吸气肌训练联合耐力训练对病毒性心肌炎心衰患者心肺耐力及外周肌力的影响

Effects of inspiratory muscle training combined with endurance training on cardiopulmonary endurance and peripheral strength in patients with viral myocarditis and heart failure

目的探究吸气肌训练(IMT)联合耐力训练对病毒性心肌炎心力衰竭患者心肺耐力及外周肌力的影响。方法2016年7月—2019年7月,共纳入郑州市心血管病医院郑州市第七人民医院心内科收治的病毒性心肌炎心衰患者76例,计算机法随机分组,康复组38例及对照组38例。康复组患者给与IMT联合耐力训练的康复干预方案;对照组患者常规治疗外无特殊干预。两组患者均于出院后12周行最大吸气压(PImax)、左心室射血分数(LVEF)、心肺运动试验(CPET)及英国医学研究委员会肌力评定法(MRC)评估心肺耐力及外周肌力。结果干预后康复组PImax高于对照组及同组干预前[(91.5±12.3)比(72.4±10.2)cmH2O(1 cmH2O=0.098 kPa),P<0.001],而对照组前后则无明显改变;康复组LVEF高于对照组[(52.0%±9.0%)与(43.3%±8.4%),P<0.001];CPET:康复组峰值公斤摄氧量(VO2peak)、无氧阈摄氧量(VO2at)均高于对照组,二氧化碳通气当量斜率(VE/VCO2 slope)低于对照组,差异有统计学意义(P<0.05);MRC高于对照组(P<0.001)。结论合理的IMT联合耐力训练的心脏康复方案能改善病毒性心肌炎心衰患者心肺耐力及外周肌力,提高生存质量,改善预后。

Objective To investigate the effects of inspiratory muscle training(IMT)combined with endurance training on cardiorespiratory endurance and peripheral muscle strength in patients with viral myocarditis and heart failure.Methods A total of 76 patients with viral myocarditis and heart failure admitted to our hospital were enrolled and randomly assigned by computer method,38 in the rehabilitation group and 38 in the control group.Patients in the rehabilitation group were initially given IMT and endurance training and the control group had no special intervention except routine treatment.Patients in both groups were given PImax,left ventricular ejection fraction(LVEF),cardiopulmonary exercise(CPET)and Medical Research Council(MRC)12 weeks after discharge to assess cardiopulmonary endurance and peripheral muscle strength.Results After intervention,PImax in the rehabilitation group was higher than that in the control group and before intervention in the same group(P<0.001).LVEF in rehabilitation group was higher than that in control group(P<0.001).CPET:VO2peak and VO2at of the rehabilitation group were both higher than those of the control group,and the slope of CO2 ventilation equivalent(VE/VCO2 slope)of the rehabilitation group was lower than that of the control group with significant difference(P<0.05).MRC of the rehabilitation group was higher than that of the control group(P<0.001).Conclusion Reasonable IMT combined with endurance training cardiac rehabilitation program can improve cardiorespiratory endurance and peripheral muscle strength in patients with viral myocarditis and heart failure,and improve the quality of life and prognosis.