心脏康复模式对急性心肌梗死冠状动脉介入术后患者心肺储备功能及生命质量的影响

Effect of cardiac rehabilitation model on cardiopulmonary reserve function, quality of life and brain natriuretic peptide level in patients with acute myocardial infarction after coronary interventione

目的:观察急性心肌梗死(AMI)经皮冠状动脉介入治疗(PCI)术后患者经心脏康复模式干预效果,指导未来AMI PCI术后合理心脏康复干预的实施。方法:前瞻选取2019年7月至2020年12月,中山医院青浦分院心内科60例接受PCI治疗的AMI患者,采用随机数字表法分为对照组和心脏康复组,各30例。对照组接受常规干预,心脏康复组接受常规干预联合心脏康复模式干预,均干预1年。分别于干预前、干预1年,检查两组肺储备功能[用力肺活量(FVC)、第一秒用力呼气容积(FEV_(1))、FEV_(1)/FVC、最大肺活量(VCmax)、最大通气量(MVV)]、心脏储备功能[LVEDD、LVESD、左心室收缩期末容量(LVESV)、左心室舒张期末容量(LVEDV)和LVEF]、评估生活质量[生活质量评价量表(SF-36)评估]、检测脑钠肽(NT-proBNP)并比较。结果:干预1年,两组肺储备功能指标水平均较干预前升高,且心脏康复组高于对照组(P<0.05);两组LVEDD、LVESD、LVESV、LVEDV值均较干预前降低,且心脏康复组低于对照组,两组LVEF值较干预前升高,且心脏康复组高于对照组(P <0.05);两组生活质量评分均较干预前升高,且心脏康复组高于对照组(P <0.05);两组血清NT-proBNP水平较干预前降低,且心脏康复组低于对照组(P <0.05);干预1年,两组峰值摄氧量、无氧阈值摄氧量较干预前升高,VE/VCO2slople较干预前降低,且心脏康复组峰值摄氧量、无氧阈值摄氧量高于对照组,VE/VCO2slople低于对照组(P <0.05)。结论:AMI患者PCI术后经心脏康复模式干预效果显著,更利于改善患者血清NT-proBNP水平、心肺储备功能,患者生活质量明显提高。

Objective: To observe the effect of cardiac rehabilitation mode on patients with acute myocardial infarction(AMI) after percutaneous coronary intervention(PCI), to guide the implementation of reasonable cardiac rehabilitation intervention after PCI in AMI in the future. Methods:From July 2019 to December 2020, 60 AMI patients treated with PCI in the Department of Cardiology of Qingpu Branch of Zhongshan Hospital were prospectively selected, a random number table method was used to divide them into control group and cardiac rehabilitation group, with 30 cases in each group. The control group received routine intervention and the cardiac rehabilitation group received routine intervention combined with cardiac rehabilitation model intervention, both were intervened for 1 year. Before and 1 year after the intervention, the pulmonary reserve function [forced vital capacity(FVC), forced expiratory volume in the first second(FEV_(1)), FEV_(1)/FVC, maximum vital capacity(VCmax), maximum ventilation(MVV)], cardiac reserve function [LVEDD, LVESD, left ventricular end systolic volume(LVESV), left ventricular end diastolic volume(LVEDV) and LVEF] between the two groups were examined, quality of life [assessed by the quality of life assessment scale(SF-36)] was assessed, brain natriuretic peptide(NT-proBNP) was detected and compared. Results: After one year of intervention, the levels of pulmonary reserve function indexes in both groups were increased than those before intervention,and the heart rehabilitation group were higher than the control group(P <0.05);the values of LVEDD,LVESD, LVESV and LVEDV in both groups were decreased than those before intervention, and the cardiac rehabilitation group was lower than the control group, LVEF in both groups was increased than that before intervention, and the heart rehabilitation group was higher than the control group(P <0.05);the scores of quality of life in both groups were increased than those before intervention, and the heart rehabilitation group was higher than the control group(P <0.05);the serum NT-proBNP level in both groups was decreased than that before intervention, and the heart rehabilitation group was lower than the control group(P<0.05);after one year of intervention, the peak oxygen uptake and anaerobic threshold oxygen uptake of both groups were increased and VE/VCO2 slople was decreased than those before intervention, the peak oxygen uptake and anaerobic threshold oxygen uptake in the cardiac rehabilitation group were higher and VE/VCO2 slople was lower than those in the control group(P <0.05). Conclusions: The intervention effect of cardiac rehabilitation mode in patients with AMI after PCI is significant, which is more conducive to improving the serum NT-proBNP level and cardiopulmonary reserve function of patients, the quality of life of patients is significantly improved.