运动疗法对老年慢性充血性心力衰竭患者的治疗效果

目的　观察运动疗法对老年慢性充血性心力衰竭患者的治疗效果。方法慢性心衰患者106例,分为运动治疗组(54例)和对照组(52例),综合观察患者运动前后的有关指标,并评价运动能力和生存质量。结果　动疗法可促进临床表现的好转,增强患者的运动能力,明显提高患者的生存质量;检测血浆心钠素、内皮素可作为运动观察的可靠指标。结论　动疗法对老年慢性充血性心力衰竭患者安全有效。     

跨理论模型在住院慢性心力衰竭患者运动康复训练中的应用

摘要 目的：探讨基于跨理论模型的干预方法在住院慢性心力衰竭患者运动康复训练中的效果。 方法：抽取住院治疗4周的心衰患者120例为研究对象,并将其随机分为干预组（60例）和对照组（60例）。干预组在常规治疗、护理及康复训练教育的基础上,接受基于跨理论模型的干预措施,对照组给予常规治疗、护理及康复训练教育。运动康复训练4周后,比较两组患者运动康复训练的行为变化、生存质量得分、6MWT、慢性心力衰竭康复训练知识的掌握情况。 结果：干预前两组运动康复训练的行为变化阶段、生存质量得分、6MWT,差异无显著性意义（P>0.05）。运动康复训练4周后干预组运动康复训练的行为变化趋势（P<0.001）、生存质量得分（25.82±9.82）、6MWT（450.93±74.27m）,均优于对照组,两组比较差异有显著性意义（χ2=21.94,t=5.059,-4.626,P<0.01）;与各组干预前比较,差异有显著性意义（P<0.05）。干预后两组康复训练知识得分比较,差异有显著性意义（P<0.01）。 结论：基于跨理论模型的干预方法能促进住院慢性心力衰竭患者运动康复训练的行为变化、提高患者对康复训练知识的掌握程度、增加患者康复训练的6MWT并提高其生存质量。     

正念疗法结合个体化心脏运动康复训练对慢性稳定型心力衰竭患者血管内皮功能、心肺功能及心理状态的影响

目的 探讨正念疗法结合个体化心脏运动康复训练对慢性稳定型心力衰竭患者血管内皮功能、心肺功能及心理状态的影响.方法 选取2019年6月至2020年7月收治的80例慢性稳定型心力衰竭患者作为研究对象,按照随机数字表法将其分为对照组和观察组,各40例.对照组给予常规护理,观察组在对照组基础上给予正念疗法结合个体化心脏运动康复...     

运动康复训练在慢性心衰患者中的康复效果

目的：探讨以有氧运动为主的运动康复在慢性心力衰竭患者中的应用效果。方法：选择2018年2月至11月诊治的120例慢性心力衰竭患者，随机分成康复训练组、体外反搏组与单纯药物治疗组，每组40例。单纯药物治疗组患者仅接受药物治疗；体外反搏组患者在药物治疗的基础上接受体外反搏治疗；康复训练组患者在药物治疗的基础上接受心脏康复训练。治疗3个月后，比较3组患者的左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)；检测3组血浆氨基末端脑钠肽前体(NT-proBNP)水平；评估3组患者的明尼苏达心力衰竭生活质量问卷；评估3组患者的疗效。结果：治疗后，康复训练组患者的LVEF高于其他2组患者(P<0.01)，LVEDD及LVESD均低于其他2组患者(P<0.01)。康复训练组患者的NT-proBNP水平及明尼苏达量表得分均低于其他2组患者(P<0.01)。康复训练组患者的总有效率(97.5%)高于体外反搏组(82.5%)及单纯药物治疗组(77.5%)患者(P<0.05)。结论：心脏康复训练治疗方案在慢性心力衰竭患者中应用效果较好，有助于恢复患者正常的心肌功能，减少患者的症状，提高生活质量，促进患者康复。     

