太极拳对老年心肌梗死后心力衰竭患者心脏功能的效果

doi:10.3969/j.issn.1006-9771.2020.08.018

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (8): 969-974.doi: 10.3969/j.issn.1006-9771.2020.08.018

太极拳对老年心肌梗死后心力衰竭患者心脏功能的效果

于曼丽¹,姜衡²(),李彬³,柴丽莉⁴,沈慧⁵,施峰⁵,谢东峰⁵,林兴中⁵

1.海军军医大学长海医院心内科,上海市 200433
2.上海交通大学附属第一人民医院松江分院心内科,上海市 201600
3.上海市松江区九亭镇社区卫生服务中心,上海市 201615
4.上海市第五康复医院,上海市 201699
5.上海市松江区石湖荡镇社区卫生服务中心,上海市 201600

收稿日期:2019-12-27 修回日期:2020-03-12 出版日期:2020-08-25 发布日期:2020-08-31
通讯作者: 姜衡 E-mail:jianghengyangzhou@126.com
作者简介:于曼丽(1985-),女,汉族,江苏滨海县人,博士,主治医师,主要研究方向：冠心病治疗及心脏康复。
基金资助:
1.上海市自然科学基金项目(No. 19ZR1455700)(19ZR1455700);2.上海市松江区科技计划资助项目(2017SJKJGG52);3.上海市卫生和计划生育委员会基金项目(201640244);4.上海市中西医结合学会社区医学与健康管理课题研究专向基金项目(2016SH31)

Application of Tai Ji Quan Exercise in Heart Rehabilitation for Elderly Patients with Heart Failure after Myocardial Infarction

YU Man-li¹,JIANG Heng²(),LI Bin³,CHAI Li-li⁴,SHEN Hui⁵,SHI Feng⁵,XIE Dong-feng⁵,LIN Xing-zhong⁵

1. Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
2. Department of Cardiology, Songjiang Branch of Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai 201600, China
3. Jiuting Town Community Health Service Center, Shanghai 201615, China
4. Fifth Rehabilitation Hospital, Shanghai 201699, China
5. Shihudang Town Community Health Service Center, Shanghai 201600, China

Received:2019-12-27 Revised:2020-03-12 Published:2020-08-25 Online:2020-08-31
Contact: JIANG Heng E-mail:jianghengyangzhou@126.com
Supported by:
Natural Science Foundation of Shanghai(19ZR1455700);Science and Technology Research Project of Shanghai Songjiang District(2017SJKJGG52);Shanghai Municipal Commission of Health and Family Planning(201640244);Community Medicine and Health Management of Shanghai Association of Integrated Traditional Chinese and Western Medicine(2016SH31)

摘要/Abstract

摘要：

目的评估太极拳在老年心肌梗死后心力衰竭患者心脏康复中的临床应用价值。方法 2017年1月至2019年6月,将200例老年心肌梗死后心力衰竭患者分为对照组(n = 100)和试验组(n = 100),对照组给予常规药物治疗,试验组在对照组的基础上增加太极拳运动。比较两组治疗24周后心功能分级、血浆脑钠肽(BNP)、醛固酮(ALD)水平,6分钟步行距离(6MWD),左室射血分数(LVEF),明尼苏达心力衰竭生活质量量表评分以及再入院率和死亡率。结果治疗后,试验组心功能变化有效者多于对照组(χ ² = 5.143, P < 0.05),无效者少于对照组( χ ² =5.924, P < 0.05);两组血浆BNP和ALD、6MWD、LVEF和生活质量评分显著改善(| t| > 9.883, P < 0.001),试验组均显著优于对照组(| t| > 4.023, P < 0.001)。试验组死亡率和再住院率均低于对照组,但无显著性差异( P > 0.05)。结论太极拳能够提高老年心肌梗死后心力衰竭患者的心功能、运动耐力和生活质量。

关键词: 心肌梗死, 心脏康复, 太极拳, 生活质量

Abstract:

