早期康复运动对心肌梗死患者的影响

背景:在传统的急性心肌梗死治疗中,要求患者绝对卧床休息1～4周,近年研究表明心肌梗死患者早期进行康复运动能改善心功能储备,增加运动耐量,增加心肌血液灌注,减少心肌缺血,并减少焦虑和抑郁情绪。目的:观察早期康复运动对急性心肌梗死患者日常生活能力、入院天数、平均住院花费、心律失常的发生率及两年内心肌梗死再发率影响。设计:非随机化同期对照分析。单位:北京天坛医院。对象:选择2002-08/2003-10在北京天坛医院循环内科住院的急性心肌梗死患者80例,所有患者年龄≤70岁,病情稳定,左心室射血分数>35%,不合并严重的高血压、严重的肺部疾病、神经和运动系统疾病。方法:将入选病例按患者意愿分成两组(n=40):①早期康复组:常规药物治疗。绝对卧床休息24h;第2天床头抬高30°左右,肢体关节的被动运动;第3～5天床上坐起,3次/d;第6～7天床边站立,3次/d;第8～9天床边活动四肢关节,在室内慢走;第10～14天练习步行。在进行康复运动出现心绞痛发作、严重心律失常或呼吸困难登症状时,应暂停运动或将运动强度返回前一阶段水平。②绝对卧床组:绝对卧床,只进行常规药物治疗,不进行康复训练。主要观察指标:采用Barthel指数(满分100分,<60分为不能自理)评定患者的日常生活能力,并对比两组的平均住院天数,住院期间的平均花费,心律失常的发生率及两年内心肌梗死的再发率。结果:80例患者均完成了治疗和随访进入结果分析。①早期康复组平均住院天数和平均住院花费较绝对卧床组少(17.1d比24.5d;9021.23元比12383.45元;P<0.05)。②Barthel指数:治疗前两组无差异,出院前早期康复组显著高于绝对卧床组(81.43±13.57,70.68±11.48,P<0.05)。③早期康复组和绝对卧床组分别有6,7例发生心律失常。④追踪观察两年,早期康复组心肌梗死的再发率(5%,2/40)明显低于绝对卧床组(22%,9/40)。结论:早期康复训练有利于提高心肌梗死患者的日常生活能力,减少平均住院天数及平均住院花费,降低再发率。

Influence of early rehabilitative exercise in patients with myocardial infarction

BACKGROUND: In treatment of traditional acute myocardial infarction,patients were required to lie on the bed resting for 1-4 weeks. Recently research showed that early rehabilitation exercise in myocardial infarction patients could ameliorate the reservation of cardio function, increase exercise tolerance, augment myocardial hemoperfusion, decrease myocardial ischemia and reduce the anxious and depressive emotion.OBJECTIVE: To observe the influence of early rehabilitation movement on activity of daily living, duration of hospital stay, mean hospitalized cost,incidence rate of arrhythmia and recurrence rate of myocardial infarction in two years.DESIGN: Non-randomized concurrent control analysis.SETTING: Beijing Tiantan Hospital.PARTICIPANTS: Totally 80 patients with acute myocardial infarction,who were hospitalized at Department of Circulation, Beijing Tiantan Hospital from August 2002 to October 2003, were enrolled. They were all at most 70 years old with stable pathogenetic condition. Left ventricular ejection fraction (LVEF) was over 35%. They were not combined with severe hypertension, severe pulmonary disease, nerve and disease of locomotor system.METHODS: The selected cases based on patients' will were assigned into two groups (n=40), ①early rehabilitation group: They were treated with routine drugs, absolute bed rest for 24 hours. At day 2 the head stock was rose about 30°to do passive exercise of extremity joint. At days 3-5, the patients sat on the bed, 3 times per day. At days 6-7,the patients stood at bedside, 3 times per day. At days 8-9, the patients moved joints of extremities at bedside and walked slowly in room. At days 10-14, the patients exercised walking. If there were angina pectoris attacks, serious cardiac arrhythmias or dyspneic respiration, etc., the movement should be suspended or the exercise intensity came back to that in the former stage. ②Absolute bed rest group: The patients were absolute bed rest, and only treated with routine drug without any rehabilitation training.MAIN OUTCOME MEASURES: Barthel index (full mark was 100 points, and ＜ 60 points represented unable self-care) was used to assess activity of daily living of patients. Mean duration of hospital stay, mean hospitalized cost, incidence rate of arrhythmia and recurrence rate of my ocardial infarction in two years were compared between the two groups.RESULTS: A total of 80 patients that conducted the therapy and follow up were involved in the result analysis. ①Mean duration of hospital stay and mean hospitalized cost in the early rehabilitation group were less than those in the absolute bed rest group (17.1 days vs 24.5 days; 9 021.23 yuan vs 12 383.45 yuan; P ＜ 0.05). ②Barthel index: There was insignificant difference before treatment between the two groups. It was significantly higher in the early rehabilitation group than that in the absolute bed rest group before discharge (81.43±13.57,70.68±11.48,P ＜ 0.05). ③Six and seven patients had the onset of arrhythmia in the early rehabilitation group and the absolute bed rest group, respectively. ④Follow-up observation was performed for two years. The recurrence rate of myocardial infarction in the early rehabilitation group (5% ,2/40) was obviously lower than that in the absolute bed rest group (22 %,9/40).CONCLUSION: The early rehabilitation training is of benefit to elevate activity of daily living of myocardial infarction patients, reduce mean duration of hospital stay and mean hospitalized cost and decrease recurrence rate.