运动训练对女性急性心肌梗死患者经皮冠状动脉介入治疗后预后的影响

摘要

目的 探讨运动训练对女性急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后预后的影响.方法 选取2014年12月—2015年12月在成都医学院第一附属医院心内科住院的女性AMI患者92例,根据患者意愿分为对照组41例和观察组51例.两组患者均行急诊PCI,并按照冠心病二级预防要求进行健康教育、饮食指导等,观察组患者在此基础上进行运动训练.比较两组患者出院后1、3、6个月主要心血管不良事件(MACEs)发生情况,出院时及出院后1、3、6个月6分钟步行距离、左心室射血分数(LVEF)、B型脑钠肽(BNP)、中国心血管病人生活质量评定问卷(CQQC)评分.结果 出院后1个月两组患者全因死亡率、心肌梗死再发率、血运重建发生率、脑梗死发生率比较,差异无统计学意义(P>0.05);出院后3、6个月两组患者全因死亡率和脑梗死发生率比较,差异无统计学意义(P>0.05),但观察组患者心肌梗死再发率和血运重建发生率低于对照组(P<0.05).出院时和出院后1个月两组患者6分钟步行距离、LVEF及BNP比较,差异无统计学意义(P>0.05);出院后3、6个月两组患者BNP比较,差异无统计学意义(P>0.05),但观察组患者6分钟步行距离长于对照组、LVEF高于对照组(P<0.05).出院时两组患者体力状况、病情、医疗状况、一般生活、社会心理状况、工作状况评分比较,差异无统计学意义(P>0.05);出院后1个月两组患者体力状况、工作状况评分比较,差异无统计学意义(P>0.05),但观察组患者病情、医疗状况、一般生活、社会心理状况评分高于对照组(P<0.05);出院后3、6个月观察组患者体力状况、病情、医疗状况、一般生活、社会心理状况、工作状况评分均高于对照组(P<0.05).结论 运动训练能有效降低女性AMI患者PCI后心肌梗死再发率和血运重建发生率,提高患者运动耐量,改善患者心功能及生活质量.%Objective To investigate the impact of exercise training on prognosis in female postoperative acute myocardial infarction(AMI)patients treated by PCI. Methods From December 2014 to December 2015,a total of 92 female inpatients with AMI were selected in the Department Cardiology,the First Affiliated Hospital of Chengdu Medical College,and they were divided into control group(n=41)and observation group(n=51)according to the patients′wishes.Patients in the two groups received emergency PCI,health education and diet guidance according to secondary prevention requirement of coronary heart disease,meanwhile patients in observation group received extra exercise training.Incidence of MACEs 1 month,3 months and 6 months after discharge,6 -minute walking distance,LVEF,BNP and CQQC score at discharge,1 month,3 months and 6 months after discharge were compared between the two groups. Results No statistically significant differences of all-cause mortality,recurrent rate of myocardial infarction,incidence of revascularization or cerebral infarction was found between the two groups 1 month after discharge,nor was all-cause mortality or incidence of cerebral infarction 3 months or 6 months after discharge(P>0.05),while recurrent rate of myocardial infarction and incidence of revascularization in observation group were statistically significantly lower than those in control group 3 months and 6 months after discharge(P<0.05). No statistically significant differences of 6-minute walking distance,LVEF or BNP was found between the two groups at discharge or 1 month after discharge(P>0.05),nor was BNP 3 months or 6 months after discharge(P>0.05);3 months and 6 months after discharge,6-minute walking distance in observation group was statistically significantly longer than that in control group, respectively,meanwhile LVEF in observation group was statistically significantly higher than that in control group,respectively (P<0.05). No statistically significant differences of performance status score,illness state score,medical service condition score,general life score,socio -psychological status score or working condition score was found between the two groups at admission,nor was performance status score or working condition score 1 month after discharge(P>0.05),while illness state score,medical service condition score,general life score and socio - psychological status score in observation group were statistically significantly higher than those in control group 1 month after discharge(P <0.05);performance status score, illness state score,medical service condition score,general life score,socio-psychological status score and working condition score in observation group were statistically significantly higher than those in control group 3 months and 6 months after discharge (P < 0.05). Conclusion Exercise training can effectively reduce the recurrence of myocardial infarction and risk of revascularization,improve the exercise tolerance,cardiac function and quality of life in female postoperative AMI patients treated by PCI.