不同康复训练次数对经皮冠状动脉介入治疗后患者心肺功能、生活质量的影响

摘要

目的 探讨康复训练及训练次数与经皮冠状动脉介入治疗术后心肺功能、生活质量之间的关系,明确康复训练的最大获益的训练次数.方法 入选 2017年11月至2018年10月于北京瑞华心脏康复中心康复训练的患者,均在心内科接受经皮腔内冠状动脉介入治疗(PCI)且心功能Ⅰ~Ⅱ级(NYHA分级),随机将患者分为三组,A组(n=20)康复训练12次,B组(n=20)康复训练24次,C组(n=20)康复训练36次.患者在运动前后行运动心肺试验、SF-36问卷调查,对照三组康复前后及不同训练次数组间的变化.结果 三组患者心肺功能在运动后均有提升,C组与康复前指标对比,VO2@peak(峰值摄氧量)、VO2@AT(无氧阈摄氧量)、WR@peak(峰值负荷)、O2/puls(氧脉博)、METs@peak(峰值代谢当量)值均有明显提高(P＜0.05),B组与康复前指标对比VO2@peak、WR@peak、METs@peak值均有明显提高(P＜0.05),A组康复训练前后差异并无统计学意义.组间对比运动康复后C组与A组对比,VO2@peak、VO2@AT、WR@peak、O2/puls、METs@peak值明显增高,差异有统计学意义(P＜0.05).C组在康复治疗后生活质量SF-36问卷大部分维度得分均有升高,特别是RP,RE得分明显增加,差异有统计学意义(P＜0.05),B组和A组康复治疗前后无明显变化.组间对比,运动康复后C组与A组、B组对比,RP、RE得分明显增高,差异显著(P＜0.05).结论 PCI术后患者心肺功能、生活质量均较前降低,心脏康复可明显提高其心肺功能、改善生活质量.康复训练次数与获益程度之间存在较强的"剂量-反应关系",建议心脏康复最佳次数不小于36次.%Objective To explore the relationship between the number of rehabilitation training and the cardiopulmonary function and quality of life of patients undergoing Percutaneous Coronary Intervention, and to determine the number of training for maximum benefit of rehabilitation training. Methods Sixty patients who received percutaneous coronary intervention (PCI) and cardiac function grades Ⅰ~Ⅱ (NYHA) were enrolled in Beijing GM Rehab clinic from November 2017 to October 2018. They were divided into three groups. Group A received 12 times rehabilitation training (n=20), group B rehabilitation training 24 times (n=20), group C rehabilitation training 36 times (n=20). Cardiopulmonary Exercise Test(CPET) and brief health status scale questionnaire SF-36 were conducted before and after exercise to compare the changes of three groups before and after rehabilitation and between different training groups. Results The cardiopulmonary function of the three groups was improved after exercise. Compared with the indexes before rehabilitation, the values of VO2@peak, VO2@AT, WR@peak, O2/pulse and METs@peak were significantly increased in group C (P<0.05). Compared with the indexes before rehabilitation, the values of VO2@peak, WR@peak and METs@peak in group B were significantly increased (P<0.05). There was no statistical difference between the A groups before and after rehabilitation training. Comparison between groups,after exercise rehabilitation,group C was compared with group A, the values of VO2@peak, VO2@AT, WR@peak, O2/pulse and METs@peak were significantly increased, the difference was significant (P<0.05). (2).The scores of most dimensions in group C increased after training, especially in RP and RE after rehabilitation treatment and the difference was statistically significant (P<0.05). There was no significant difference between group B and group A before and after rehabilitation treatment. Comparison groups A and group B,the scores of RP and RE of group C were significantly increased after exercise rehabilitation, and the difference was significant (P<0.05). Conclusion Cardiopulmonary function and quality of life of patients after PCI were all lower than before. Cardiac rehabilitation can significantly improve their cardiopulmonary function and quality of life. There is a strong dose-response relationship between the number of rehabilitation training and the degree of benefit. It is suggested that the optimal number of cardiac rehabilitation should not be less than 36 times.