急诊经皮冠状动脉介入治疗术后常规康复训练与心肺康复运动对老年急性心肌梗死患者心肺功能、心脏舒张功能及心血管不良事件的影响

Effect of routine rehabilitation training and cardiopulmonary rehabilitation exercise after emergency percutaneous coronary intervention on cardiorespiratory function,cardiac diastolic function and cardiovascular adverse events in elderly patients with acute myocardial infarction

目的探讨急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后常规康复训练与心肺康复运动对老年急性心肌梗死(acute myocardial infarction,AMI)患者心肺功能、心脏舒张功能及心血管不良事件的影响。方法选取2017年9月至2019年8月在中国人民解放军空军军医大学第一附属医院行急诊PCI治疗的老年AMI患者174例,采用随机数字表法将其分为对照组(92例)和研究组(82例)。对照组患者于PCI术后给予患者常规康复训练干预,研究组患者于PCI术后实施心肺康复运动干预,两组患者康复训练干预周期均为12周。分别于干预前、干预12周后采用心肺功能检测仪测定两组患者心肺功能指标;采用彩色多普勒超声诊断仪测定两组患者心脏舒张功能指标;记录两组患者康复训练干预期间心血管不良事件的发生情况。结果干预12周后,两组患者最大氧脉搏(maximal oxygen consumption per heart rate,VO_(2 max)/HR)、最大代谢当量(maximal metabolic equivalent,MET_(max))、峰值千克摄氧量(peak oxygen uptake per kilogram,VO_(2 peak)/kg)均显著高于本组干预前(均P<0.05),且研究组患者VO_(2 max)/HR、MET_(max)、VO_(2 peak)/kg均显著高于对照组(均P<0.05);干预12周后,两组患者舒张早期二尖瓣血流频谱E峰峰值与舒张晚期二尖瓣血流频谱A峰峰值之比(E/A)均显著高于本组干预前(均P<0.05),舒张早期二尖瓣血流频谱E峰峰值与舒张早期二尖瓣环最大运动E'峰峰值之比(E/E')均显著低于本组干预前(均P<0.05),且研究组患者E/A水平显著高于对照组(P<0.05),E/E'水平显著低于对照组(P<0.05);研究组患者心绞痛、心律失常、心力衰竭等心血管不良事件总发生率显著低于对照组(P<0.05)。结论相较于常规康复训练,急诊PCI术后实施心肺康复运动干预更有助于促进老年AMI患者心肺功能恢复,改善患者心脏舒张功能,减少心血管不良事件发生。

Objective To investigate the effect of routine rehabilitation training and cardiopulmonary rehabilitation exercise after emergency percutaneous coronary intervention(PCI)on cardiorespiratory function,cardiac diastolic function and cardiovascular adverse events in elderly patients with acute myocardial infarction(AMI).Method A total of 174 elderly patients with AMI who underwent emergency PCI in the First Affiliated Hospital of PLA Air Force Military Medical University from September 2017 to August 2019 were randomly divided into control group(92 cases)and study group(82 cases).Control group was given routine rehabilitation training intervention after PCI,and study group was given cardiopulmonary rehabilitation exercise intervention after PCI.The intervention period of rehabilitation training in both groups was 12 weeks.Before and 12 weeks after the intervention,the indexes of cardiopulmonary function were measured by cardiopulmonary function detector;the indexes of diastolic function were measured by color Doppler ultrasound;the incidence of cardiovascular adverse events during rehabilitation training intervention in two groups was recorded.Result After the 12 weeks of intervention,the levels of maximal oxygen consumption per heart rate(VO_(2 max)/HR),maximal metabolic equivalent(MET_(max)),peak oxygen uptake per kilogram(VO_(2 peak)/kg)in two groups were higher than those before the intervention(all P<0.05),and the levels of VO_(2 max)/HR,MET_(max),VO_(2 peak)/kg in study group were higher than those in control group(all P<0.05).After 12 weeks of intervention,the E/A in both groups were higher than that before intervention(all P<0.05),and the E/E'were lower than that before intervention(all P<0.05),the E/A in study group was higher than that of control group(P<0.05),and the E/E'was lower than that of control group(P<0.05).The total incidence of angina pectoris,arrhythmia,heart failure and other cardiovascular adverse events in study group was lower than that in control group(P<0.05).Conclusion Compared with the conventional rehabilitation training,the implementation of cardiopulmonary rehabilitation exercise intervention after PCI is more conducive to promote the recovery of cardiopulmonary function,improve the diastolic function and reduce the incidence of cardiovascular adverse events in elderly patients with AMI.