Objective To explore the effect of Tai Ji Quan in the progress of rehabilitation training for elderly patients with heart failure after myocardial infarction.Methods From January, 2017 to June, 2019, a total of 200 elderly patients with heart failure after myocardial infarction were divided into control group (n = 100) and experimental group (n = 100). The control group received routine medicine, and the experimental group received Tai Ji Quan exercise in addition. After 24-week treatment, their cardiac functional grading, plasma levels of brain natriuretic peptide (BNP) and aldosterone (ALD), six minutes walking distance (6MWD), left ventricular ejection fractions (LVEF), quality of life, and readmission rate and mortality rate were compared. Results After treatment, the cardiac function was better in the experimental group than in the control group (χ ² > 5.143, P < 0.05); the plasma levels of BNP and ALD, 6MWD, LVEF and quality of life significantly improved (| t| > 9.883, P < 0.001), and were better in the experimental group than in the control group (| t| > 4.023, P < 0.001). The readmission rate and mortality rate were lower in the experimental group than in the control group, but no significant difference was found ( P > 0.05). Conclusion Tai Ji Quan exercise could improve the cardiac function, exercise tolerance and quality of life of the elderly patients with heart failure after myocardial infarction.

Key words: myocardial infarction, cardiac rehabilitation, Tai Ji Quan, quality of life

中图分类号:

R541.6

于曼丽,姜衡,李彬,柴丽莉,沈慧,施峰,谢东峰,林兴中. 太极拳对老年心肌梗死后心力衰竭患者心脏功能的效果[J]. 《中国康复理论与实践》, 2020, 26(8): 969-974.

YU Man-li,JIANG Heng,LI Bin,CHAI Li-li,SHEN Hui,SHI Feng,XIE Dong-feng,LIN Xing-zhong. Application of Tai Ji Quan Exercise in Heart Rehabilitation for Elderly Patients with Heart Failure after Myocardial Infarction[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(8): 969-974.

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参考文献 21

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项目	对照组(n = 100)	试验组 (n = 100)	χ²/t值	P值
年龄(岁)	68.3±6.4	67.7±5.8	0.799	0.425
性别(男/女,n)	54/46	52/48	0.080	0.777
受教育水平(大专以上/大专以下,n)	32/68	29/71	0.212	0.645
体质量指数(kg/m²)	25.7±2.6	25.5±2.7	0.560	0.576
心功能NYHA分级(Ⅱ/Ⅲ,n)	42/58	45/55	0.183	0.669
LVEF(%)	46.5±4.5	46.4±3.2	0.199	0.843

组别	治疗前		治疗后		t值	P值
组别	n	BNP	n	BNP	t值	P值
对照组	100	460.3±36.8	94	312.7±34.5	30.144	< 0.001
试验组	100	462.7±35.8	97	259.3±10.6	71.440	< 0.001
t值		-0.467		14.349
P值		0.641		< 0.001

组别	治疗前		治疗后		t值	P值
组别	n	ALD	n	ALD	t值	P值
对照组	100	154.8±10.5	94	115.5±12.5	29.603	< 0.001
试验组	100	154.9±11.4	97	80.7±10.4	49.620	< 0.001
t值		-0.039		21.051
P值		0.969		< 0.001

组别	治疗前		治疗后		t值	P值
组别	n	6MWD	n	6MWD	t值	P值
对照组	100	184.2±36.6	94	286.7±34.9	-42.675	< 0.001
试验组	100	182.7±39.3	97	350.9±41.0	-40.353	< 0.001
t值		0.293		-11.462
P值		0.770		< 0.001

组别	治疗前		治疗后		t值	P值
组别	n	LVEF	n	LVEF	t值	P值
对照组	100	46.5±4.5	94	50.6±5.4	-9.883	< 0.001
试验组	100	46.4±3.2	97	54.2±6.7	-12.185	< 0.001
t值		0.199		-4.023
P值		0.843		< 0.001

太极拳对老年心肌梗死后心力衰竭患者心脏功能的效果

Application of Tai Ji Quan Exercise in Heart Rehabilitation for Elderly Patients with Heart Failure after Myocardial Infarction

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组别	n	显效	有效	无效	恶化
对照组	94	2	52	32	8
试验组	97	8	69	18	2
χ²值		2.476	5.143	5.924	2.807
P值		0.116	0.023	0.015	0.094

组别	治疗前		治疗后		t值	P值
组别	n	评分	n	评分	t值	P值
对照组	100	80.6±10.4	94	68.5±12.5	10.547	< 0.001
试验组	100	80.5±9.5	97	54.8±10.3	18.951	< 0.001
t值		0.078		8.287
P值		0.938		< 0.001

组别	n	死亡	再住院
对照组	100	6(6)	21(21)
试验组	100	3(3)	11(11)
χ²值		0.465	3.720
P值		0.495	0.054

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