运动康复对急性心肌梗死患者左室重构和功能的影响

目的探讨有指导的运动康复对急性心肌梗死(AMI)患者左室重构和收缩功能的影响。方法64例无并发症首发AMI患者随机分为运动组与对照组,对运动组患者进行个体化的运动锻炼指导。采用超声心动图、血N-末端脑钠肽前体(NT-proBNP)及心肺运动试验检测。结果两组患者随访终点时运动组NTpro-BNP水平较基线值下降[(335.64±246.14)ng/L比(845.29±93.48)ng/L,P<0.05],并显著低于对照组[(1099.83±168.75)ng/L];左室射血分数(LVEF)增加[(60.0±8.0)%比(55.0±8.6)%,P<0.05],对照组NT-proBNP及LVEF与基线值比较无统计学意义(P>0.05);运动组患者心室舒张末径(LVDd)无明显变化[(50.3±3.9)mm比(50.7±4.5)mm,P>0.05],而对照组LVDd则较心肌梗死早期增大[(52.6±5.4)mm比(50.9±5.8)mm,P<0.05]。结论运动康复锻炼可改善无并发症AMI患者心脏收缩功能,限制左室的异常重构。

The impact of exercise rehabilitation on left ventricular remodeling and systolic function in acute myocardial infarction patients

OBJECTIVE: To investigate the influence of rehabilitation on left ventricular remodeling and systolic function in acute myocardial infarction patients. METHODS: Patients meeting the inclusion criteria with uneventful clinical course after a first myocardial infarction were randomly assigned to a 3-month exercise training period (exercise group, n = 35) or a control group (n = 29). Before randomization, all patients underwent NT-proBNP test, 2-dimensional echocardiography, and submaximal exercise test. RESULTS: (1) At baseline, there were no significant differences in NT-proBNP, left ventricular end-diastolic diameter (LVDd) and left ventricular ejection fraction (LVEF) between the exercise and control groups. After 3 months, a significant decrease in NT-proBNP was observed only in the exercise group [from (845.29 +/- 93.48) ng/L to (335.64 +/- 246.14) ng/L, P < 0.05], but not in the control group [from (1091.62 +/- 101.78) ng/L to (1099.83 +/- 168.75) ng/L, P > 0.05) and there was significant difference in NT-proBNP level between the two groups after 3 months (P < 0.01). The LVDd increased in the control group [from (50.9 +/- 5.8) to (52.6 +/- 5.4) mm, P < 0.05] but not in the exercise group [from (50.7 +/- 4.5) to (50.3 +/- 3.9) mm, P > 0.05] and there was significant difference in LVDd between the two groupsafter 3 months (P < 0.05). Conversely, LVEF improved in the exercise group [from (55.0 +/- 8.6)% to (60.0 +/- 8.0)%, P < 0.05] but not in the control group (P > 0.05) and there was significant difference in LVEF between the two groups after 3 months (P < 0.05). (2) NT-proBNP was inversely correlated with LVEF. CONCLUSIONS: Rehabilitation exercise training under instructions based on family condition in the early and recovery stage of AMI can lower the NT-proBNP level, improve ejection fraction, and prevent the increase of left ventricular end-diastolic diameter. Therefore, it may reduce unfavorable remodeling response and improve cardiac systolic function hereafter.