运动训练方案对慢性心力衰竭患者运动耐量和心功能的影响

背景目前国内慢性心力衰竭患者康复治疗虽有一个较为固定的运动方案,但因运动量过大或过小、依从性差等,不适用于老年及病情稍重的慢性心力衰竭患者.临床工作中需要具有依从性好、运动量适中和可重复性的运动方案.目的观察慢性心力衰竭患者经运动训练干预后,运动耐量和心功能指标的变化.设计随机对照的对比观察.对象选择2002-8/2003-10湖北武汉协和医院老年病科住院的慢性心力衰竭患者70例.患者均知情同意,纽约心脏病协会心功能分级为(2.69±0.13)级,心力衰竭病程均＞6个月.随机将患者分为运动组(n=34)和对照组(n=36).运动组男19例,女15例,心功能分级为(2.68±0.12)级;对照组(n=36),男19例,女17例.方法运动组患者进行为期3周的自行车测力计训练、平板步行训练和徒步行走训练;对照组患者限制活动3周.所有患者试验前后在自觉劳累程度记分相同的状态下进行6 min步行试验;实验前后于清晨空腹抽取肘前静脉血5 mL,测定血浆白细胞介素6、去甲肾上腺素水平,并测定左室射血分数.主要观察指标两组患者干预前后6 min步行距离、血浆白细胞介素6、去甲肾上腺素水平及左室射血分数和心功能级别比较.结果最终进入结果分析慢性心力衰竭患者70例.运动组干预后6 min步行距离、左室射血分数明显长于或高于对照组和干预前385±30)m,(43±5)%;(324±35)m,(39±6)%;(292±30)m,(35±4)%,P＜0.05].运动组干预后血浆白细胞介素6,去甲肾上腺素水平及心功能级别明显低于对照组和干预前0.86±0.25)pmol/L,(2.05±0.48)nmol/L,(1.89±0.11)级;(1.00±0.25)pmol/L,(2.21±0.47)nmol/L,(2.45±0.12)级;(1.12±0.23)pmol/L,(2.46±0.53)nmol/L,(2.68±0.12)级,P＜0.05～0.01].结论本文中制定的运动训练方案能改善慢性心力衰竭患者的运动耐力及心功能,具有较好的个体依从性.

Movement training for exercise tolerance and cardiac function in patients with chronic heart failure

BACKGROUND:Now a correspondingly stable project was performed in the rehabilitative treatment for patients with chronic heart failure in China,but it was difficult to be carried out on the wide range because of difficulties in adjusting movement capacity,lower compliance and so on,especially for the elder patients or those with severe chronic heart failure.The movement project will be required with the advantages of good compliance,moderate movement capacity and reproducibility in clinic.OBJECTIVE:To investigate the change of exercise tolerance and cardiac function after the intervention in movement training in patients with chronic heart failure.DESIGN: Randomized and controlled observation.PARTICIPANTS:Seventy inpatients with stable chronic heart failure were chosen from the Department of Gerontology in Wuhan Union Hospital of Hubei Province from August 2002 to October 2003.All patients agreed to this test. Functional class of New York Heart Association (NYHA) was (2.69±0.13).Chronic heart failure duration of all patients was over six months. Seventy patients were randomly divided into movement group(n=34) and control group(n=36).In the movement group with 19 males and 15 females,functional class was(2.68±0.12).In the control group,there were 19 males and 17females.METHODS:The patients in the movement group underwent three weeks of movement training (bicycle ergometer,treadmill walking and walking on foot). The patients in the control group underwent three weeks of activity restriction. All patients received the 6-minute walking test under the condition of the same rating of perceived exertion before and after the test. Totally 5 mL of venous blood was drawn without eating anything in the morning before and after the test.The levels of interleukin-6 and norepinephrine were evaluated and left ventricle ejection fraction was observed and determined.MAIN OUTCOME MEASURES:Comparison of walking distance,interleukin-6,norepinephrine,l.eft ventricle ejection fraction and cardiac functional class before and after the intervention in all patients.RESULTS:Seventy patients with chronic heart failure were involved in the statistical analysis at last. After the intervention,walking distance covered during 6minutes and left ventricle ejection fraction in the movement group were obviously longer and higher than those before the intervention and in the control group (385±30)m,(43±5)％;(324±35)m,(39±6)％;(292±30)m,(35±4)％,P＜ 0.05].After the intervention,the levels of plasma interleukin-6 and norepinephrine and cardiac functional class in the movement group were lower than those in the control group and before the intervention(0.86±0.25) pmol/L,(2.05±0.48) nmol/L,(1.89±0.11);(1.00±0.25) pmol/L,(2.21 ±0.47) nmol/L, (2.45 ±0.12);(1.12±0.23) pmol/L,(2.46 ±0.53) nmol/L,(2.68±0.12),P＜ 0.05-0.01].CONCLUSION:The project of movement training designed in our study can improve exercise tolerance and ameliorate cardiac function in patients with chronic heart failure. This project has the advantage of better compliance designed according to oneself.