减重支持锻炼联合呼吸肌康复训练对心力衰竭患者经皮冠状动脉介入治疗后心肺功能的影响

Effect of weight loss support exercise combined with respiratory muscle rehabilitation training on cardiopulmonary function in patients with heart failure after percutaneous coronary intervention

目的探究减重支持锻炼联合呼吸肌康复训练对心力衰竭患经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后心肺功能的影响。方法选取南京医科大学附属脑科医院2015年6月至2019年12月收治的102例行PCI治疗的心力衰竭患者作为研究对象,按随机数字表法分为对照组(n=51)和观察组(n=51)。对照组患者PCI治疗后给予常规药物及康复治疗,观察组在对照组的基础上给予减重支持锻炼及呼吸肌康复训练,连续治疗3个月。比较两组患者治疗前后心肺功能、心肌损伤标志物浓度、日常生活活动能力(activities of daily living,ADL)评估及6 min步行试验结果。结果治疗后,两组患者射血分数(ejection fraction,EF)、左心室缩短分数(left ventricular fractional shortening,LVFS)及心排血量(cardiac output,CO)均明显上升,差异有统计学意义(P<0.05);且观察组患者心功能EF、LVFS及CO均优于对照组,差异有统计学意义(P<0.05)。两组患者第1秒呼气量(FEV1)和FEV1/FVC(用力肺活量)比值较治疗前均明显上升,差异有统计学意义(P<0.05);且观察组FEV1/FVC显著优于对照组,差异有统计学意义(P<0.05)。治疗后,患者C-反应蛋白(C-reactive protein,CRP)、氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、心肌肌钙蛋白I(cardiac troponinl,cTnI)及肌酸激酶同工酶(creatine kinase isoenzyme MB,CK-MB)浓度均降低,差异有统计学意义(P<0.05);且观察组患者心肌损伤标志物CRP、NT-proBNP、cTnI及CK-MB浓度均显著低于对照组,差异有统计学意义(P<0.05)。两组患者治疗后ADL评分及6 min步行试验距离也有显著上升,其中观察组结果均高于对照组,差异有统计学意义(P<0.05)。结论减重支持锻炼联合呼吸肌康复训练有利于降低心力衰竭患者PCI治疗后心肌损伤标志物浓度,改善心肌缺血及自主神经调节功能,进而改善患者心肺功能,提高患者个体生活能力。

Objectives To explore the effect of weight loss support exercise combined with respiratory muscle rehabilitation training on cardiopulmonary function in patients with heart failure after percutaneous coronary intervention(PCI).Methods Totally 102 heart failure patients receiving PCI in Brain Hospital of Nanjing Medical University were selected as study subjects from June 2015 to December 2019,and randomly divided into control group(n=51)and observation group(n=51).Patients in control group were given routine drugs and rehabilitation treatment after PCI,and patients in observation group were treated with weight loss support exercise and respiratory muscle rehabilitation training on the basis of control group for 3 months.Cardiopulmonary function,myocardial injury markers,activities of daily living(ADL)assessment and 6-minute walking test were compared between the two groups,before and after treatment.Results After treatment,ejection fraction(EF),left ventricular fractional shortening(LVFS)and cardiac output(CO)significantly increased in both groups(P<0.05).And EF,LVFS and CO in observation group were better than those in control group(P<0.05).After treatment,FEV1 and FEV1/FVC in the two groups were significantly higher than those before treatment(P<0.05).Meanwhile,FEV1/FVC in observation group was significantly better than that in control group(P<0.05).The concentrations of C-reactive protein(CRP),N-terminal pro-brain natriuretic peptide(NT-proBNP),cardiac troponinl(cTnI)and creatine kinase isoenzyme MB(CK-MB)in the two groups significantly decreased after treatment(P<0.05).Serum concentrations of CRP,NT-proBNP,cTnI and CK-MB were significantly lower in observation group than in control group after treatment(P<0.05).ADL score and 6 min walking distance significantly increased in both groups after treatment(P<0.05);and serum concentrations of CRP,NT-proBNP,cTnI and CK-MB were significantly higher in observation group than in control group(P<0.05).Conclusions Weight loss support exercise combined with respiratory muscle rehabilitation training is beneficial to reduce serum concentrations of myocardial injury markers in patients with heart failure after PCI,improve myocardial ischemia and autonomic nerve regulation co-energy,thus promoting cardiopulmonary function of patients and increasing ability of individual life.