不同心脏康复模式在急性心肌梗死经皮冠状动脉介入治疗术后早期的临床价值研究
发布时间：2018-08-26 13:27
【摘要】：目的明确早期心脏康复训练对急性心肌梗死(AMI)经皮冠状动脉介入治疗(PCI)术后患者的临床价值,进一步探索不同心脏康复模式对AMI患者预后的效果。方法选取2014年1月—2016年5月绍兴市人民医院接受PCI的AMI患者90例,采用随机数字表法分为3组,传统常规组(30例)、传统强化组(30例)和新型优化组(30例)。传统常规组根据2006年颁布的中国PCI术后心脏康复程序中急症PCI术后1周康复程序制定,以步行等简单的方式作为主要运动形式;传统强化组根据2006年颁布的中国PCI术后心脏康复程序中择期PCI术后康复程序制定,基础活动量和总活动量强于传统常规组;新型优化组在传统常规康复模式基础上,综合荷兰Avans大学、UMC St RAdboud医学院及香港伊利沙伯医院接受的最新心脏康复理念,为患者提供早期、个体化和精确定量的新型心脏康复方案。3组均为期6个月。各组患者分别于PCI术后即刻(康复前)和心脏康复干预6个月后(康复后)行心脏彩色多普勒检查,测量左心室射血分数(LVEF)、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)、室壁运动积分指数(WMSI)。测定血清中肿瘤坏死因子α(TNF-α)、一氧化氮(NO)、内皮素1(ET-1)、可溶性血管细胞黏附分子1(sVCAM-1)水平。观察患者心脏康复干预期间恶性心律失常、心绞痛、心力衰竭、猝死发生情况。结果康复前3组患者LVEF、LVESV、LVEDV、WMSI、TNF-α、NO、ET-1、sVCAM-1水平比较,差异均无统计学意义(P0.05)。康复后传统强化组WMSI低于传统常规组,新型优化组LVEF高于传统常规组和传统强化组、WMSI低于传统常规组和传统强化组(P0.05)。3组康复后LVEF较康复前升高(P0.05)。康复后传统强化组TNF-α、ET-1、sVCAM-1水平低于传统常规组,NO水平高于传统常规组;新型优化组TNF-α、ET-1、sVCAM-1水平低于传统常规组和传统强化组、NO水平高于传统常规组和传统强化组(P0.05)。3组康复后TNF-α、ET-1、sVCAM-1水平较康复前降低,NO水平较康复前升高(P0.05)。3组患者心脏康复干预期间恶性心律失常发生率比较,差异有统计学意义(P0.05);心绞痛、心力衰竭发生率比较,差异无统计学意义(P0.05)。3组患者均无猝死发生。结论早期心脏康复训练对AMI PCI术后患者的心功能及预后有明显改善,新型康复模式有效实现康复模式的个体化、人性化,最大限度地保护AMI患者的心功能,切实改善AMI患者的预后。
[Abstract]:Objective to determine the clinical value of early cardiac rehabilitation training in patients with acute myocardial infarction (AMI) after (PCI) after percutaneous coronary intervention (PCI), and to explore the effect of different cardiac rehabilitation models on the prognosis of AMI patients. Methods from January 2014 to May 2016, 90 AMI patients received PCI in Shaoxing people's Hospital were randomly divided into three groups: conventional group (30 cases), traditional reinforcement group (30 cases) and new optimization group (30 cases). The traditional routine group according to the Chinese PCI postoperative cardiac rehabilitation procedures issued in 2006 emergency PCI 1 week rehabilitation procedures, such as walking as the main form of exercise; The traditional reinforcement group was established according to the selective PCI rehabilitation procedure of the Chinese PCI postoperative cardiac rehabilitation procedure promulgated in 2006. The basic activity and total activity of the traditional group were higher than those of the traditional routine group, and the new optimized group was based on the traditional routine rehabilitation mode. To provide the patients with early, individualized and accurate quantitative new cardiac rehabilitation regimen for 6 months, the latest cardiac rehabilitation concept accepted by Avans St RAdboud School of Medicine and Queen Elizabeth Hospital in Hong Kong was synthesized. The patients in each group underwent echocardiography immediately after PCI (before rehabilitation) and 6 months after cardiac rehabilitation (after rehabilitation). Measurement of left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), wall motion integral index (WMSI). Serum levels of tumor necrosis factor 伪 (TNF- 伪), nitric oxide (NO), endothelin 1 (ET-1) and soluble vascular cell adhesion molecule 1 (sVCAM-1) were measured. To observe the incidence of malignant arrhythmia, angina pectoris, heart failure and sudden death during cardiac rehabilitation intervention. Results there was no significant difference in the levels of LVEF,LVESV,LVEDV,WMSI,TNF- 伪 noumenon ET-1 and sVCAM-1 between the three groups before rehabilitation (P0.05). After rehabilitation, the WMSI of the traditional enhancement group was lower than that of the traditional routine group, and the LVEF of the new optimized group was higher than that of the conventional group and the traditional reinforcement group (P0.05). The LVEF of the new optimized group was higher than that of the pre-rehabilitation group (P0.05). After rehabilitation, the level of TNF- 伪 -ET-1 and sVCAM-1 in the conventional enhancement group was lower than that in the conventional group, and the level of no in the conventional group was higher than that in the conventional group. The level of TNF- 伪 -ET-1 / sVCAM-1 in the new optimized group was lower than that in the conventional group and the traditional reinforcement group (P0.05). The level of TNF- 伪 -ET-1 / sVCAM-1 was higher than that of the pre-rehabilitation group (P0.05). The cardiac rehabilitation intervention of the patients in the group (P0.05) was higher than that in the pre-rehabilitation group (P0.05), and the level of TNF- 伪 -ET-1 / sVCAM-1 was lower than that in the pre-rehabilitation group (P0.05). A comparison of the incidence of malignant arrhythmias during the period, The difference was statistically significant (P0.05); the incidence of angina pectoris and heart failure had no statistical significance (P0.05). Conclusion early cardiac rehabilitation training can significantly improve the cardiac function and prognosis of patients after AMI PCI. The new rehabilitation model can effectively realize the individualization of rehabilitation mode, humanize, and protect the cardiac function of AMI patients to the maximum extent. To improve the prognosis of AMI patients.
