早期心脏康复策略对急性心肌梗死行经皮冠状动脉介入术后心功能及运动耐力的影响

Effect of early cardiac rehabilitation program on cardiac function and exercise endurance in patients with acute myocardial infarction after percutaneous coronary intervention

目的探讨早期心脏康复策略对急性心肌梗死(AMI)行经皮冠状动脉介入术(PCI)术后近期和远期康复的效果。方法选择98例行PCI治疗的AMI患者,按照随机数字表法分为试验组49例和对照组49例。对照组给予常规术后康复训练,试验组实施早期心脏康复策略。比较2组康复前和康复1周后的心功能、日常生活能力和运动耐力。患者随访6个月,比较2组患者远期生命质量和心脏不良事件发生率。结果康复1周后,试验组左心室射血分数(LVEF)、左室舒张末期内径(LVDD)、日常生活能力得分、6分钟步行试验(6MWT)距离分别为(56.74±8.92)%、(49.29±5.09)mm、(76.00±5.95)分、(378.12±48.54)m,对照组分别为(52.10±7.44)%、(48.47±4.04)mm、(72.93±6.51)分、(355.69±46.36)m,试验组LVEF、日常生活能力得分、6MWT距离明显高于对照组(t值为0.878~2.792,P<0.05)。随访6个月后试验组SF-36量表中生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康等维度得分分别为(75.14±12.15)、(56.38±7.65)、(68.79±6.65)、(68.48±10.91)、(80.82±7.12)、(66.44±9.61)、(77.75±13.05)、(77.07±8.46)分,对照组为(72.70±10.97)、(52.05±5.61)、(62.07±5.51)、(65.76±8.45)、(78.33±8.71)、(65.20±6.84)、(72.53±9.66)、(75.49±5.76)分,试验组生理职能、躯体疼痛、情感职能维度得分明显高于对照组(t值为3.199、5.448、2.248,P<0.05)。试验组心律失常、心绞痛发生率分别为4.08%(2/49)、6.12%(3/49),明显低于对照组的16.33%(8/49)、20.41%(10/49),差异有统计学意义(χ^(2)值为4.009、4.346,P<0.05)。结论早期心脏康复策略可提高AMI患者PCI术后心功能和运动耐力,减少心脏不良事件的发生和改善患者的生命质量。

Objective To investigate early cardiac rehabilitation program on short term and long term effect of patients with acute myocardial infarction after percutaneous coronary intervention.Methods A total of 98 acute myocardial infarction patients who undergo percutaneous coronary intervention were randomly assiged to the study group(n=49)and the control group(n=49).Participants in the control group received exercise training,while the study group carried out early cardiac rehabilitation program.The cardiac function,activity of daily living and exercise endurance were compared in both groups before and 1 week after intervention,in addition,the patient`s quality of life and the incidence of adverse cardiac events were also compared before and 6 months after intervention.Results After 1 week of intervention,the value of LVEF,LVDD,scores of activity of daily living and 6MWT were(56.74±8.92)%,(49.29±5.09)mm,(76.00±5.95)and(378.12±48.54)m in the study group,those index were(52.10±7.44)%,(48.47±4.04)mm,(72.93±6.51),(355.69±46.36)m in the control group,the LVEF,scores of activity of daily living and 6MWT were significantly increased in the study group compared to the control group(t=0.878-2.792,P<0.05).After 6 months of intervention,the scores physical function,role-physical,bodily pain,general health,vitality,social function,role-emotional,mental health were[(75.14±12.15),(56.38±7.65),(68.79±6.65),(68.48±10.91),(80.82±7.12),(66.44±9.61),(77.75±13.05),(77.07±8.46)]and[(72.70±10.97),(52.05±5.61),(62.07±5.51),(65.76±8.45),(78.33±8.71),(65.20±6.84),(72.53±9.66),(75.49±5.76)]in the study group and control group,respectively.The scores of role-physical,bodily pain,role-emotional were significantly increased in the study group compared to the control group(t=2.248-3.448,P<0.05).The study group showed lower incidence of angina and arrhythmia compared to the control group(4.08%and 6.12%vs 16.33%and 20.41%),the differences had statistical significance(χ^(2)=4.009 and 4.346,P<0.05).Conclusion Early cardiac rehabilitation program improve the cardiac function and exercise endurance in patients with acute myocardial infarction after percutaneous coronary intervention,reduce the the incidence of adverse cardiac events and improved patients`quality of life.