综合康复治疗对冠心病患者症状及运动能力改善的研究

目的：了解康复治疗对冠心病患者临床症状、心功能及运动能力的影响。方法：42例门诊冠心病者被随机分为康复组（21例,运动康复＋药物治疗）、常规治疗组（21例,单纯药物治疗）。康复程序采用个体化原则,患者进行6个月的康复治疗,主要以运动疗法为主,兼以药物、心理治疗及康复咨询。结果：与治疗前比较,治疗后两组心绞痛发作频率有明显下降,硝酸甘油用量有明显减少,康复组疗效明显优于常规治疗组[心绞痛发作频率（0．9±0．5）次／周比（3．2±1．0）次／周,硝酸甘油用量：（1．2±0．5）片／周比（3．6±1．0）片／周,P〈0．05];与治疗前比较,治疗后康复组运动能力明显增加[（3．1±1．5）METs比（4．0±1．6）METs],心功能分级明显改善[（2．5±0．6）级比（1．9±0．5）级,P均〈0．05],常规治疗组治疗前后无明显差异（P〉0．05）。结论：康复治疗可以改善冠心病患者的心功能、运动能力、临床症状。     

老年急性心肌梗塞早期运动康复的疗效分析

目的 :观察 13例老年急性心肌梗塞 (AMI)患者早期运动康复的疗效。方法 :将 13例老年 AMI分为低危、中危、高危组 ,分别完成 2、 3、 4周康复程序 ,其中 9例患者出院前进行活动平板运动试验。结果 :12例患者如期完成康复程序 ,生活质量及心率变异性明显改善 ,出院前生活均能自理 ,其中 9例运动试验测定的 METS达 5 .17±0 .71。结论 :老年 AMI患者病情平稳后 ,在密切监测、正确药物治疗下进行早期运动康复是可行、安全的 ,可改善患者的预后     

10例急性心肌梗塞患者运动康复疗效观察

目的 :观察 10例急性心肌塞 (AMI)患者早期运动康复疗效。方法 :10例 AMI患者在药物治疗同时进行 4周运动康复程序 ,并与 10例仅以药物治疗的 AMI患者 (对照组 )进行比较。结果 :4周后 AMI患者康复组与对照组在高密度脂蛋白胆固醇 (HDL- C)、甘油三脂 (TG)、QT离散度(QTd)运动代谢当量 (METs)、心理状态等方面存在显著差异。结论 :无严重并发症的 AMI病人 ,在医务人员监护、指导下循序渐进地进行运动康复可以升高 HDL- C,降低 TG和 QTd,增加 METs,改善病人心理状态 ,促进 AMI康复     

急性心肌梗死患者实施早期运动康复的疗效

目的：探讨急性心肌梗死（AMI）早期运动康复的效果。方法：选择64例生命体征稳定的AMI患者,随机分为早期运动康复组和常规康复组,每组32例。早期运动康复组在发病24h后由床旁康复师给予早期运动康复指导,常规康复组由同水平资质康复师在其绝对卧床1周后给予其运动康复指导。此外两组接受的其他治疗及护理完全相同。观察并统计两组患者的主要不良心血管事件（MACE）（再梗死、死亡、严重心律失常、梗死后心绞痛、心力衰竭）情况、住院天数和生活自理能力情况,并进行比较分析。结果：出院前早期康复组和常规康复组的并发症发生率（40．63％比43．75％）和生活可自理的患者比例（100％比96．88％）无显著差异（P〉0．05）,但早期康复组患者的住院天数明显短于常规康复组[（9．23±1．45）d比（15．03±2．53）d,P〈0．01]。结论：早期运动康复训练对于生命体征稳定的急性心肌梗死患者能缩短患者的住院天数,而且是安全的。     

老年急性心肌梗死早期运动康复的疗效分析

目的观察13例老年急性心肌梗死(AMI)患者早期运动康复的疗效.方法将13例老年AMI患者分为低危、中危、高危组,分别完成2、3、4周康复程序,其中9例患者出院前进行活动平板运动试验.结果12例患者如期完成康复程序,生活质量及心率变异性明显改善,出院前生活均能自理,其中9例运动试验测定的METS达5.17±0.71.结论老年AMI患者病情平稳后,在密切监测、正确药物治疗下进行早期运动康复是可行、安全的,可改善患者的预后.     