【作者单位】： 浙江省绍兴市人民医院浙江大学绍兴医院;
【基金】：浙江省中医药科学研究基金项目(2014ZA113)
【分类号】：R542.22
[Abstract]:Objective to determine the clinical value of early cardiac rehabilitation training in patients with acute myocardial infarction (AMI) after (PCI) after percutaneous coronary intervention (PCI), and to explore the effect of different cardiac rehabilitation models on the prognosis of AMI patients. Methods from January 2014 to May 2016, 90 AMI patients received PCI in Shaoxing people's Hospital were randomly divided into three groups: conventional group (30 cases), traditional reinforcement group (30 cases) and new optimization group (30 cases). The traditional routine group according to the Chinese PCI postoperative cardiac rehabilitation procedures issued in 2006 emergency PCI 1 week rehabilitation procedures, such as walking as the main form of exercise; The traditional reinforcement group was established according to the selective PCI rehabilitation procedure of the Chinese PCI postoperative cardiac rehabilitation procedure promulgated in 2006. The basic activity and total activity of the traditional group were higher than those of the traditional routine group, and the new optimized group was based on the traditional routine rehabilitation mode. To provide the patients with early, individualized and accurate quantitative new cardiac rehabilitation regimen for 6 months, the latest cardiac rehabilitation concept accepted by Avans St RAdboud School of Medicine and Queen Elizabeth Hospital in Hong Kong was synthesized. The patients in each group underwent echocardiography immediately after PCI (before rehabilitation) and 6 months after cardiac rehabilitation (after rehabilitation). Measurement of left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), wall motion integral index (WMSI). Serum levels of tumor necrosis factor 伪 (TNF- 伪), nitric oxide (NO), endothelin 1 (ET-1) and soluble vascular cell adhesion molecule 1 (sVCAM-1) were measured. To observe the incidence of malignant arrhythmia, angina pectoris, heart failure and sudden death during cardiac rehabilitation intervention. Results there was no significant difference in the levels of LVEF,LVESV,LVEDV,WMSI,TNF- 伪 noumenon ET-1 and sVCAM-1 between the three groups before rehabilitation (P0.05). After rehabilitation, the WMSI of the traditional enhancement group was lower than that of the traditional routine group, and the LVEF of the new optimized group was higher than that of the conventional group and the traditional reinforcement group (P0.05). The LVEF of the new optimized group was higher than that of the pre-rehabilitation group (P0.05). After rehabilitation, the level of TNF- 伪 -ET-1 and sVCAM-1 in the conventional enhancement group was lower than that in the conventional group, and the level of no in the conventional group was higher than that in the conventional group. The level of TNF- 伪 -ET-1 / sVCAM-1 in the new optimized group was lower than that in the conventional group and the traditional reinforcement group (P0.05). The level of TNF- 伪 -ET-1 / sVCAM-1 was higher than that of the pre-rehabilitation group (P0.05). The cardiac rehabilitation intervention of the patients in the group (P0.05) was higher than that in the pre-rehabilitation group (P0.05), and the level of TNF- 伪 -ET-1 / sVCAM-1 was lower than that in the pre-rehabilitation group (P0.05). A comparison of the incidence of malignant arrhythmias during the period, The difference was statistically significant (P0.05); the incidence of angina pectoris and heart failure had no statistical significance (P0.05). Conclusion early cardiac rehabilitation training can significantly improve the cardiac function and prognosis of patients after AMI PCI. The new rehabilitation model can effectively realize the individualization of rehabilitation mode, humanize, and protect the cardiac function of AMI patients to the maximum extent. To improve the prognosis of AMI patients.
【作者单位】： 浙江省绍兴市人民医院浙江大学绍兴医院;
【基金】：浙江省中医药科学研究基金项目(2014ZA113)
【分类号】：R542.22
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