不同强度的运动康复训练对慢性心力衰竭患者疗效及安全性比较

目的:探究高强度间歇训练(HIIT)/中等强度持续训练(MCT)对慢性心力衰竭(CHF)患者的有效性和安全性。方法:254例慢性心力衰竭的患者,以1∶1∶1的比例随机分配至HIIT组、MCT组和常规运动(RRE)组,均训练12周,随访至52周。通过超声心动图比较各组左心室舒张末期内径(LVEDD)、左室射血分数(LVEF)从基线到12周、52周的变化,通过心肺运动试验比较峰值摄氧量(VO2peak)、最大摄氧量时呼吸商的变化,使用医院焦虑和抑郁量表(HADS)、综合情绪量表(GMS)评估生活质量,运动训练的安全性通过严重不良事件(SAE)的比率来评估。结果:基线~12周,HIIT组LVEDD的变化与MCT组LVEDD变化的差异无统计学意义,HIIT组中LVEDD的变化明显大于RRE组(P<0.05);HIIT组和MCT组VO2peak变化明显大于RRE组(均P<0.05);LVEF、最大摄氧量时呼吸商变化在3组间比较差异均无统计学意义。基线~52周,3组患者LVEDD、LVEF、VO2peak及最大摄氧量时呼吸商变化的差异均无统计学意义。在基线、12周和52周时,3组患者生活质量评估,HADS、GMS评分差异均无统计学意义。在随访期间,3组患者之间SAE发生情况差异无统计学意义。结论:HIIT和MCT这两种不同的训练方案都能使患者受益,运动训练可改善患者逆转左心室重构,但本研究中HIIT和RRE对于LVEDD的改善作用并没有明显差异。两种运动方案都在VO2peak上获得明显改善,对于CHF患者的预后具有积极意义。另外,HIIT和MCT的安全性较RRE并没有明显的劣势。     

运动训练对充血性心力衰竭患者心功能及住院时间的影响

目的探讨运动训练对充血性心力衰竭患者心功能恢复及住院时间的影响。方法74例充血性心力衰竭患者被随机分成运动训练组和对照组,以NYHA心功能分级及Benack评分对两组患者在试验前和试验终止时的心功能进行评定。结果运动训练组心功能改善程度优于对照组（P＜0．01）,且住院时间明显缩短。结论提示运动训练对心衰患者心功能恢复有积极意义。     

运动康复训练对老年冠心病慢性心力衰竭患者心功能及预后的影响

目的:探讨运动康复训练对老年冠心病慢性心力衰竭患者心功能及预后的影响。方法:选取我院2010年6月~2013年3月收治的冠心病慢性心力衰竭患者90例,将其随机等分为对照组和试验组,对照组给予慢性心力衰竭常规治疗,试验组在对照组基础上给予运动康复训练,比较两组各检测指标的变化。结果:出院6个月后,试验组患者左室射血分数、A峰E峰流速比值高于治疗前和对照组,左室舒张末径、左房内径、心胸比低于治疗前和对照组;试验组治疗后6 min步行距离长于对照组,生活质量评分和再住院率均低于对照组,以上结果经比较有统计学意义(P0.05)。结论:运动康复训练方便易行、安全可靠、经济适用,可以改善老年心力衰竭患者的心功能和预后,降低再住院率,达到了早期康复、恢复劳动能力、提高生活质量的目的,具有良好的临床应用价值。     

运动康复路径在老年慢性心力衰竭患者运动康复中的应用

目的探讨运动康复路径在老年慢性心力衰竭患者运动康复中的应用效果。方法采用随机数字表法,将100例老年慢性心力衰竭患者分为研究组和对照组,每组各50例,对照组实施常规护理,研究组采用运动康复路径对患者实施康复运动干预。观察患者各项心功能指标情况和再住院率。结果经过康复运动后,研究组患者左室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末容积(left ventricular volume index of diastolic end,LVEDV)、左心室收缩末容积(left ventricular endystolic volume,LVESV)均优于干预前和对照组;6min步行距离大于干预前和对照组;再住院率低于对照组(均P0.05)。结论实施运动康复路径可提高老年慢性心力衰竭患者康复运动的主动性和积极性,进而有效改善老年慢性心力衰竭患者的心功能,提高患者运动耐力,降低再住院率,促进患者康复。     

6分钟步行试验在老年慢性心衰患者康复中的应用

目的:采用6分钟步行试验探讨运动训练对老年慢性心衰患者的生活质量和心功能的恢复的影响。方法:实验分两组:训练组(n=50)和对照组(n=48)。两组分别在入院时和治疗两月后接受6分钟步行试验,心脏B超和生活质量调查。结果:训练组2月后与入院时相比HR、RPP、6分钟步行距离、EF值及生活质量评分均有明显改善,P<0.05;对照组入院时与治疗2月后相比差异无显著意义,P>0.05。结论:适度的运动训练对慢性心力衰竭患者可以有显著的生理和心理改善作用。     

Impact of CPAP on physical exercise tolerance and sympathetic-vagal balance in patients with chronic heart failure

Background:

Chronic heart failure (CHF) leads to exercise intolerance. However, non-invasive ventilation is able to improve functional capacity of patients with CHF.