早期运动康复训练对老年急性心肌梗死患者生活质量的影响

目的 观察老年急性心肌梗死(acute myocardial infarction,AMI)患者早期运动康复训练的疗效及对其生活质量的影响.方法 将188例老年AMI患者随机分为康复组(94例)和常规组(94例),常规组行传统治疗,康复组在常规治疗的基础上进行康复训练,记录其常规活动指标、心率变异性,活动前、后测血压,心率及心电图,患者生活质量改善情况.结果 康复组和常规组在活动前、后心率、血压、心电图的比较上无明显差异(P>0.05);患者生活质量状况改善情况的比较上,康复组在战胜疾病有信心例数、对疾病有了解例数、对危险因素有了解例数上均较常规组高;胸闷、心悸例数,失眠、焦虑例数,食欲不振例数上均较常规组低,差异具有统计学意义(P<0.05或P<0.01).康复组SDNN、SDNNI、SDANN均较常规组高,差异具有统计学意义(P<0.05或P<0.01).结论 对AMI患者进行早期运动康复训练可以明显提高其运动贮量,改善左室、自主神经调节及心率变异性,降低AMI猝死率及病死率,且无明显不良反应,提高生活质量,减少家庭负担,值得临床推广.     

运动康复改善慢性心力衰竭患者心功能、运动耐量和生活质量的研究

210例慢性心力衰竭(CHF)患者,随机分为康复组116例和对照组94例,康复组给予常规药物治疗加康复运动训练指导,对照组按常规药物治疗.6个月后观察两组心功能、运动耐量的改变,并对其生活质量进行评定.发现康复组心功能和生活质量明显提高,左室射血分数、E/A比值、6 min步行距离均明显增加.认为运动康复可以改善CHF患者的心功能,提高患者的运动耐量和生活质量.     

溶栓治疗对急性心肌梗死患者运动耐量的影响

目的 :探讨溶栓治疗对急性心肌梗死 (AMI)患者急性期和远期运动耐量的影响。方法 :将 143例 AMI患者分为溶栓再通组 (35例 )、未通组 (2 3例 )和非溶栓组 (85例 ) ,比较三组急性期和远期运动耐量。结果 :急性期 ,再通组的运动量、运动时间、最大心率、心率血压乘积均明显高于未通组和非溶栓组 (P<0 .0 5 ) ,运动诱发的心绞痛或血压下降≥ 10 m m Hg(1m m Hg=0 .133k Pa)的比率明显低于后两者 (P <0 .0 5 )。远期随访 ,三组的运动量、最大心率、运动时间、心率血压乘积及运动诱发心绞痛或血压下降的比率均无显著性差异 (P >0 .0 5 )。结论 :溶栓再通能显著提高 AMI患者急性期运动耐量 ,但对远期运动耐量改善不明显     

康复运动对心肌梗死急性期及恢复期患者心功能的影响

目的 :观察对急性心肌梗死 (AMI)急性期和恢复期患者进行康复治疗的效果。方法 :对 16例 AMI患者进行半年个体化的康复治疗 ,并于发病半年后进行心脏功能评定 ,其中 8例患者还于发病 1个月后进行了心脏功能评定。结果 :8例患者心脏功能由发病 1个月时的 4.98± 0 .6 6 METs提高到发病半年时的 8.2 0± 2 .33METs,峰值心率血压乘积(RPP,10 2 m m Hg×次 /分 )亦由 12 5 .36± 2 9.6 3提高到 184.42± 30 .6 0。 16例患者发病半年时心脏功能为 8.0 2±2 .0 3METs。结论 :对 AMI急性期和恢复期患者进行康复治疗可增强其心脏功能 ,改善心肌氧供 ,提高生活质量     

