个体化精准运动为核心的整体康复方案对冠心病介入治疗术后患者整体功能再提高的临床研究*

目的: 探讨个体化精准运动为核心的整体康复方案对冠心病介入治疗术后患者整体功能再提高的作用。方法: 选择2016 年6 月至2019 年12 月间在北京康复医院临床诊断为冠心病稳定性心绞痛患者20 例,随机分为对照组（n=10）和运动组（n=10）。全部患者择期行冠状动脉介入治疗,术后对照组患者仅进行除运动康复之外的常规治疗指导;运动组患者进行12周个体化运动为核心的心脏康复,介入前、介入后2周、康复后12周分别评估患者标准化症状限制性极限运动的心肺运动试验（CPET）指标、心脏超声、6 min步行距离（6MWD）等。结果: 所有患者均安全无并发症完成症状限制性CPET,运动组患者完成12周全程运动康复治疗。组间比较显示,介入前和介入后2周,对照组和运动组患者CPET指标以及左心室射血分数、6MWD等均无明显差异（P>0.05）。康复12周后,运动组患者无氧阈（ml/min、ml/（min·kg））、峰值摄氧量（ml/（min·kg））、氧脉搏（ml/beat）和6MWD较对照组明显升高,差异有统计学意义（P<0.05）。组内比较显示,康复治疗12周后,运动组患者无氧阈（ml/min、ml/（min·kg）、%pred）、峰值摄氧量（ml/min、ml/（min·kg）、%pred）、峰值氧脉搏（ml/beat）和6MWD均较介入前明显改善,差异有统计学意义（P<0.05）;而且与介入后2周比较,无氧阈（ml/（min·kg））和峰值摄氧量（ml/（min·kg））均明显升高,差异有统计学意义（P<0.05）。对照组患者在康复12周后无氧阈（ml/min）和峰值氧脉搏（ml/beat）较介入前改善,差异有统计学意义（P<0.05）,但CPET指标与介入后2周比较无明显差异。结论: 冠状动脉介入术后进行个体化运动康复为核心的整体管理可进一步提高冠心病稳定性心绞痛患者运动心肺功能和运动耐力。运动康复是介入术后患者二级预防的重要内容,需要大量推广。

Effects of cardiac rehabilitation protocol centered with personalized - exercise training on further improvement of holistic function in patients with coronary heart disease after percutaneous coronary intervention

Objective: To investigate the effects of cardiac rehabilitation protocol centered with personalized - exercise training (ET) on further improvement of holistic function in patients with stable angina after percutaneous coronary intervention (PCI). Methods: 20 patients who were diagnosed with stable angina in Beijing Rehabilitation Hospital from June 2016 to December 2019, were randomly divided into control group (n=10) and ET group (n=10). All patients were received PCI selectively. After PCI, patients in Control group were treated with conventional cardiac rehabilitation without ET; patients in ET group were treated with ET-based cardiac rehabilitation for 12 weeks. Cardiopulmonary exercise testing (CPET) parameters, echocardiogram and 6-minute walking distance (6MWD) of 2 groups of patients were recorded respectively before PCI, 2 weeks after PCI and 12 weeks after ET. Results: All patients in 2 groups finished symptom limited maximum CPET, and patients in ET group finished 12 weeks - ET safely without complications. Before PCI and 2 weeks after PCI, there were no differences in parameters including anaerobic threshold (AT), peak oxygen uptake, peak oxygen pulse, left ventricular ejection fraction (LVEF) and 6MWD between control group and ET group（P>0.05）; after 12-week treatment, AT(ml/min,ml/(min·kg)), peak oxygen uptake(ml/(min·kg)), peak oxygen pulse(ml/beat) and 6MWD of patients in ET group were higher significantly than those of patients in control group (P<0.05). In ET group, the variables including AT (ml/min、ml/(min·kg)、%pred), peak oxygen uptake(ml/min,ml/(min·kg),%pred), peak oxygen pulse (ml/beat) and 6MWD of patients after 12-week ET were significantly higher than those of patients before PCI treatment (P<0.05); notably, AT (ml/(min·kg)) and peak oxygen uptake (ml/(min·kg)) of patients in ET group were significantly higher after 12-week ET program compared with those of patients 2 weeks after PCI ( P<0.05). In Control group, AT（ml/min）and peak oxygen pulse（ml/beat）of patients after 12-week treatment were higher than those of patients before PCI ( P<0.05), but there were no difference between 2 weeks after PCI and 12-week treatment ( P>0.05). Conclusion: Personalized - exercise training after PCI could further improve the cardiac function and exercise endurance, ET - based cardiac rehabilitation is an important part of secondary prevention for patients after PCI, which needs to be widely promoted.