早期心脏康复程序对急性心肌梗死患者经皮冠状动脉介入术后心脏收缩功能的影响

Value of an early cardiac rehabilitation program on cardiac contraction function of acute myocardial infarction patients after percutaneous coronary intervention

目的:通过三维斑点追踪成像技术评估急性心肌梗死患者(AMI)经皮冠状动脉介入术(PCI)后的左室整体及局部收缩功能变化,探讨以社区为主的早期心脏康复训练对AMI患者的心功能影响。方法:根据是否愿意参加心脏康复,将急性心肌梗死术后患者分为康复组(25例)和对照组(25例)。其中,康复组参与12周的心脏康复程序,进行早期心脏康复训练。对照组仅接受常规护理。在研究开始前、结束后,所有患者均接受三维斑点追踪成像(Three-dimensional speckle tracking imaging,3D-STI)检查,获得左心室整体及各节段纵向、径向、周向及面积应变值(LS、RS、CS、AS)。结果:经过12周的康复程序后,康复组的整体纵向应变(global longitudinal strain,GLS)、整体圆周应变(global circumferential strain,GCS)、整体径向应变(global radial strain,GRS)、整体面积应变(global area strain,GAS)及左室射血分数(left ventricular ejection fraction,LVEF)较对照组显著增加(P<0.01)。根据左室心肌节段分区法,两组间左前降支供血区域各有150节段,左回旋支供血区域各有125节段,右冠脉供血区域各有125节段。经过12周的康复程序后,康复组不同冠脉供血区域的LS、RS、CS、AS较对照组显著增加(P<0.05)。结论:早期心脏康复治疗可以改善经PCI术后患者的心脏收缩功能。

Objective： To explore the value of an early cardiac contraction rehabilitation （CR） program on the improvement of cardiac function for acute myocardial infarction （AMI） patients after percutaneous coronary intervention （PCI） using the three-dimensional speckle tracking imaging （3D-STI）. Method： According to the willingness to participate in the CR program, the low-risk AMI patients after PCI were assigned to either the rehabilitation group （n=25） or the control group （n=25）. The rehabilitation group was entailed to participate in an early 12-week CR program and the control group received only ordinary care. Before and after the study, all subjects in both groups underwent the 3D-STI examinations. Global and segmental longitudinal strain （LS）, radial strain （RS）, area strain （AS）, circumferential strain （CS）, left ventricular ejection fraction （LVEF） were measured. Result： After 12 weeks rehabilitation, compared with the control group, the GLS, GRS, GCS, GAS and LVEF in the rehabilitation group were increased significantly, the difference was statistically significant （P〈0.01）. According to the division of left ventricular myocardium, there were 150 segments in each group of the left ante- rior descending artery blood supply area, 125 segments in left circumflex artery blood supply area, and 125 segments in the right coronary artery blood supply area. After 12-week follow-up, compared with the control group, the LS, RS, CS, AS of each different coronary artery blood supply area in the rehabilitation group in- creased significantly （P〈0.05）. Conclusion： Early community-based cardiac rehabilitation can greatly improve cardiac function in AMI patients after PCI.