两种生理性缺血训练在冠心病患者中应用效果

Effects of two kinds of physiological ischemia training in coronary heart disease patients

目的:验证生理性缺血训练在冠心病患者中的有效性,并探讨两种可控性生理性缺血训练方法的差别,为以后的临床应用提供客观依据。方法:采用方便抽样方法,于南通市老年康复医院抽选60例冠心病患者,按随机数字表法将患者分为等长收缩组(20例)、袖带加压组(20例)、对照组(20例)。所有入组病例均接受有效的药物常规治疗。其中,等长收缩组:通过握力器诱导上肢肌肉等长收缩,收缩强度为最大等长收缩强度的40%—50%,从而造成肢体骨骼肌短暂可逆的生理性缺血。袖带加压组:通过血压计袖带加压至200mm Hg的压力值压迫上臂主要供血血管,形成骨骼肌暂时可逆的生理性缺血。对照组:除药物治疗外,不接受任何干预。干预的时间跨度3个月,2015年11月—2016年1月。比较干预前后各组患者循环血中血管内皮生长因子(vascular endothelial growth factor,VEGF)、一氧化氮(nitric oxide,NO)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、左室射血分数(left ventricular election traction,LVEF)、无氧阈水平变化。结果:干预前,三组患者的VEGF、NO、SBP、DBP、LVEF、无氧阈指标均无显著差异(P>0.05)。经过3个月干预后,等长收缩组、袖带加压组、对照组分别有1、2、2例失访;等长收缩组和袖带加压组患者的VEGF、NO、LVEF、无氧阈均高于对照组,收缩压和舒张压均相比对照组小幅度降低,并具有显著性差异(P<0.01);其中,等长收缩组与袖带加压组患者经3个月干预后的VEGF、NO水平并无明显差异(P>0.05),而等长收缩组患者的LVEF、无氧阈高于袖带加压组患者(P<0.01),收缩压和舒张压均低于袖带加压组患者(P<0.01)。每次干预过程中,等长收缩组患者的舒张压较干预前升高(P<0.01);收缩压也升高,但无显著性差异(P>0.05);而袖带加压组患者干预时较干预前的收缩压、舒张压均无显著性差异(P>0.05)。结论:等长收缩训练和血压计袖带加压训练均能形成可控性骨骼肌的生理性缺血,经过3个月干预后,冠心病患者循环血中VEGF和NO升高,增加了促进冠脉侧支循环新生的可能性;同时LVEF和无氧阈增加,反映心功能改善;患者收缩压和舒张压均有所降低;而等长收缩训练组在降压和改善心功能方面效果更佳。

Objective：To verify the effects of two controllable Physiological ischemia training（PIT） in coronary heart disease（CHD） patients.Method：From November, 2015 to January, 2016, a total of 60 CHD patients were randomly selected and divided into the IETG（Isometric exercise training group）（n=20）, CITG（Cuff inflation training group）（n=20） and NEG（None exercise group）（n=20）. All of them received 3 months of routine drug treatment. Patients in the IETG performed isometric handgrip exercises, and in the CITG were kept the cuff inflation training, whereas patients in the NEG remained sedentary. BP（Blood pressure）, VEGF（vascular endothelial growth factor）, NO（Nitric oxide）, LVEF（Left ventricular ejection fraction）, Anaerobic threshold were evaluated before and at the end of interventions.Result：There was no significant difference in VEGF, NO, SBP, DBP, LVEF, anaerobic threshold among the three groups before training（P〉0.05）. After 3 months intervention, in the IETG and CITG, the VEGF, NO,LVEF, Anaerobic threshold significantly increased and the SBP, DBP reduced comparing with the NEG（P〈0.01）. There was no statistically significant difference between IETG and CITG in VEGF and NO（P〉0.05）. In the IETG, the LVEF, Anaerobic threshold were significantly higher than the CITG（P〈0.01）. While SBP and DBP was significantly lower in the IETG than in the CITG（P〈0.01）. During training, the DBP was moderately increased（P〈0.01）, the SBP was also increased（P〉0.05） without statistically significant difference in the IETG. While the CITG had no significant impact on BP during training（P〉0.05）.Conclusion：Isometric exercise training and Cuff inflation training can cause controllable PIT. After 3 months intervention, the increasing of VEGF and NO enhances the possibility of promoting coronary collateral circulation. At the same time, the increasing of LVEF and Anaerobic threshold reflects the improvement of cardiac function. The SBP and DBP of Patients were reduced. The IETG had better effect on reducing blood pressure and improving cardiac function than CITG.