急性心肌梗死康复治疗的研究

目的:探讨康复治疗对急性心肌梗死（AMI）患者运动贮量,生活、工作能力的影响。方法:对13例AMI患者进行住院期（第一期）和院外恢复期（第二期）的康复治疗,时间3个月;与只做传统治疗的12例对照组患者进行第二期的生活、工作峰值耗氧量（代表运动贮量）,运动试验参数做对比。结果:（1）康复组13例患者康复治疗前活动平板运动试验阳性4例,康复治疗后阳性减少2例;运动时间康复前为587±257秒,康复后增至1027±308秒,有显著差异（P<0.001）,康复后心率、收缩压恢复时间较康复前明显缩短（P<0.05）;（2）康复组第二期的生活、工作峰值耗氧量（METs）较对照组显著增加（P<0.05）.结论:康复治疗可改善AMI患者的生活质量,增强其工作能力,收到重大的社会、经济效益。     

老年急性心肌梗死早期康复的临床观察

目的：探索老年急性心肌梗死（ＡＭＩ）早期康复治疗的安全、有效、可行性。方法：根据个体化及活动量循序渐进的原则,对２０例老年ＡＭＩ无并发症患开展８～１４日程序康复治疗。结果：２０例老年ＡＭＩ患早期康复治疗未发生一例并发症,出院３个月随访的５０％患ＬＶＥＦ≥５０％,另５０％患ＬＶＥＦ达４５％左右,未发生再梗,可生活自理。２０例患随访一年均健在。结论：ＡＭＩ早期康复活动是安全、有效、可行的。     

融合心脏康复治疗对心肌梗死患者心肺运动功能和心理状态的影响

目的探讨机构心脏康复联合居家康复的融合心脏康复模式对心肌梗死患者心肺功能和心理状态的影响。方法纳入2017年7月至2018年3月转诊至解放军总医院第一医学中心心血管内科心脏康复中心治疗的3个月内曾患急性心肌梗死的患者84例。分为治疗组和对照组,每组42例。对照组患者于入组时进行1次健康宣教。治疗组患者采用融合心脏康复治疗:2次/周门诊运动治疗,持续18周,每次运动治疗结束后由医护人员进行15 min健康宣教,并指导患者居家运动训练计划;18周后转入完全居家康复程序,继续治疗6周。对比2组患者治疗前后的体质量指数、腰臀比、心肺运动试验指标、广泛性焦虑量表(GAD-7)及患者健康问卷(PHQ-9)评分等指标。采用SPSS 19.0软件进行数据处理。依据数据类型,组间比较分别采用t检验或χ~2检验。结果组内比较:与治疗前相比,治疗后治疗组患者的腰臀比[(0.91±0.64)和(0.93±0.51)]、GAD-7评分[(2.60±3.02)和(4.69±4.61)]、PHQ-9评分[(4.14±2.54)和(6.26±3.51)]、二氧化碳通气当量斜率(VE/VCO_2 slope)[(23.46±5.09)和(25.31±4.00)]均显著降低(P0.05),而峰值千克摄氧量(Peak VO_2/kg)[(23.43±5.88)和(20.70±4.13)ml/(min·kg)]、最大代谢当量(MET_(max))[(6.62±1.68)和(5.92±1.18)]、氧脉搏[(13.25±4.06)和(11.78±3.48)ml/beat]均显著升高(P0.05)。组间比较:与对照组相比,治疗组患者治疗后的Peak VO_2/kg[(23.43±5.88)和(19.48±4.47)ml/(min·kg)]、MET_(max)[(6.62±1.68)和(5.66±1.25)]、氧脉搏[(13.25±4.06)和(11.76±0.70)ml/beat]均显著升高(P0.05),而腰臀比[(0.91±0.64)和(0.94±0.44)]显著降低(P0.05)。结论融合心脏康复治疗可以提高心肌梗死患者的心肺运动功能,改善焦虑抑郁等精神障碍,值得临床推广。     

Various aspects of rehabilitation of patients with myocardial infarct at the hospital stage

The paper presents the results of accelerated physical rehabilitation in 1449 patients with large-focal myocardial infarction. Gradual expansion of movement regimen was based on a programme comprising 7 hospital stages for three clinical groups of patients; those with mild (I), medium (II) and severe (III) course of the disease. Rehabilitation procedures were to take up 35-40 days in Group I, 40-45 days in Group II, and 50 and more days in Group III. The control group was composed of 220 patients on conventional treatment with prolonged bed rest. Accelerated rehabilitation was successful in 78.2% of the patients from Group I and II. The study-group patients showed reduced incidence of recurrent acute coronary insufficiency, relapses of myocardial infarction, thromboembolism, late cardiorrhexis, as compared to the controls. The duration of hospital stay was reduced by 23.1 days. Mortality (after 3-5 days of acute condition) dropped from 8.9% to 5.2%. Exercise tolerance was three times as great, as compared to that of the controls.     

