运动康复对经皮冠状动脉介入术后急性冠状动脉综合征患者的效果

doi:10.3969/j.issn.1006-9771.2021.02.015

Abstract

Abstract: Objective

To analyze the effects of exercise-based cardiac rehabilitation (ER) on patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI), and to identify which type of ACS patients would benefit most in terms of cardiovascular functional capacity after ER.

Methods

From December, 2017 to July, 2019, 31 ACS patients who discharged in a stable situation after PCI were studied. All patients were referred to a three-month ER program after discharge. They were divided into normal wall motion group (normal group, n = 14) and abnormal regional wall motion group (abnormal group, n = 17) according to baseline myocardial wall motion reported by echocardiography. The degree of wall motion abnormalities was quantified by the wall motion score index (WMSI). Echocardiography and cardiopulmonary exercise testing (CPET) were performed before and after ER.

Results

Eight patients were dropped, and 23 patients completed the trial. WMSI decreased in the abnormal group (Z = -2.852, P = 0.004), and the left ventricular ejection fraction (LVEF) didn't change in both groups (P > 0.05) after ER. CPET showed that the heart rate at rest decreased in the normal group after ER (t = -2.268, P = 0.047); and the peak work rate, peak oxygen uptake, percentage of predicted value of peak oxygen uptake, peak minute ventilation and the third minute heart rate recovery increased in the abnormal group after ER (t > 2.739, P < 0.05).

Conclusion

ER during recovery period could help more improve the cardiac function and exercise tolerance of ACS patients with abnormal WMSI after PCI. WMSI is an important indicator of cardiac function in ACS patients with preserved ejection fraction.

Key words: acute coronary syndrome, cardiac rehabilitation, wall motion score index, cardiopulmonary exercise testing

CLC Number:

R541.4

Wei YUAN,Shan NIE,Nan JIA,Zhi-chang ZHENG,Hao-yan WANG. Effect of Exercise-based Cardiac Rehabilitation on Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(2): 208-215.

Figures/Tables 3

References 38

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项目	正常组 (n = 14)	异常组 (n = 17)	t/Z值	P值
性别(男/女，n)	9/5	17/0		0.012
年龄(岁)	61±8	53±12	2.177	0.038
体质量指数(kg/m²)	25.73±2.50	27.53±4.00	-1.456	0.156
目前吸烟者[n(%)]	2(14.3)	9(52.9)		0.057
吸烟量(包年)	0.75(0,9.63)	20(6,27)	-2.168	0.032
并发高血压[n(%)]	11(78.6)	11(64.7)		0.456
并发糖尿病[n(%)]	5(35.7)	6(35.3)		1.000
β受体阻滞剂[n(%)]	8(57.1)	12(70.6)		0.477

项目	正常组(n = 11)		异常组(n = 12)		t/Z 值^a	P值^a	t/Z值^b	P值^b	t/Z值^c	P值^c	t/Z值^d	P值^d
项目	康复前	康复后	康复前	康复后	t/Z 值^a	P值^a	t/Z值^b	P值^b	t/Z值^c	P值^c	t/Z值^d	P值^d
LVEF(%)	66.63±3.07	67.17±1.94	60.91±5.48	62.42±5.52	3.117	0.006	2.290	0.035	0.484	0.649	0.872	0.402
LVEDd (mm)	51.48±3.38	53.38±1.95	52.43±4.45	51.85±5.46	-0.573	0.572	0.906	0.380	1.680	0.123	-0.573	0.578
E/A	0.91±0.43	1.00±0.26	1.16±0.40	1.05±0.21	-1.456	0.160	-0.491	0.628	0.657	0.526	-1.187	0.260
WMSI	1.00(1.00,1.00)	1.00(1.00,1.00)	1.21(1.09,1.29)	1.03(1.00,1.14)	-4.307	<0.001	-2.631	0.044	0.000	1.000	-2.852	0.004

项目	正常组(n = 11)		异常组 (n = 12)		t值^a	P值^a	t值^b	P值^b	t值^c	P值^c	t值^d	P值^d
项目	康复前	康复后	康复前	康复后	t值^a	P值^a	t值^b	P值^b	t值^c	P值^c	t值^d	P值^d
最大运动负荷(W)	108±22	117±26	119±16	137±18	-1.327	0.201	-2.202	0.039	1.833	0.097	4.762	0.001
AT[ml/(min·kg)]	13.40±1.94	14.30±2.89	12.35±2.79	14.13±2.87	1.038	0.311	0.139	0.891	0.951	0.364	2.136	0.056
pVO₂(ml/min)	1468.73±310.04	1490.82±301.24	1604.83±198.31	1814.92±303.09	-1.266	0.220	-2.569	0.018	0.439	0.670	3.872	0.003
pVO₂[ml/(min·kg)]	20.32±3.65	20.58±3.47	19.50±2.50	22.37±3.79	0.639	0.530	-1.173	0.254	0.341	0.741	3.873	0.003
pVO₂pred(%)	78.37±11.32	79.27±9.11	66.00±10.13	77.25±13.06	2.766	0.012	1.069	0.297	0.310	0.763	3.793	0.003
pVE[ml/(min·kg)]	50.91±13.62	52.36±14.85	52.58±10.10	63.08±6.67	-0.042	0.967	-2.200	0.046	0.526	0.611	5.467	< 0.001
O₂pulse	11.97±2.30	12.51±2.61	12.99±1.92	13.68±2.24	-1.159	0.259	-1.160	0.259	1.690	0.122	1.713	0.115
静息心率(次/min)	73±9	66±5	71±8	68±9	0.502	0.621	-0.910	0.375	-2.268	0.047	-1.093	0.298
HRR3(次/min)	31±9	33±10	33±6	44±13	-0.650	0.523	-2.223	0.038	0.787	0.449	2.739	0.019

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Effect of Exercise-based Cardiac Rehabilitation on Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention

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