Objectives:

The aim of this study was to evaluate the effectiveness of continuous positive airway pressure (CPAP) on physical exercise tolerance and heart rate variability (HRV) in patients with CHF.

Method

: Seven men with CHF (62±8 years) and left ventricle ejection fraction of 41±8% were submitted to an incremental symptom-limited exercise test (IT) on the cicloergometer. On separate days, patients were randomized to perform four constant work rate exercise tests to maximal tolerance with and without CPAP (5 cmH₂O) in the following conditions: i) at 50% of peak work rate of IT; and ii) at 75% of peak work rate of IT. At rest and during these conditions, instantaneous heart rate (HR) was recorded using a cardiofrequencimeter and HRV was analyzed in time domain (SDNN and RMSSD indexes). For statistical procedures, Wilcoxon test or Kruskall-Wallis test with Dunn''s post-hoc were used accordingly. In addition, categorical variables were analysed through Fischer''s test (p<0.05).

Results:

There were significant improvements in exercise tolerance at 75% of peak work rate of IT with CPAP (405±52 vs. 438±58 s). RMSSD indexes were lower during exercise tests compared to CPAP at rest and with 50% of peak work rate of IT.

Conclusion:

These data suggest that CPAP appears to be a useful strategy to improve functional capacity in patients with CHF. However, the positive impact of CPAP did not generate significant changes in the HRV during physical exercises.     

Combined endurance and muscle strength training in female and male patients with chronic heart failure

BACKGROUND: Exercise training has now become established practice in patients with chronic heart failure. Women are often under-represented in intervention studies compared to men. For this reason it was our aim to conduct a combined endurance and muscle strength training program to evaluate its effect on clinical performance data and health-related psychosocial factors in women and men. METHODS: One hundred and sixteen women, mean age 69 +/- 9 years, body mass index (BMI) 25.8 +/- 4.9, and 169 men, mean age 66 +/- 9 years, BMI 26.6 +/- 3.6 underwent combined endurance/resistance training. The training program lasted 29 +/- 7 days and comprised bicycle ergometer training, a 6-min walk test as a training unit and muscle strength training for the lower and upper extremities. RESULTS: Differences between women and men were found in clinical parameters. In particular, statistically significant differences were revealed between the women and men with regard to cardiopulmonary performance. Quality of life was significantly improved on discharge with regard to both physical and mental health, whereas anxiety and depression showed no significant alteration. CONCLUSION: A specialized in-hospital program for women and men combining endurance/resistance training and education is feasible. But our program revealed a very low level of cardiopulmonary performance in women. Women need to be encouraged and motivated to participate in such programs.     

慢性心衰高强度间歇运动序贯中等强度持续运动治疗模式的初步研究

目的:比较高强度间歇运动序贯中等强度持续运动(HFM)与单纯中等强度持续运动(MCE)在慢性心衰患者康复治疗中的效果。方法:筛选符合条件的慢性心衰(CHF)患者78例,分为HFM组和MCE组,每组39例。HFM组的运动方案为12周高强度间歇运动序贯中等强度持续运动训练,MCE组为12周中等强度持续运动训练。运动康复前后采用心肺运动测试(CPET)测试2组患者心肺功能变化,评估康复效果。结果:前8周,HFM组每周运动后即刻的心率收缩压乘积(RPP)、主观用力评分(RPE)值均显著高于MCE组(P0.05),高强度间歇运动(HIIT)后RPP值上升都在正常可控范围内,休息5min后恢复接近安静水平。训练12周后,2组患者的通气无氧阈(AT)、最大摄氧量(Peak VO2)、峰值氧脉搏、一秒用力呼气容积(FEV1%)、左心室射血分数(LVEF)均显著高于治疗前(均P0.05),HFM组的AT、Peak VO_2、峰值氧脉搏及LVEF均显著高于MCE组(均P0.05)。结论:高强度间歇运动序贯中等强度持续运动治疗模式较中等强度持续运动更能安全且有效地提升慢性心衰患者的心肺功能。     

Time course of effects of cardiac resynchronization therapy in chronic heart failure: benefits in patients with preserved exercise capacity

