有氧康复运动对慢性心力衰竭患者心室重构及血管内皮功能的影响

目的:探讨有氧康复运动对慢性心力衰竭(chronic cardiac failure,CHF)患者心室重构及血管内皮功能的影响。方法:78例CHF患者随机分为运动组(n=39)、对照组(n=39)。对照组给予常规内科药物治疗、日常活动能力训练,运动组在此基础上根据美国心脏病学会(American Heart Association,AHA)的《三阶段康复运动方案》进行有氧康复运动,共持续12周。比较两组治疗前后心脏结构和功能、血管内皮功能及生活质量的改善情况。结果:干预后,两组左室收缩末期内径(left ventricular end systolic diameter,LVESD)、左室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、明尼苏达心衰生活质量(Minnesota Living With Heart Failure,MLHF)评分、血清内皮素-1(Endothelin-1,ET-1)、血管紧张素Ⅱ(angiotensin Ⅱ,Ang Ⅱ)水平均明显减小,左室射血分数(left ventricular ejection fraction,LVEF)、6分钟步行试验(6 minute walking test,6MWT)、血清一氧化氮(nitric oxide,NO)、降钙素基因相关肽(calcitonin gene-related peptide,CGRP)水平均明显升高,且运动组LVESD、LVEDD、MLHF评分、血清ET-1、Ang Ⅱ水平明显低于对照组,LVEF、6MWT、血清NO、CGRP水平明显高于对照组,差异均有统计学意义(P0.05)。运动组干预期间心衰再入院率显著低于对照组,差异均有统计学意义(P0.05)。结论:有氧运动康复训练有助于改善CHF患者的血管内皮功能,延缓或逆转心室重构,提高生活质量,改善预后。

Influence of Aerobic Rehabilitation Exercise on the Ventricular Remodeling and Endothelial Function of Patients with Chronic Cardiac Failure

ABSTRACT Objective: To explore the influence of aerobic rehabilitation exercise on the ventricular remodeling and endothelial function of patients with chronic cardiac failure (CHF). Methods: 78 cases of patients with CHF were randomly divided into the exercise group (n=39) and the control group (n=39). The control group was given routine drug treatment, ability training of daily living, while the exercise group was given aerobic rehabilitation exercise according to "three stages of rehabilitation exercise plan" by the American heart association (AHA) for 12 weeks based on the control group. The improvement of cardiac structure and function, endothelial function, and quality of life were compared between two groups before and after treatment. Results: After intervention, the levels of LVESD, LVEDD, serum ET-1, Ang II, and MLHF scores were reduced significantly in both groups, the levels of LVEF, 6MWT, NO, CGRP were significantly increased(P<0.05). The levels of LVESD, LVEDD, serum ET-1, Ang II, and MLHF scores in exercise group were significantly lower than those in the control group (P<0.05), the levels of LVEF, 6MWT, NO, CGRP in exercise group were significantly higher than those in the control group(P<0.05). The readmission rate because of heart failure in exercise group was significantly lower than that of the control group (P<0.05). Conclusion: Aerobic rehabilitation exercise is helpful to improve the vascular endothelial function, delay or reverse the ventricular remodeling and improve the quality of life and the prognosis for CHF patients.