运动疗法对冠心病患者PTCA及支架术后心功能和自主神经功能的影响

目的 :探讨运动疗法对冠心病患者PTCA或支架术后的心功能及自主神经功能的影响。方法 :对 37例PTCA或支架术后的患者进行运动心功能评定 ,制定康复运动处方 ,进行 8周康复运动训练 ,采用Bruce方案亚级量分级运动试验进行康复评定 ,采用心率变异 (HRV)对训练前后患者的自主神经功能进行评价。结果 :实施运动疗法后患者心率增值较 8周前明显增加 (P <0 0 1) ,血压 (包括收缩压和舒张压 )、心率 -血压乘积 (RPP)均比治疗前显著下降 (P <0 0 5或P <0 0 1) ,患者在运动实验中的运动时间延长、运动负荷增加 (P <0 0 1) ,运动诱发的最大ST段压低明显改善(P <0 0 1)。训练前患者时域和频域指标显著低于对照组 (P <0 0 1) ,训练后以上各项指标较康复训练前均有回升 (P <0 0 5或P <0 0 1)。结论 :康复运动训练能提高PTCA或支架术后冠心病患者的心功能 ,改善心脏自主神经功能。

Effects of Exercise Training on Cardiac Function and Automatic Nervous Activity in Patients with Coronary Artery Disease following PTCA or Intracoronary Stent Implantation

Objective The purpose of this study was to examine the effects of exercise training on cardiac function and automatic nervous activity in patients with coronary artery disease(CAD) following PTCA or intracoronary stent implantation. Methods For this study, 37 CAD patients (28 men and 9 women; aged 56.23 ±11.16 years) participated in a supervised 8-week training program with 35 healthy controls(27 men and 8 women; aged 55.72 ±10.34 years). Cardiac function was assessed with indexes obtained during exercise testing using the standard Bruce protocol (submaximal gradural treadmill exercise) before and after 8 weeks training. Meanwhile, heart rate variability (HRV) was used to value the automatic nervous activity. Results After 8 weeks, the margin between maximal HR and resting HR (△HR=HR max-HR resting) was significantly broader (P<0.01), blood pressure including systolic and diastolic pressure and rate - pressure product (RPP) were significantly decreased (P< 0.05 or P<0.01), the duration of exercise and the maximal work load were significantly increased (P< 0.01),the maximal lowered ST segment induced by exercise were improved greatly (P<0.01). Compared with the control, time and frequency domain were significantly lower in patients than in control group subjects before exercise(P<0.01), whereas increased significantly after exercise (P<0.05 orP<0.01). Conclusion Rehabilitation exercise can improve cardiac function as well as cardiac automatic nervous activity.