Objectives: To assess in patients with chronic heart failure the effect of cardiac resynchronization therapy (CRT) over 12 months' follow-up the time course of the changes in functional and neurohormonal indices and to identify responders to CRT.
Methods: Eighty-nine patients (74.1 ± 1 years, left ventricular ejection fraction [LVEF] < 35%), QRS complex duration >150 ms, in stable New York Heart Association (NYHA) class III or IV on optimal medical treatment were prospectively randomized either in a control (n = 45) or CRT (n = 44) group and underwent clinical evaluation, cardiopulmonary exercise testing (CPET), 2D-Echo, heart rate variability (HRV), carotid baroreflex (BRS), and BNP assessments before and at 6- and 12-month follow-up.
Results: In the CRT group, improvement of cardiac indices and BNP concentration were evident at medium term (over 6 months) follow-up, and these changes persisted on a longer term (12 months) (all P < 0.05). Instead CPET indices and NYHA class improved after 12 months associated with restoration of HRV and BRS (all P < 0.05). We identified 26 responders to CRT according to changes in LVEF and diameters. Responders presented less depressed hemodynamic (LVEF 25 ± 1.0 vs 22 ± 0.1%), functional (peak VO₂ 10.2 ± 0.2 vs 6.9 ± 0.3 ml/kg/min), and neurohormonal indices (HRV 203.6 ± 15.7 vs 147.6 ± 10.ms, BRS 4.9 ± 0.2 vs 3.6 ± 0.3 ms/mmHg) (all P < 0.05). In the multivariate analysis, peak VO₂ was the strongest predictor of responders.
Conclusions: Improvement in functional status is associated with restoration of neurohormonal reflex control at medium term. Less depressed functional status (peak VO₂) was the strongest predictor of responders to CRT.     

心脏康复模式对慢性心力衰竭患者心肺储备功能、生活质量及NT-proBNP水平的影响

目的探讨应用心脏康复模式对慢性心力衰竭患者心肺储备功能、生活质量及血清标志物N末端脑钠肽前体(NTproBNP)水平的影响。方法选取2013年4月至2015年4月该院心内科诊治的98例慢性心力衰竭患者为研究对象,按随机数字表法将患者分为对照组和心脏康复组,每组各49例。对照组患者予以常规慢性心力衰竭治疗与护理,康复组则在此基础之上分别予以强化心脏康复模式的干预方案,比较两组患者心肺储备功能、生活质量和NT-proBNP水平的变化。结果干预后,康复组患者心力衰竭相关知识的掌握率、去除高危因素重要性的知晓率较干预前显著提高(P0.05),对照组与干预前比较差异无统计学意义(P0.05);且康复组患者心力衰竭发生次数和间隔时间均显著优于对照组(P0.05),但两组患者并发症的发生率比较,差异无统计学意义(P0.05);干预后两组患者的生活质量评分均显著升高,且康复组患者生活质量各项指标得分值的增加幅度显著优于对照组(P0.05);康复组心肺功能指标左心室收缩期末容量(LVESV)、左心室舒张期末容量(LVEDV)、左心室射血分数(LVEF)和最大通气量(MVV)均较干预前明显增加,且4项指标的改善水平均显著高于对照组(P0.05);而其他指标干预前后差异无统计学意义(P0.05);另外,干预后两组患者NT-proBNP水平均显著下降,且康复组的降低幅度较对照组更为明显(P0.05)。结论心脏康复模式可明显提高慢性心力衰竭患者对疾病相关知识的掌握,降低复发率,延长间隔时间,提高生活质量,改善患者的心肺储备功能和NT-proBNP水平。     

运动疗法对慢性心力衰竭患者预后的影响

目的探讨运动疗法对行标准化治疗的慢性心力衰竭患者预后的影响。方法慢性心力衰竭患者54例随机分为运动组和对照组各27例,运动组在标准化治疗基础上进行运动训练治疗,对照组仅进行标准化治疗,随访12个月比较2组治疗效果。结果治疗前2组临床特征、NYHA心功能分级、左室射血分数、6min步行距离、血浆N末端脑钠肽、生存质量评分及药物使用率比较差异均无统计学意义（P〉0．05）;运动训练12个月后,2组左室射血分数、6min步行距离、生存质量评分、NYHA心功能分级、血浆N末端脑钠肽水平比较差异有统计学意义（P〈0．05）;运动疗法与血浆N末端脑钠肽水平较低是再住院和死亡的保护因素;室性心律失常、肾功能不全、伴有慢性肺疾病是再住院和死亡事件发生的促进因素。结论运动疗法可提高心力衰竭患者运动耐量和生活质量,改善患者心功能并明显降低死亡及再住院终点事件发生率。     

