中低强度持续性训练在射血分数正常的心力衰竭患者康复治疗中疗效评估

目的探讨中低强度持续性训练对射血分数正常的心力衰竭患者心脏康复治疗中疗效评估及安全性。方法将80例射血分数正常(LVEF≥50%)的心力衰竭患者1:1随机分成观察组和对照组。观察组患者在常规药物治疗基础上行中低强度持续性训练,包括杨式太极拳、八段锦、站桩等。>5次/周,>30 min/次。对照组给予常规药物治疗,患者在家中自行运动,无运动医嘱。患者于出院后3、6个月随访时再次进行心脏超声、生化、心电图、血压、心肺运动试验及6分钟步行试验等检查,重新评估患者的心脏康复情况。包括左心室射血分数、脑纳肽、血糖、总胆固醇、心电图、血压、峰值摄氧量(peak VO_(2))、峰值公斤摄氧量(peak VCh/kg)、无氧阅(Aerobic threshold,AT)、氧脉搏(VO_(2)/HR)、运动耐量(METs)、二氧化碳通气当量斜率(VE/VCO_(2)slope)、摄氧量与功率变化斜率(VCVWRslope)、摄氧效率斜率(OUES)和步行距离等。结果3个月随访时,观察组与对照组比较,peak VO_(2)、OUES、步行距离明显改善(P<0.05)。6个月随访时,观察组除运动耐量外,其他指标均比对照组明显改善,差异均有统计学意义(P<0.05)。结论杨式太极拳、八段锦、站桩等中低强度持续性训练在射血分数正常的心力衰竭患者心脏康复治疗中疗效满意,值得推广。

Objective To explore the efficacy evaluation and safety comparison of moderate and low intensity continuous training in cardiac rehabilitation for patients with heart failure with normal ejection fraction.Methods Eighty patients with chronic heart failure with normal ejection fracrion(Left ventricular ejection fraction LVEF)≥50%were randomly divided into two groups:observation group and control group.On the basis of conventional drug therapy,patients in the observation group received medium and low intensity continuous training including Tai Ji Quan.Ba Duan Jin and standing exercise.Patients were required to exercise more than half an hour five times a week.The control group was given conventional drug therapy,and the patients exercised at home without exercise prescription.Echocardiography,biochemical examination,Electrocardiogram(ECG).blood pressure,cardiopulmonary exercise test and 6-minute walking test were performed again at 3 months and 6 months follow-up after discharge to re-evaluate the cardiac rehabilitation status of the patients including left ventricular ejection fraction,BNP,blood glucose,total cholesterol,ECG,blood pressure,Peak VO_(2)/kg,AT,VO_(2)/HR,METs,VE/CO_(2) slope,VO_(2)/WR slope,OUES,walking distance,etc.Results At 3 months follow-up,the indicators of peak VO_(2),OUES and walking distance in the observation group were significantly improved compared with the control group(P<0.05).At the 6-month follow-up,more indicators in the observation group were significantly improved compared with the control group.The differences were statistically significant(P<0.05).Conclusion Tai Ji Quan,Ba Duan Jin and standing exercise are effective in cardiac rehabilitation of patients with chronic heart failure with normal ejection fraction.These are worth promoting.