早期心脏康复对急性冠状动脉综合征患者经皮冠状动脉介入术后疗效的影响

Clinical study of early cardiac rehabilitation in patients with acute coronary syndrome undergoing percutaneous coronary intervention

目的探讨早期心脏康复干预对急性冠状动脉综合征(ACS)患者经皮冠状动脉介入(PCI)术后内皮素-1(ET-1)、炎性细胞因子、运动耐量及心脏功能的影响。方法选取2018年1月至2019年1月我院接诊的ACS择期PCI术患者108例,用随机数字表法分为对照组(常规治疗)和观察组(在常规治疗基础上联合早期心脏康复治疗),每组54例。观察2组治疗前后血清N端B型脑钠肽前体(NT-proBNP)、ET-1、超敏C反应蛋白(Hs-CRP)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子α(TNF-α)水平和最大摄氧量(VO2max)、无氧阈(AT)、二氧化碳通气当量斜率(VE/VCO2 slope)、左心室射血分数(LVEF)以及6 min步行距离(6MWT)。结果治疗3个月后,观察组Hs-CRP、IL-6、IL-10、TNF-α及ET-1、NT-proBNP及VE/VCO2 slope均较治疗前和对照组显著降低,VO2max、AT、6MWT及LVEF较治疗前和对照组显著提高,差异均有统计学意义(均P<0.05)。结论早期心脏康复干预可显著提升ACS患者PCI术后运动耐力,能有效降低炎性细胞因子及ET-1水平,是冠状动脉粥样硬化性心脏病PCI术后二级预防的重要组成部分。

Objective To investigate the impact of early cardiac rehabilitation intervention on the levels of endothelin 1(ET-1)and inflammatory factors,exercise tolerance,and cardiac function in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods One hundred and-eight patients with ACS treated with elective PCI who were admitted to our hospital between January 2018 and January 2019 were enrolled in the study.The patients were randomly categorized into two groups.The control group received a conventional treatment,and the observation group received a combination of early cardiac rehabilitation in accordance with the conventional treatment.Serum levels of N-terminal pro-brain natriuretic peptide(NT-proBNP),ET-1,inflammatory factor hypersensitive C-reactive protein(Hs-CRP),interleukin 6(IL-6),IL-10,and tumor necrosis factorα;maximal oxygen uptake(VO2max);anaerobic threshold(AT);carbon dioxide venting equivalent slope(VE/VCO2 slope);left ventricular ejection fraction(LVEF);and 6-minute walking distance(6MWT)were measured before and after treatment.Results After 3 months of treatment,the levels of the inflammatory factors Hs-CRP,IL-6,IL-10,ET-1,and NT-proBNP in the observation group significantly decreased compared with those in the control group(P<0.05).VO2max,AT,6MWT,and LVEF after treatment were significantly higher in the observation group than in the control group.NT-proBNP level and VE/VCO2 slope after treatment were significantly lower in the observation group than in the control group,and the differences were statistically significant(P<0.05).Conclusion Early cardiac rehabilitation intervention significantly improved the exercise endurance of patients with ACS after PCI and effectively reduced the levels of inflammatory factors and ET-1,which is an important component of secondary prevention after PCI in patients with coronary heart disease.