坐式八段锦对冠状动脉旁路移植术后病人Ⅰ期心肺功能的影响

Effect of Sitting Baduanjin on Stage Ⅰ Cardio-pulmonary Function of Patients after Coronary Artery Bypass Grafting

目的比较冠状动脉旁路移植(CABG)术后病人单独执行常规Ⅰ期心脏康复与在此基础上叠加坐式八段锦康复的治疗效果,评价坐式八段锦对冠心病CABG术后病人Ⅰ期心脏康复的有效性。方法选取2016年7月—2017年5月在中国医学科学院阜外医院确诊为冠心病并住院接受择期CABG的病人256例,最终完成试验245例(脱落11例),采用随机数字表法将其分为试验组(n=124)和对照组(n=121)。两组均在相应的手术、药物及护理基础治疗上,全程执行标准化Ⅰ期心脏康复流程,包括心脏康复宣教、预康复和涵盖了运动康复、呼吸锻炼及疼痛、睡眠、营养、心理、戒烟干预的正式康复等;试验组在对照组基础上增加坐式八段锦康复运动训练内容。病人在出院前进行6 min步行试验下的心肺功能评估等,比较两组病人的心肺功能情况。结果试验组、对照组在6 min步行试验下的峰值摄氧量(PVO_(2))分别为(13.70±2.32)mL/(kg·min)、(12.55±2.77)mL/(kg·min),两组比较差异无统计学意义(P>0.05)。试验组6 min步行试验下的步行距离、最大摄氧量(VO_(2)max)、无氧阈及无氧阈检出率等运动心肺检测指标略高于对照组,VO_(2)max检出率、二氧化碳通气当量斜率(VE/VCO_(2))略低于对照组,其中两组无氧阈检出率比较差异有统计学意义(P<0.05),VO_(2)max检出率、VE/VCO_(2)比较差异均无统计学意义(P>0.05)。试验组出院时左室射血分数高于对照组,但差异无统计学意义(P>0.05),两组出院时纽约心脏病协会(NYHA)心功能分级比较差异无统计学意义(P>0.05)。结论坐式八段锦训练可以改善CABG术后Ⅰ期心脏康复病人部分心肺功能指标,如提高术后病人6 min步行试验下的无氧阈检出率。

Objective To assess the efficacy of Sitting Baduanjin for phaseⅠcardiac rehabilitation patients after coronary artery bypass grafting(CABG).Methods Two hundred and fifty-six coronary heart disease patients who received selective CABG in Fuwai Hospital,Chinese Academy of Medical Sciences from July 2016 to May 2017,of which 245 cases completed the study(11 cases fell off).The patients were randomly divided into test group(n=124)and control group(n=121).Besides the surgery,drug and nursing basic therapy,the patients of both groups were early treated by phaseⅠcardiac rehabilitation(CR)including the CR education,pre-rehabilitation and formal rehabilitation(including exercise rehabilitation,breathing exercises,pain,sleep,nutrition,psychology,smoking cessation intervention).The patients in test group added sitting Baduanjin rehabilitation exercise training on the basis of control group.The cardio-pulmonary function was evaluated by the 6-minute walking test before discharge,and the cardio-pulmonary function was compared between two groups.Results At discharge,peak VO_(2)(PVO_(2))of test group and control group were(13.70±2.32)mL/(kg·min)and(12.55±2.77)mL/(kg·min),respectively,and the difference was not statistically significant(P>0.05).The six minute walking distance,maximal oxygen uptake(VO_(2)max),anaerobic threshold(AT),and AT detection rate in test group were slightly higher than those in control group,while the detection rate of VO_(2)max and VE/VCO_(2) in test group were slightly lower than those of control group.There was statistical significance in the detection rate of AT between two groups(P<0.05),while there was no statistical significance in the detection rate of VO_(2)max and VE/VCO_(2) between two groups(P>0.05).At discharge,the left ventricular ejection fraction of test group was higher than that of control group,but the difference was not statistically significant(P>0.05),and there was no statistical difference in New York Heart Association(NYHA)cardiac function classification between two groups(P>0.05).Conclusion Sitting Baduanjian training can improve cardiopulmonary function indexes of patients with stageⅠcardiac rehabilitation after CABG,such as increasing the detection rate of AT under 6 minute walking test.