运动训练对老年舒张性心力衰竭病人心肺功能及生活质量的影响

Effects of exercise training on cardio-pulmonary function and quality of life in elderly patients with chronic diastolic heart failure

目的研究有氧运动联合抗阻运动训练对老年舒张性心力衰竭病人心肺功能及生活质量的影响。 方法选取2016年5月至2017年12月在心内科就诊的老年慢性舒张性心力衰竭的病人,随机分为运动组与对照组。2组均参照慢性舒张性心力衰竭诊疗指南给予药物治疗,运动组在此基础上以50%~70%峰值摄氧量进行有氧运动训练,并进行核心肌群的抗阻训练,每周3次,共6个月。观察2组在运动训练前后多普勒超声心动图(UCG)、运动心肺功能试验(CPET)、心理评测[9项病例健康问卷(PHQ-9)、7项广泛性焦虑自评量表(GAD-7)]及生活质量(SF-36评分)等方面的差异。结果运动训练前2组病人的各项评估结果差异无统计学意义(P>0.05);训练6个月后,运动组运动时间(exercise duration,ED)、最大运动当量(mets-max)、峰值摄氧量(VO 2peak)、无氧阈(aerobic threshold,AT)、左心室射血分数(LVEF)、舒张早期二尖瓣血流速度与舒张早期二尖瓣环运动速度的比值(E/E’)、每搏输出量(SV)、SF-36评分均较治疗前明显改善,且均优于对照组( P<0.05)。运动组PHQ-9、GAD-7评分在治疗后有所降低,但差异无统计学意义,与对照组比较,差异亦无统计学意义( P>0.05)。结论与单纯药物治疗相比,增加运动训练可明显提高老年慢性舒张性心力衰竭病人的临床治疗效果,改善其心肺功能及生活质量。

Objective To observe the effects of aerobic training combined with resistance training on cardio-pulmonary function and quality of life(QOL) in the elderly patients with chronic diastolic heart failure. Methods A total of 68 elderly patients aged 65-80 years old with chronic diastolic heart failure in cardiovascular department from May 2016 to December 2017 were enrolled and randomized to training group(n = 34) and control group(n = 34). Two groups received medical care as usual. Training group performed aerobic training at 50% to 70% peak oxygen uptake(VO2 peak)for 40 min and resistance training with 10 repetitions maximum(10RM)degree for 15 min,3 times a week for 6 months. All patients received echocardiography(UCG),cardiopulmonary exercise test(CPET),and PHQ-9,GAD-7,SF-36 test before and after 6 months treatment to assess the cardio-pulmonary function and QOL. Results Before training,the patients in the two groups showed no significant difference in CPET,UCG,SF-36 scores,PHQ-9 scores and GAD-7 scores( P>0.05). After 6 months treatment,compared with control group,training group had higher left ventricular ejection fractions(LVEF)(60.8±6.2 vs 56.9±4.7),higher SV(69.5±16.8 vs 58.1±15.7),longer ED(439.2±71.8 vs 370.8±63.1),higher Mets-max(7.3±2.7 vs 6.0±2.5),higher VO2 peak(14.9±2.7 vs 12.8±3.2),higher AT(13.6±2.8 vs 10.7±3.1),higher SF-36 scores,and the lower E/E’(9.8±3.1 vs 12.4±5.2)( P <0.05),but there were no significant differences in the PHQ-9 scores and GAD-7 scores( P>0.05)between two groups. Conclusions Exercise training can improve the cardio-pulmonary function and QOL in the elderly patients with chronic diastolic heart failure,and it is more effective than usual care.