运动康复对经皮冠状动脉介入术后急性冠状动脉综合征患者的效果

Effect of Exercise-based Cardiac Rehabilitation on Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention

目的通过心脏超声和心肺运动试验(CPET)评估急性期接受经皮冠状动脉介入(PCI)治疗的急性冠脉综合征(ACS)患者进行运动训练为主的心脏康复的疗效,探讨何种类型的ACS患者能从运动康复治疗中更多获益。方法连续纳入2017年12月至2019年7月本院PCI术后的ACS患者31例。根据基线期心脏超声所示左心室室壁运动功能分为室壁运动正常组(正常组,n=14)和存在节段性室壁运动异常组(异常组,n=17),以室壁运动积分指数(WMSI)量化室壁运动异常的程度。所有患者在出院后于稳定状态下接受为期3个月的个体化运动康复治疗,运动康复前后均行心脏超声和CPET。结果8例脱落,共23例患者完成试验。心脏超声显示,运动康复后异常组WMSI明显降低(Z=-2.852,P=0.004);而左室射血分数在两组中均无显著改变(P>0.05)。CPET显示,运动康复后,正常组仅静息心率减慢(t=-2.268,P=0.047);异常组最大运动负荷、峰值摄氧量、峰值摄氧量占预计值百分比、峰值分钟通气量和运动终止后第3分钟的心率恢复均较康复前提高(t>2.739,P<0.05)。结论急性期接受PCI治疗后存在WMSI异常的ACS患者,在病情恢复期接受运动康复治疗,更易获得心脏功能和运动耐量的进一步改善。WMSI在反映保留射血分数的ACS患者的心脏功能改善方面具有重要意义。

Objective To analyze the effects of exercise-based cardiac rehabilitation(ER)on patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI),and to identify which type of ACS patients would benefit most in terms of cardiovascular functional capacity after ER.Methods From December,2017 to July,2019,31 ACS patients who discharged in a stable situation after PCI were studied.All patients were referred to a three-month ER program after discharge.They were divided into normal wall motion group(normal group,n=14)and abnormal regional wall motion group(abnormal group,n=17)according to baseline myocardial wall motion reported by echocardiography.The degree of wall motion abnormalities was quantified by the wall motion score index(WMSI).Echocardiography and cardiopulmonary exercise testing(CPET)were performed before and after ER.Results Eight patients were dropped,and 23 patients completed the trial.WMSI decreased in the abnormal group(Z=-2.852,P=0.004),and the left ventricular ejection fraction(LVEF)didn't change in both groups(P>0.05)after ER.CPET showed that the heart rate at rest decreased in the normal group after ER(t=-2.268,P=0.047);and the peak work rate,peak oxygen uptake,percentage of predicted value of peak oxygen uptake,peak minute ventilation and the third minute heart rate recovery increased in the abnormal group after ER(t>2.739,P<0.05).Conclusion ER during recovery period could help more improve the cardiac function and exercise tolerance of ACS patients with abnormal WMSI after PCI.WMSI is an important indicator of cardiac function in ACS patients with preserved ejection fraction.