及总分均明显低于对照组，NT—proBNP及cTnT水平均低于对照组（均P〈0．05）。对照组1例、观察组2例患者失访。观察组因心力衰竭再入院率明显低于对照组[11．9％（5／42）比32．6％（14／43）]（P=0．022），2组心力衰竭病死率、其他原因病死率和总病死率差异无统计学意义（均P〉0．05）。结论在常规药物治疗基础上加用心脏康复运动治疗，可明显改善老年CHF患者的运动耐力及心功能，减轻心肌损伤，提高生活质量，减少疾病的复发。

Objective To observe the clinical effect of cardiac rehabilitation training program on elderly patients with chronic heart failure. Methods A total of 88 elderly patients with chronic heart failure from January 2012 to December 2015 in Beijing Anzhen Hospital, Capital Medical University were randomly divided into control group and observation group, with 44 cases in each group. The control group had routine treatment; the observa- tion group had cardiac rehabilitation training additionally ; the treatment lasted for 6 months. Heart function, 6 rain walking distance and score of Minnesota Heart Failure Quality of Life Questionnaire （ MLHFQ ） were measured; plasm levels of N-terminal pro-B type natriuretic peptide（NT-proBNP） and cardiac troponin T（cTnT） were deter- mined; readmission rate and death rate were recorded. Resnlts The 6 rain walking distance in observation group was significantly longer and left ventricular ejection function was significantly higher than those in control group after treatment （ P 〈 0.05 ）. The physical dimension, emotional dimension and total scores of MLHFQ in observation group were significantly lower than those in control（ P 〈 0.05 ）. The levels of NT-proBNP and eTnT in observation group were significantly lower than those in control（P 〈0.05）. The readmission rate in observation group（ 1 lost of follow up） was significantly lower than that in control group （2 lost of follow up） [ 11.9% （5/42） vs 32.6% （ 14/43 ） ] （P = 0.022）. The death rate had no significant difference between groups （P 〉 0.05 ）. Conclusion Cardiac rehabilita- tion training in combination with routine medication can improve exercise tolerance and heart function, alleviate myocardial injury, improve life quality and reduce recurrence in elderly patients with chronic heart failure.