康复运动对急性心肌梗塞PCI后患者氧代谢当量及左室功能的影响

目的:探讨康复运动训练对急性心肌梗塞(AMI)经皮冠状动脉介入治疗(PCI)后患者氧代谢当量(METs)及左室功能的影响。方法:50例PCI后AMI患者被随机分成运动组和对照组各25例,在发病后2～4周分别进行心肺功能及左心功能测定,运动组进行有指导的康复运动训练,对照组不给于训练指导。6个月后再以运动心肺功能仪直接测定METs,以超声心动描记术测定左室射血分数(LVEF)。结果:运动组实际完成23例,对照组完成24例。运动组较对照组METs[(5.24±0.94)∶(3.94±0.38),P0.001]显著改善,LVEF[(0.526±0.040)∶(0.488±0.037),P0.01]显著提高。结论:急性心肌梗塞患者经过运动训练后其氧代谢当量及左室射血分数得到显著提高,运动训练有利于其社会和家庭回归,值得推广。     

Cardiac exercise tolerance of infarct patients in exercise therapy

92 female patients with myocardial infarction were divided into three exercise groups of 25 W, 50 W and 75 W according to their symptom-limited working capacity and examined during bicycle ergometer training. Exercise tolerance, training heart rate and arterial lactic acid were analyzed. RESULTS: 1. Increase in maximal working capacity corresponds to a decrease in limiting cardiac symptoms, or an increase of limiting symptoms, e.g., in tired leg muscles. 2. Intensity of training (as a percentage of maximal symptom-limited work capacity) is 55 +/- 21%, 73 +/- 15%, and 90 +/- 8% for groups of 25, 50 and 75 W (p less than 0.05) respectively. 3. Training heart rate and lactic acid increase significantly proportional to the increase of work capacity. 4. In all three exercise groups, training heart rate corresponds to about 84% maximal heart rate measured at maximal working capacity. 5. Mean maximal lactic acid level is at 3.18 +/- 0.97 mmol/l for the whole exercise group on 75 W. Within this group, only a small subgroup of seven women, who were limited in maximal working capacity by tired leg muscles, reached the so-called anaerobic threshold of 4 mmol/l lactic acid. 6. Female patients greater than or equal to 60 years have partially significant higher mean lactic acid levels for the same exercise load as women less than or equal to 59 years. CONCLUSION: Gender specific differences in performance in women and the cardiac situation in female patients were considered on the basis of symptom-limited performance and body-weight-related physical training, regulated by individual training heart rate.     

Diastolic dysfunction in exercise and its role for exercise capacity

Diastolic dysfunction is frequent in elderly subjects and in patients with left ventricular hypertrophy, vascular disease and diabetes mellitus. Patients with diastolic dysfunction demonstrate a reduced exercise capacity and might suffer from congestive heart failure (CHF). Presence of symptoms of CHF in the setting of a normal systolic function is referred to as heart failure with normal ejection fraction (HFNEF) or, if evidence of an impaired diastolic function is observed, as diastolic heart failure (DHF). Reduced exercise capacity in diastolic dysfunction results from a number of pathophysiological alterations such as slowed myocardial relaxation, reduced myocardial distensibility, elevated filling pressures, and reduced ventricular suction forces. These alterations limit the increase of ventricular diastolic filling and cardiac output during exercise and lead to pulmonary congestion. In healthy subjects, exercise training can enhance diastolic function and exercise capacity and prevent deterioration of diastolic function in the course of aging. In patients with diastolic dysfunction, exercise capacity can be enhanced by exercise training and pharmacological treatment, whereas improvement of diastolic function can only be observed in few patients.     

Diabetes and exercise

This review describes (1) the metabolic and hormonal response to exercise in normal and diabetic man, and (2) the potential benefits of physical training in diabetes. Whereas in normal man plasma glucose varies little during exercise, the insulin-dependent diabetic subject may experience an increase in plasma glucose, a modest decrease or a marked decrease which can result in symptomatic hypoglycemia. Evidence is reviewed that the glycemic response depends on the ambient plasma concentration of insulin and that this may be influenced by an effect of exercise on the absorbtion of insulin from its site of injection. The response to exercise of noninsulin-dependent diabetic subjects and of diabetic subjects with autonomic neuropathy is also described. Physical training improves glucose tolerance in some noninsulin-dependent diabetic subjects and in insulin-dependent patients, it may diminish insulin requirements. It may also have a role in retarding the development of cardiovascular complications. Physical training is not totally innocuous, however, and in many patients with diabetes special precautions are required.