有氧运动对AMI患者急诊PCI术后康复和预后的影响

Influence of aerobic exercise on rehabilitation and prognosis of AMI patients after emergency PCI

目的:研究有氧运动锻炼对急性心肌梗死(AMI)患者急诊经皮冠状动脉介入治疗(PCI)术后康复和预后的影响。方法:于我院行急诊PCI的120例AMI患者被随机均分为常规治疗组与有氧运动组(常规治疗组基础上行有氧运动干预),观察比较两组干预前、干预12个月后血浆N基末端脑钠肽前体(NT-proBNP)、糖化血红蛋白(HbA1c)、同型半胱氨酸(Hcy)及脂蛋白a[Lp(a)]水平,LVEF、6min步行距离(6MWD)、随访一年的主要不良心血管事件(MACE)发生率及生存情况。结果:与常规治疗组比较,干预12个月后,有氧运动组血浆NT-proBNP[(367.07±229.41)ng/L比(158.22±154.34)ng/L]、HbA1c[(5.89±0.82)%比(5.40±0.69)%]、Hcy[(12.40±3.02)μmol/L比(11.02±4.18)μmol/L]、Lp(a)水平[(171.78±113.04)mg/L比(121.42±66.13)mg/L]均显著降低,LVEF[(52.42±5.56)%比(54.40±4.23)%]、6MWD[(471.25±31.02)m比(488.63±30.42)m]均显著升高(P<0.05或<0.01)。随访:一年,有氧运动组MACE发生率显著低于常规治疗组(6.7%比26.7%,P=0.003);Kaplan-Meier生存分析显示,随访一年,有氧运动组无MACE生存率显著高于常规治疗组(93.3%比78.3%,P=0.004)。结论:有氧运动锻炼可促进急性心肌梗死患者急诊PCI术后康复,降低MACE发生率,改善预后。

Objective:To study influence of aerobic exercise on rehabilitation and prognosis of patients with acute myocardial infarction(AMI)after emergency percutaneous coronary intervention(PCI).Methods:A total of 120 AMI patients undergoing emergency PCI were randomly and equally divided into routine treatment group and aerobic exercise group(received aerobic exercise based on routine treatment group).Plasma levels of N-terminal pro-brain natriuretic peptide(NT-proBNP),glycosylated hemoglobin(HbA1 c),homocysteine(Hcy)and lipoprotein(a)[Lp(a)];LVEF and 6-min walking distance(6 MWD)before and 12 months after intervention,incidence of major adverse cardiovascular events(MACE)and survival situation during one-year follow-up were observed and compared between two groups.Results:Compared with routine treatment group,after 12-month intervention,there were significant reductions in plasma levels of NT-proBNP[(367.07±229.41)ng/L vs.(158.22±154.34)ng/L],HbA1 c[(5.89±0.82)%vs.(5.40±0.69)%],Hcy[(12.40±3.02)μmol/L vs.(11.02±4.18)μmol/L]and Lp(a)[(171.78±113.04)mg/L vs.(121.42±66.13)mg/L],and significant rise in LVEF[(52.42±5.56)%vs.(54.40±4.23)%]and 6 MWD[(471.25±31.02)m vs.(488.63±30.42)m]in aerobic exercise group(P<0.05 or<0.01).After one-year follow-up,incidence rate of MACE in aerobic exercise group was significantly lower than that of routine treatment group(6.7%vs.26.7%,P=0.003);Kaplan-Meier survival analysis indicated that MACE-free survival rate in aerobic exercise group was significantly higher than that of routine treatment group(93.3%vs.78.3%,P=0.004).Conclusion:Aerobic exercise can promote rehabilitation,reduce incidence rate of MACE and improve prognosis in patients with acute myocardial infarction after emergency PCI.