心脏再同步化治疗慢性充血性心力衰竭患者舒张功能的评价

目的 应用超声心动图评价心脏同步化治疗对重度心衰患者左室舒张功能的长期影响.方法 18例左室非同步的慢性充血性心衰患者行心脏同步化治疗.并于治疗前,治疗后1周、6个月、12个月行超声心动图检查,测量左室射血分数(LVEF),二尖瓣血流E、A峰值,应用组织多普勒技术测量二尖瓣瓣环收缩期峰值速度(Sm),舒张早期峰值速度(Em),舒张晚期峰值速度(Am).结果 起搏后第1周LVEF明显高于起搏前(P<0.001).二尖瓣环间隔部Am术后6个月[(11.3±2.9)cm/s]、1年[(12.5±3.6)cm/s]明显高于起搏前[(9.2±1.7) cm/s](P<0.05).二尖瓣环侧壁Am术后6个月[(12.1±3.2)cm/s]和术后1年[(13.5±3.2)cm/s]高于起搏前[(11.8±2.9)cm/s](P<0.05).二尖瓣环间隔部Em起搏前后未见显著性变化.结论 超声心动图是评价心脏同步化治疗左室运动不同步的心衰患者舒张功能明显改善的一种可靠方法.     

Increased expression of VEGF following exercise training in patients with heart failure

BACKGROUND AND AIMS: During the last decades several angiogenic factors have been characterized but so far it is unknown whether local muscle exercise training increases the expression of these factors in patients with moderate heart failure. Expression of the major putative angiogenic factor vascular endothelial growth factor (VEGF) at the level of messenger RNA (mRNA) and/or protein was therefore studied before and after 8 weeks of training in patient with chronic heart failure. METHODS: VEGF mRNA and protein concentrations were determined in skeletal muscle biopsies before and after 8 weeks of one-legged knee extension training in patients with chronic heart failure (New York Heart Association II-III). RESULTS: Exercise training increased the citrate synthase activity and peripheral exercise capacity by 46% and 36%, respectively, in parallel with a two-fold increase in VEGF at both the mRNA (P = 0.03) and protein (P = 0.02) levels CONCLUSION: The increase in VEGF gene expression in response to exercise training indicates VEGF to be one possible mediator in exercise-induced angiogenesis and may therefore regulate an important and early step in adaptation to increased muscle activity in patient with chronic heart failure.     

Drug and device therapy for patients with chronic heart failure

Evaluation of: Grosu A, Senni M, Iacovoni A et al. Cardiac Resynchronization in Combination with β-blocker Treatment in Advanced Chronic Heart Failure (CARIBE-HF): the results of the CARIBE-HF study. Acta Cardiol. 66(5), 573–580 (2011).

Untreated heart failure is a terminal illness with a poor prognosis. β-blockers are an established therapy used to reduce morbidity and mortality. Hypotension and bradycardia often hinder optimal β-blocker administration in patients with chronic heart failure. The efficacy of cardiac resynchronization therapy (CRT) in affecting favorable cardiac remodeling and reducing mortality in heart failure patients with electrical dyssynchrony has been demonstrated in landmark trials only in patients receiving optimal medical therapy. This paper demonstrates the favorable effects of CRT on cardiac hemodynamics facilitating uptitration of β-blocker therapy. It highlights the synergistic relationship of the two therapies and emphasizes the importance of optimizing medical therapy before and after CRT implantation.     

运动疗法应用于慢性心力衰竭患者的疗效观察

目的：观察运动疗法对慢性心力衰竭（CHF）患者的疗效。方法：对28例CHF患者在常规治疗的基础上．实施运动疗法，并与27例非康复组患者进行对照比较；观察一年以后患者的心功能、运动耐量、生存质量、6min步行距离、再住院率和死亡率。结果：一年后，康复组和对照组比较，心功能改善（P〈0．05）；运动耐量、生存质量、6min步行距离显著改善（P〈0．01）；再住院率降低（P〈0．05）；死亡率未降低（P〉0．05）。结论：运动疗法可以改善心功能。提高运动耐量和生存质量，降低再住院率。