心脏康复训练对寒冷地区急性心肌梗死患者经皮冠状动脉介入术后心功能及预后影响的研究

The effect of cardiac rehabilitation training on cardiac function and prognosis of patients with acute myocardial infarction after percutaneous coronary intervention in cold area

目的评价心脏康复训练对我国寒冷地区急性心肌梗死患者经皮冠状动脉介入(PCI)术后心功能恢复水平和预后的影响。方法本研究回顾性纳入了2016年1月至2023年12月在黑龙江省鹤岗市人民医院心内科就诊并确诊为急性ST段抬高型心肌梗死的1914例患者。所有纳入患者均接受了急诊冠状动脉造影及PCI治疗。根据是否接受心脏康复训练,患者被分为康复训练组(833例)和常规治疗组(1081例)。比较2组患者临床资料、院内并发症情况,分析康复训练组出院后心肺运动试验结果,比较2组随访1年主要不良心血管事件(MACE)发生情况。结果康复训练组房性和室性心律失常发生率均低于常规治疗组(均P<0.05)。在康复训练组中,患者出院后分别在1、3、6、12个月进行随访,并接受心肺运动试验,结果显示患者的功率、心率、二氧化碳排出量、氧气摄取量、肺每分通气量、死腔通气比、呼气末二氧化碳分压、碳水化合物代谢百分比、心输出量及每搏输出量等指标较前均有显著改善(均P<0.05)。患者1年随访时,康复训练组MACE发生率显著低于常规治疗组[25.2%(210/833)比39.3%(425/1081)],差异有统计学意义(P<0.001)。结论心脏康复训练可有效改善我国寒冷地区急性心肌梗死患者PCI术后心功能恢复水平和疾病预后。

Objective To evaluate the effects of cardiac rehabilitation training on cardiac function recovery and prognosis of patients with acute myocardial infarction after percutaneous coronary intervention(PCI)in cold areas of China.Methods A total of 1914 patients diagnosed with acute ST-segment elevation myocardial infarction in the Department of Cardiology,Hegang People′s Hospital,Heilongjiang Province from January 2016 to December 2023 were retrospectively enrolled in this study.All enrolled patients underwent primary coronary angiography and PCI.Patients were divided into rehabilitation training group(833 cases)and conventional treatment group(1081 cases)according to whether they received cardiac rehabilitation training.The clinical data and in-hospital complications of the two groups were compared,and the results of cardiopulmonary exercise test after discharge of the rehabilitation training group were analyzed.The incidence of major adverse cardiovascular events(MACE)in 1 year of follow-up was compared between the two groups.Results The incidences of atrial and ventricular arrhythmia in the rehabili-tation training group was lower than those in the conventional treatment group(both P<0.05).In the rehabilitation training group,patients were followed up at 1,3,6,and 12 months after discharge and underwent cardiopulmonary exercise testing.The results showed that the patients′power,heart rate,carbon dioxide output,oxygen intake,lung ventilation per minute,dead space ventilation ratio,end-tidal carbon dioxide partial pressure,carbohydrate metabolism percentage,cardiac output and stroke volume were significantly improvement compared to before(all P<0.05).At 1-year follow-up,the incidence of MACE in the rehabilitation training group was significantly lower than that in the conventional treatment group[25.2%(210/833)vs 39.3%(425/1081)](P<0.001).Conclusion Cardiac rehabilitation training can effectively improve the recovery of cardiac function and prognosis of patients with acute myocardial infarction after PCI in cold areas of China.