脓毒症患者心力衰竭后实施早期心功能康复锻炼的效能研究

A clinical efficacy study of an early cardiac rehabilitation exercise in patients with sepsis-induced heart failure

目的探讨脓毒症患者心力衰竭后实施早期心功能康复锻炼的临床效能。方法选取2020年2月至2022年9月收治的脓毒症合并心力衰竭患者80例,随机数字表法分为对照组(常规干预,n=40)和研究组(开展早期心功能康复锻炼,n=40)。比较干预前后2组心功能改善情况[左心室收缩末内径(LVESD)、左心室舒张末内径(LVEDD)、左心室射血分数(LVEF)及舒张早期/舒张晚期左房室瓣血流速度(E/A比值)]及心肺指标(心肌肌钙蛋白I、D-二聚体、心脏指数及氧合指数),记录2组临床相关指标及干预前、后血清炎性因子水平[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)及白介素-10(IL-10)]变化情况,生活质量改善情况[生活质量评价量表(SF-36)]。结果研究组LVESD、LVEDD、心肌肌钙蛋白I及D-二聚体水平均低于对照组(P<0.05),LVEF、E/A比值、心脏及氧合指数均高于对照组(P<0.05)。研究组机械通气时间及ICU住院时间均短于对照组(P<0.05),2组住院期间死亡人数比较,差异无统计学意义(P>0.05)。研究组IL-6、IL-10及TNF-α水平均低于对照组(P<0.05),研究组SF-36各项评分均高于对照组(P<0.05)。结论脓毒症患者心力衰竭后实施早期心功能康复锻炼有利于促进患者心功能恢复,减少主要心血管不良事件发生,有效改善血清炎性因子水平及患者生活质量。

Objective To explore the clinical efficacy of an early cardiac function rehabilitation exercise in sepsis patients with heart failure.Methods A total of 80 patients with sepsis and heart failure admitted from February 2020 to September 2022 were selected as the research objects.They were randomly assigned into the control group(routine intervention,n=40)and the study group(early cardiac function rehabilitation exercise,n=40)by random number table method.The improvement of cardiac function(left ventricular end systolic diameter[LVESD],left ventricular end diastolic diameter[LVEDD],left ventricular ejection fraction[LVEF]and early diastolic/late diastolic left atrioventricular valve flow velocity[E/A ratio])and cardiopulmonary indicators(cardiac troponin I,D-dimer,cardiac index and oxygenation index)were compared between the two groups before and after intervention.The clinical indicators,and serum inflammatory factors(tumor necrosis factor-α[TNF-α],interleukin-6[IL-6]and interleukin-10[IL-10])before and after intervention,and the improvement of quality of life(36-Item Short Form Survey[SF-36])were recorded.Results LVESD,LVEDD,cardiac troponin I and D-dimer levels in the study group were significantly lower than those of the control group(P<0.05),while LVEF,E/A ratio,heart and oxygenation index were significantly higher(P<0.05).The duration of mechanical ventilation and intensive care unit(ICU)stay in the study group were significantly shorter than those of the control group(P<0.05).There was no significant difference in the number of deaths during hospitalization between the two groups(P>0.05).After intervention,IL-6,IL-10 and TNF-α levels in the study group were significantly lower than those of the control group(P<0.05),and the SF-36 scores were significantly higher than those of the control group(P<0.05).Conclusion An early cardiac function rehabilitation exercise in sepsis patients with heart failure can promote the recovery of cardiac function,reduce the incidence of major adverse cardiovascular events,effectively reduce serum inflammatory factors and improve the quality of life.