早期心脏康复对老年急性心肌梗死PCI术后心功能及心理状态的影响

摘要 目的：探讨早期心脏康复对老年急性心肌梗死（acute myocardial infarction, AMI）患者经皮冠状动脉介入（percutaneous coronary intervention, PCI）术后心功能及心理状态的影响。方法：2018年1月~2018年12月间成功实施PCI的62例老年AMI患者随机分为研究组（n=31）和对照组（n=31）,同时选择30例健康体检者作为健康组。对照组按照《中国经皮冠状动脉介入治疗后康复程序》给予常规康复训练,研究组结合根据6 min步行试验（6min walking test, 6MWT）制定个性化的康复训练方案,包括院内、院外心脏康复干预、心理干预及随访,为期6个月。比较两组术后心功能、心理状态、终点事件的发生情况。结果：康复后6个月,两组左心室舒张末期内径(left ventricular end-diastolic diameter, LVEDD)、左室收缩末期内径（left ventricular end-systolic diameter, LVESD）、左心室射血分数(left ventricular ejection fraction, LVEF)各心功能指标均较康复前明显提高,且研究组明显优于对照组(P<0.05)。研究组康复后6个月LVEF与健康组比较,差异无统计学意义(P>0.05)。康复后6个月,两组90项症状自评量表（symptom check list-90, SCL-90）各项目中除敌对、偏执外,其余项目评分均显降低,且研究组躯体化、强迫症状、抑郁、焦虑、精神病性显著低于对照组(P<0.05)。康复随访期间,研究组终点事件的总发生率9.7%,显著低于对照组25.8%,且6 min步行距离（6 min walking distance, 6MWD亦较对照组明显增加(P<0.05)。结论：早期心脏康复可明显促进老年AMI患者PCI术后心功能恢复,改善心理状态,降低术后不良终点事件发生风险。

Effect of Early Cardiac Rehabilitation on Cardiac Function and Mental State after PCI in Elderly Patients with Acute Myocardial Infarction

ABSTRACT Objective: To explore the influence of early cardiac rehabilitation on cardiac function and mental state after percutaneous coronary intervention(PCI) in elderly patients with acute myocardial infarction (AMI). Methods: 62 elderly patients with AMI who successfully underwent PCI during January 2018 to December 2018 were randomly divided into the study group (n=31) and the control group (n=31). Meanwhile, 30 healthy subjects were selected as the healthy group. The control group was given routine rehabilitation training according to the "rehabilitation procedure after percutaneous coronary intervention", and the study group was given personalized rehabilitation training program was developed according to the 6-min walking test (6MWT) for 6 months, including in-hospital and out-hospital cardiac rehabilitation intervention, psychological intervention and follow-up. The occurrence of cardiac function, mental state and end-point events were compared between the two groups. Results: Six months after rehabilitation, all cardiac function indicators of LVEDD, LVESD and LVEF in the two groups were significantly improved compared with those before rehabilitation, and the study group was significantly better than the control group (P<0.05). There was no significant difference in LVEF between the study group and the healthy group at 6 months after rehabilitation (P>0.05). Six months after rehabilitation, the scores of all items in the SCL-90 scale in the two groups were significantly lower than those in the control group except hostility and paranoia, and somatization, compulsive symptoms, depression, anxiety and psychosis in the study group were significantly lower than those in the control group (P<0.05). During the rehabilitation follow-up, the total incidence of endpoint events in the study group was 9.7%, significantly lower than that in the control group, 25.8%, and 6MWD was also significantly higher than that in the control group (P<0.05). Conclusion: Early cardiac rehabilitation can significantly promote the recovery of cardiac function after PCI in elderly AMI patients, improve their psychological state, and reduce the risk of adverse end-point events after PCI.