步行训练对老年慢性心力衰竭患者心脏功能康复的影响

目的:观察步行训练方式对老年慢性心力衰竭患者心功能康复的效果和安全性。方法:295例Ⅱ～Ⅲ级慢性心功能不全的老年患者随机被分为康复组(152例)和对照组(143例),康复组在药物治疗基础上进行步行训练,对照组只进行药物治疗。经过6个月的随访,对比两组治疗前、后的血压、静息心率、6min步行距离、心脏超声的左室射血分数(LVEF)和左室舒张末期内径(LVEDd)等的变化情况。结果:运动训练前不同组间一般情况、血压、静息心率、6min步行距离和左室功能无明显差异(P0.05);运动训练6个月后各组死亡情况没有差别;步行运动训练组总再次住院率(20.4%∶33.6%)和因心血管疾病再次住院率(11.8%∶22.8%)明显低于对照组(P均0.05);与运动训练前及对照组治疗后比较,康复组治疗后静息心率明显下降(72.1±15.7)次/min,(74.3±16.8)次/min∶(66.8±12.4)次/min],6min步行距离(284.9±104.7)m,(296.1±134.5)m∶(328.6±124.2)m]和LVEF(33.4±9.7)%,(30.4±9.6)%∶(35.9±10.9)%]均明显增加(P均0.01);血压和LVEDd无明显变化(P0.05)。结论:一定强度的步行训练对老年慢性充血性心力衰竭患者心脏功能的康复是安全和有效的。

Walking training improves heart function in aged patients with chronic heart failure

Objective： To evaluate the effects of walking training on aged patients with chronic heart failure （CHF）. Methods： A total of 295 aged patients with class Ⅱ～Ⅲ CHF were randomly divided into rehabilitative group （152 cases） and medical treatment control group （control group, 143 cases）. Patients in rehabilitative group received walking training on the basis of medical treatment, while those in control group received medical treatment alone. Resting heart rate, blood pressure, 6 min walking test and echocardiography tested for left ventricular ejection fraction （LVEF） and left ventricular end-diastolic dimension （LVEDd）7 were measured in all patients before and after exercise training. Af- ter 6 mSnths follow-up, the results of the two groups were compared and analyzed. Results： There was no significant difference between the two groups in general conditions, blood pressure, resting heart rate. 6 min walking distance and the function of left ventricle before exercise training （P〉0.05）. After 6 months, the overall rate of rehospitalization （20. 4% vs. 33.6%） and the rate of rehospitalization caused by cardiovascular events （11.8% vs. 22. 8%）, P〈0.05 all] in exercise training group were significantly lower than those of control group. Compared with the data before ex- ercise training and of control group after treatment, lower resting heart rate E （72.1± 15.7 ） times,/min, （ 74.3 ± 16.8） tlmes/min vs. （66.8±5.12.4） times/mini, increased 6 rain walking distance （284.9±104.7） m, （296.1±134.5） m vs. （328.6±124.2） m＇] and LVEF （33.4±9.7）%, （30.4±9.6）.% vs. （35.9±10.9）74, P〈0.01 all] were showed in rehabilitative group after exercise training. But no significant difference existed between the two groups in mortality, blood pressure and LVEDd after exercise training 6 months （P〉0.05）. Conclusion： Walking training of certain intensity can safely and effectively improve heart function of aged CHF patients.