42例急性心肌梗死住院期综合康复医疗临床观察

目的：探讨急性心肌梗死早期综合康复医疗的可行性。安全性及临床效果。方法：对４２例初发急性心肌梗死（ＡＭＩ）患采取递增体力活动为主。辅以宣教、咨询的２周康复医疗,并与同期收住的３０例急性心肌梗死非康复医疗主国对照组。结果：康复组不增加并发症发生率（Ｐ〉０．０５）,且能明显缩短住院时间,改善功能贮量,改善精神、心理状态,改善生活质量。结论：通过严格筛选、密切监测,对无或有轻度并发症的ＡＭＩ患住院期     

康复疗养对老年陈旧性心肌梗塞患者P波离散度的影响

目的：探讨康复疗养对老年陈旧性心肌梗塞（OMI）患者P波离散度（Pd）的影响。方法：利用常规心电图观察并分析两组（常规疗养组、海水浴体疗组）各30例OMI患者，疗养1个月前、后的Pmax（P波最长时值）、Pd变化。结果：（1）同组疗养前＼后比较，两组Pmax、Pd均呈非常显著性差异（P〈0．01）；（2）两组间对比，疗养前Pmax、Pd无显著性差异（P〉0．05）、疗养后Pmax呈显著性差异（P〈0．05），Pd呈非常显著性差异（P〈0．01）。结论：（1）康复疗养能不同程度地缩短OMI者的P波离散度，有利患者心房电生理稳定；（2）海水浴体疗方法对Pd的改善优于常规疗养方法。     

Effect of complications in the acute period of myocardial infarction on physical exertion tolerance at the hospital stage of rehabilitation

Physical stress tolerance and its hemodynamic support were examined in 95 patients with early myocardial infarction, 50 normal subjects and 25 coronary patients. It is suggested that the stress tolerance test is advisable at an early stage of complicated macrofocal myocardial infarction. The safety of the test improves considerably where it is performed under continuous electrocardiographic and chest-rheographic control. An abnormal diastolic impedance wave, emerging during exercise, may serve an additional diagnostic indicator of stress intolerance.     

康复运动治疗对急性心肌梗死患者左心功能的影响

目的:探讨康复运动对急性心肌梗死伴左心衰竭患者左心功能的改善作用。方法:35例急性心肌梗死合并左心功能不全患者(LVEF 36.45±5.67)在病情平稳后进行四周康复运动治疗,康复运动前、后分别进行心脏功能评定,并于出院前进行平板运动试验。结果:所有患者均完成了住院期间康复治疗,无严重心律失常、再次心肌梗死、心功能恶化等严重心脏病事件发生。左室收缩功能:LVEF,每搏量,心搏出量,均有明显增加,P<0.01。26例完成平板运动试验,运动贮量为5.56±1.23METs。结论:康复运动治疗能明显改善急性心肌梗死患者的左心功能及生活质量,促进社会与职业的回归。     

急性心肌梗塞患者早期康复运动的疗效及对预后影响

目的：探讨急性心肌梗塞(AMI)患者早期康复运动的疗效及对预后的影响。方法：80例 AMI 患者,按自愿原则分成两组：康复组：进行常规药物治疗,并实行早期严格合理的运动疗法；对照组：绝对卧床,只进行常规药物治疗,不进行康复训练。采用 Barthel 指数评定患者的日常生活能力,并对比两组的平均住院天数,住院期间的费用,心律失常的发生率、生活自理能力,以及两年后 AMI 的再发率。结果：与对照组比较,康复组平均住院天数、费用显著减少,日常生活活动能力、生活自理能力显著增强,两年后 AMI 的再发率显著减少(P 均＜0.05)；心律失常两组无显著差异(P＞0.05)。结论：急性心肌梗塞患者早期康复训练有利于提高日常生活能力,减少平均住院天数、费用,降低再发率,改善预后。     

两周运动康复疗法对急性心肌梗塞的疗效观察

目的：探讨两周康复疗法对急性心肌梗塞的疗效。方法：比较１７例接受康复治疗的急性心肌梗塞患和对照组２０例患的临床疗效。结果：康复组１７例病人顺利完成两周康复治疗。门诊随访１～６个月,１例发生心衰,１例出现心绞痛,无再次心肌梗塞和死亡,生活基本自理．对照组２例发生心衰,２例发生心绞痛,再梗塞１例,心脏性猝死１例。结论：两周康复治疗可以促进急性心肌梗塞的康复,改善病人的预后。     

Effect of intensive physical training on the hospital stage of the rehabilitation of patients with macrofocal myocardial infarct

Thirty-five patients with large-focal myocardial infarction were divided into the main (21) and the control (14) groups. The main-group patients were subjected to intensive exercise beginning with day 10-22 of the disease; its program was designed so as to match the data of bicycle ergometry checkups and included bicycle-ergometric riding and rationed walking. It was demonstrated that the main group patients showed better physical stress tolerance, improved myocardial functional potentials, better psychological outlook and smaller pulmonary venous congestion at the time of transfer to the sanatorium stage of rehabilitation. It is suggested that exercise be incorporated in the hospital rehabilitation complex for patients with large-focal myocardial infarction.     

