心肺康复运动对老年急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后窦性心率震荡的影响

Effect of cardiopulmonary rehabilitation exercise on sinus heart rate oscillations in elderly patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention

目的探讨心肺康复运动对老年急性ST段抬高型心肌梗死(ASTEMI)患者接受经皮冠状动脉介入术(PCI)后窦性心率震荡的影响。方法选择龙岩市第二医院2021年6月—2023年10月收治的99例老年ASTEMI患者作为研究对象,均接受PCI术,根据术后康复干预措施分为对照组(49例;给予常规康复干预)和观察组(50例;进行心脏康复运动),两组患者术后均干预3个月。比较两组患者窦性心率震荡〔震荡初始(TO)、震荡斜率(TS)〕、心肺功能〔最大摄氧量(VO_(2max))、最大代谢当量(MET_(max))、最大每搏摄氧量(VO_(2max)/HR)〕、心脏舒张功能〔左心房容积指数(LAVI)、二尖瓣舒张早期血流峰值减速时间(DT)、左心室血流传播速度(FPV)、左心房容积(LAV)〕指标水平以及心血管不良事件发生率。结果干预后观察组TO显著低于对照组,TS显著高于对照组〔TO:(1.88±0.19)%比(2.17±0.24)%;TS(ms/RR):3.13±0.42比2.95±0.25;均P<0.05〕;观察组VO_(2max)、MET_(max)、VO_(2max)/HR均显著高于对照组〔VO_(2max)(mL·min^(-1)·kg^(-1)):24.65±3.11比21.35±2.64;MET_(max):8.62±1.63比7.25±1.58;VO_(2max)/HR(mL):17.06±2.55比15.14±2.18;均P<0.05〕,观察组LAVI、LAV均显著低于对照组,DT、FPV均显著高于对照组〔LAVI(mL/m^(2)):25.14±2.11比30.54±2.46;LAV(mL):28.23±4.16比37.11±5.02;DT(ms):129.32±10.14比116.31±8.02;FPV(cm/s):51.49±4.05比47.53±3.81;均P<0.05〕。观察组心血管不良事件发生率显著低于对照组(4.00%比18.37%,P<0.05)。结论在老年ASTEMI患者PCI术后实施心肺康复运动能够改善窦性心率震荡,减少心血管不良事件,促进心肺功能、心脏舒张功能恢复。

Objective To investigate the effect of cardiopulmonary rehabilitation exercise on sinus heart rate oscillations in elderly patients with acute ST segment elevation myocardial infarction(ASTEMI)after percutaneous coronary intervention(PCI).Methods The 99 elderly ASTEMI patients admitted to Longyan Second Hospital from June 2021 to October 2023 were selected as research objects and underwent PCI.According to different postoperative rehabilitation intervention measures,the patients were divided into control group(49 cases;routine rehabilitation intervention)and observation group(50 cases;cardiac rehabilitation exercise),and treated for 3 months after surgery.The indexes of sinus heart rate oscillations[turbulence onset(TO)and turbulence slope(TS)],cardiopulmonary function[maximum oxygen intake(VO_(2max)),maximum metabolic equivalent(MET_(max)),maximum oxygen intake per heartbeat(VO_(2max)/HR)],diastolic function of heart[left atrial volume index(LAVI),peak deceleration time(DT)of mitral valve early diastolic blood flow,left ventricular flow propagation velocity(FPV),left atrial volume(LAV)]and incidence rates of cardiovascular adverse events(arrhythmia,angina pectoris,heart failure)between two groups were compared.Results After intervention,TO of observation group was lower than that of control group,and TS was higher[TO:(1.88±0.19)%vs.(2.17±0.24)%;TS(ms/RR):3.13±0.42 vs.2.95±0.25;both P<0.05].The VO_(2max),MET_(max)and VO_(2max)/HR of observation group were higher than those of control group[VO_(2max)(mL·min^(-1)·kg^(-1)):24.65±3.11 vs.21.35±2.64;MET_(max):8.62±1.63 vs.7.25±1.58;VO_(2max)/HR(mL):17.06±2.55 vs.15.14±2.18;all P<0.05].The LAVI and LAV in observation group were lower than those of control group,and DT and FPV were higher[LAVI(mL/m^(2)):25.14±2.11 vs.30.54±2.46;LAV(mL):28.23±4.16 vs.37.11±5.02;DT(ms):129.32±10.14 vs.116.31±8.02;FPV(cm/s):51.49±4.05 vs.47.53±3.81;all P<0.05].The incidence rate of cardiovascular adverse events in observation group was lower than that in control group(4.00%vs.18.37%,P<0.05).Conclusion Cardiopulmonary rehabilitation exercise in elderly ASTEMI patients after PCI could improve the sinus heart rate oscillation,reduce cardiovascular adverse events,and promote the recovery of cardiopulmonary function and cardiac diastolic function.