曲美他嗪联合运动疗法对冠心病经皮冠状动脉介入术后患者心脏康复的影响

The effect of trimetazidine combined with exercise therapy on rehabilitation in patients with coronary heart disease after percutaneous coronary intervention

目的:探讨曲美他嗪联合运动疗法对冠心病经皮冠状动脉介入(PCI)术后患者心脏康复作用的影响。方法:纳入冠心病PCI术后1个月内的患者90例,随机分成治疗A组、治疗B组及对照组,每组各30例。A组在冠心病二级预防治疗的基础上加用曲美他嗪并联合运动疗法、B组在冠心病二级预防治疗的基础上加用曲美他嗪、对照组仅给予冠心病二级预防治疗。观察期为6个月。监测3组患者的6 min步行试验(6MWT)的距离、6MWT时的心率及动脉血氧饱和度、左室舒张末期内径(LVEDD)、左室收缩末期内经(LVESD)、左室间隔厚度(LVIVS)、左心室后壁厚度(LVPWT)、左室射血分数(LVEF)及正常舒张功能的比例。结果:组内比较:与治疗前相比,3组的6MWT的距离明显增多、6MWT时的心率明显降低、正常舒张功能的比例明显升高并且LVEF明显增加,差异具有统计学意义(P<0.05)。治疗后组间比较:A组分别与B组及对照组相比,6MWT的距离明显增加、6MWT时的心率明显降低、正常舒张功能的比例明显升高且左室射血分数明显增加,差异具有统计学意义(P<0.017);B组与对照组相比,治疗后LVEF明显增加,差异具有统计学意义(P<0.017),6MWT的距离、6MWT时的心率及正常舒张功能的比例两组无明显改善(P>0.05)。结论:曲美他嗪联合运动疗法对冠心病PCI术后患者的心脏康复效果优于常规的冠心病二级预防治疗。

OBJECTIVE To explore the effect of trimetazidine combined with exercise therapy on rehabilitation in patients with recent revascularization of coronary artery. METHODS Ninety patients with coronary heart disease after percutaneous coronary intervention（ PCI） within 1 month were included,randomly divided into treatment group A,treatment group B and control group,30 patients in each group. Patients received secondary prevention of coronary heart disease plus trimetazidine combined with exercise therapy in group A,received conventional therapy plus trimetazidine in group B,and only routine secondary prevention of coronary heart disease in control group. Patients were observed for 6 months to monitor 6-minute walk test（ 6MWT） distance,6MWT heart rate and arterial oxygen saturation,left ventricular end-diastolic diameter（ LVEDD） and left ventricular end-systolic diameter（ LVESD）,left ventricular septal thickness（ LVIVS）,left ventricular posterior wall thickness（ LVPWT）,left ventricular ejection fraction（ LVEF）,and normal diastolic function ratio. RESULTS Intragroup comparison： compared with values before treatment,in 3 groups,6MWT distance increased significantly,heart rate of 6MWT significantly decreased,normal diastolic proportional function significantly increased and LVEF increased（ P 0. 05）. Intergroup comparison after treatment： compared with group B and control group,6MWT distance increased significantly,the heart rate in 6MWT significantly decreased,normal diastolic functional proportion increased significantly and LVEF significantly increased in group A（ P〈0. 017）. Compared with control group,LVEF significantly increased after treatment in group B（ P〈0. 017）,the 6MWT distance,heart rate of 6MWT and normal diastolic functional proportion of both groups were not significantly improved（ P〉0. 05）. CONCLUSION Compared to conventional secondary prevention of coronary heart disease,trimetazidine combined with exercise therapy shows superior effect on cardiac rehabilitation in patients with coronary heart disease after PCI.