急性心肌梗塞溶栓治疗中血小板活化状态的动态改变

血小板表面CMP－140是反映血小板活化的特异性指标。应用活化依赖性单克隆抗体测定27例急性心肌梗塞（AMI）患者联合溶栓、常规治疗中血小板表面GMP－140、血浆内GMP-140，以及血浆血栓素B2、6-酮-前列腺素F1α的改变。观察到以上指标在AMI早期增高，说明血小板处于高活化状态。在AMI不同治疗中以上指标呈不同的动态变化。溶栓再通患者的血小板表面GMP－140比未再通的患者较早恢复正常。结果提示血小板表面GMP－140与血栓形成及溶解有关，是判定溶栓效果的一项重要指标。在AMI患者溶栓同时联合应用特异性高、效力强的抗血小板药物将对溶栓治疗产生促进作用。     

Efficacy of early reperfusion therapy at the acute stage of myocardial infarction in elderly patients: the USIK database

The role of early reperfusion therapy at the acute stage of myocardial infarctus in elderly patients is debated. The aim of this study was to analyze the prognostic role of reperfusion with i.v. thrombolysis or primary PTCA in the nationwide USIK database, which prospectively included all pts admitted to a CCU for an AMI < 48 hours in France in November 1998. For the purpose of the present study, only patients admitted within 24 hours of AMI and with one-year follow-up available were included. Of the 1838 patients included, 785 were > 70 years-old, of whom 225 (29%) had early reperfusion therapy with thrombolysis (N = 173) or primary PTCA (N = 52). Patients treated with early reperfusion had a baseline profile that differed substantially from that of patients treated conventionally: women (31% vs 50%, p < 0.001), admission within six hours of symptom onset (84% vs 55%, p < 0.001), history of systemic hypertension (48% vs 60%, p < 0.002), stroke (5% vs 11%, p < 0.01), peripheral arterial disease (8% vs 18%, p < 0.001); congestive heart failure (5% vs 20%, p < 0.001) or previous MI (12% vs 25%, p < 0.001), more anterior location of current MI (40% vs 28%, p < 0.002). Overall one-year Kaplan-Meier survival was 78% for patients with versus 64% for those without reperfusion therapy (p < 0.01). In patients with Q wave myocardial infarction, Cox multivariate analysis showed that reperfusion therapy was an independent predictor of survival (RR 0.66; 95% Confidence Interval: 0.45-0.96), along with age, anterior location and history of congestive heart failure. Therefore, data from this large "real life" registry indicate that reperfusion therapy with either thrombolysis or primary PTCA is associated with improved one-year survival in patients over 70 years of age.     

康复运动有助于心肌梗塞患者的恢复

目的:探讨早期康复运动对急性心肌梗塞患者的疗效。方法:将2002年8月到2004年10月在我院循环内科住院并符合入选标准的80例急性心肌梗塞患者,按自愿原则,分成两组,治疗组早期进行常规药物治疗,并早期实行严格合理的运动疗法,对照组绝对卧床,只进行常规药物治疗,不进行康复训练。采用Barthel指数评定患者的日常生活能力,并对比两组的平均住院天数,住院期间的平均花费,心律失常的发生率及生活自理能力,两组患者两年后心肌梗塞的再发率。结果:治疗组平均住院天数、平均花费较对照组减少(P<0.05),日常生活能力较对照组有显著改善(P<0.05),心律失常的发生率两组之间无显著性差异,治疗组的生活自理能力优于对照组(P<0.05)。两年后,治疗组心肌梗塞的再发率均低于对照组(P<0.05)。结论:康复运动有助于心肌梗塞患者的恢复。     

急性心肌梗死介入治疗术后的康复运动疗法研究进展

急性心肌梗死(acute myocardial infarction,AMI)是临床上常见的急危重症,发病率呈现逐年升高的趋势,死亡率均随年龄的增加而增加。经皮腔内冠状动脉介入治疗（percutaneous coronary intervention PCI）术成为AMI的重要治疗手段。但PCI没有改变动脉粥样硬化的进程,且支架本身还存在再狭窄和支架内血栓等并发症,因此,冠心病的康复治疗也从传统的心肌梗死后的康复发展到AMI介入性治疗后的康复。本文就AMI介入治疗术后的康复运动疗法及现状作简要综述。