门诊和住院运动锻炼为核心的整体管理对慢性心力衰竭患者心脏康复治疗效果影响的临床研究

The impacts of outpatient vs inpatient holistic management based on exercise training on cardiac rehabilitation efficacy among patients with chronic heart failure

目的:探讨门诊运动康复和住院运动康复对慢性心力衰竭(CHF)患者心脏康复治疗效果的影响。方法:选择2015年9月至2018年9月间在北京康复医院临床诊断为CHF患者36例,按照随机原则和患者参与意愿分为3组:对照组(n=12):进行除运动锻炼治疗之外的常规心脏康复指导;住院运动康复组(n=12)和门诊运动康复组(n=12):患者在我院分别住院或门诊进行运动锻炼为核心的心脏康复。根据心肺运动试验(CPET)制定个体化运动处方。功率车运动强度为无氧阈以上Δ50%功率负荷,30 min/d,每周5 d,共12周。治疗前、后分别评估患者CPET指标、超声心动图指标、6 min步行距离(6MWD)、生活质量(QoL)评分等。结果:所有CHF患者安全无并发症完成症状限制性CPET,运动康复组患者安全完成全程12周运动康复。组间比较显示,治疗前,3组患者CPET指标、超声心动图指标、6MWD和QoL均无明显差异(P>0.05)。治疗后,住院和门诊运动康复组患者无氧阈(ml/min,ml/(min·kg),%pred)、峰值摄氧量(ml/min,ml/(min·kg),%pred)、峰值氧脉搏(ml/beat)、峰值功率(W,%pred)、左心室射血分数、6MWD较对照组升高(P<0.05),QoL评分较对照组降低(P<0.05);门诊运动康复组和住院运动康复组之间比较,CPET指标、超声心动图指标、6MWD和QoL评分等均无明显差异(P>0.05)。治疗前后比较显示,对照组患者治疗后上述指标与治疗前比较,差异均无统计学意义(P>0.05);治疗后住院运动康复组和门诊运动康复组患者无氧阈(ml/min,ml/(min·kg))、峰值摄氧量(ml/min,ml/(min·kg),%pred)、峰值氧脉搏(ml/beat,%pred)、峰值功率(W/min、%pred)、左心室射血分数和6MWD均较治疗前升高(P<0.05),QoL评分较治疗前降低(P<0.05)。结论:门诊运动康复可显著改善CHF患者心肺功能、运动耐力和生活质量,与住院运动康复效果无明显差异。门诊康复作为心脏康复一种有效的治疗模式,值得大力推广。

Objective:To evaluate the impacts of outpatient vs inpatient exercise training(ET)on cardiac rehabilitation efficacy among patients with chronic heart failure(CHF).Methods:Thirty six patients who were diagnosed with CHF in Beijing Rehabilitation Hospital from September 2015 to September 2018,were randomly divided into three groups:control group(n=12),outpatient ET group(n=12)and inpatient ET group(n=12).Patients in control group were treated with conventional cardiac rehabilitation without ET,patients in outpatient and inpatient ET groups were treated with holistic cardiac rehabilitation with the core of ET according to individualized exercise prescription based on cardiopulmonary exercise testing(CPET).Exercise intensity of cycle ergometer wasΔ50%power above anaerobic threshold(AT),30 min/d,5 d/week,for 12 weeks.General information,CPET parameters,echocardiogram,6 minute walking distance(6MWD)and quality of life(QoL)score of three groups of patients before and after treatment were recorded.Results:All patients in 3 groups finished symptom-limited CPET and patients in ET groups finished 12 weeks–ET safely without complications.Before treatment,there were no significant differences in CPET parameters,echocardiogram results,6MWD and QoL score among 3 groups(P>0.05).After treatment,AT(ml/min,ml/(min·kg),%pred),peak oxygen uptake(V 4 O_(2))(ml/min,ml/(min·kg),%pred),peak oxygen pulse(ml/beat),peak workload(W/min,%pred),left ventricular ejection fraction(LVEF)and 6MWD of patients in outpatient and inpatient ET groups were significantly higher than those of patients in control group(P<0.05),QoL score of patients in outpatient and inpatient ET groups was lower than that of patients in control group(P<0.05).To be noted,there were no obvious differences in CPET indexes,echocardiogram results,6MWD and QoL score in patients between outpatient ET group and inpatient ET group(P>0.05).For patients in control group,there were no significant differences in above parameters before and after treatment(P>0.05).AT(ml/min,ml/(min·kg)),Peak V 4 O_(2)(ml/min,ml/(min·kg),%pred),peak oxygen pulse(ml/beat,%pred),peak workload(W/min,%pred),LVEF and 6MWD of patients in outpatient and inpatient ET groups were significantly higher than those before treatment(P<0.05),QoL score of patients in outpatient and inpatient ET groups after treatment was significantly lower than that before treatment(P<0.05).Conclusion:Outpatient ET can improve the cardiopulmonary function,exercise tolerance and QoL of CHF patients,which has no significant difference compared with inpatient ET,indicating that outpatient cardiac rehabilitation,as an effective rehabilitation mode,is deserved to be applied widely.