运动康复治疗对射血分数保存心力衰竭患者运动耐力、舒张功能和生活质量的影响

丁立群; 张云梅; 张进; 壮可; 范洁; 杨洁琼

doi:10.13201/j.issn.1001-1439.2017.09.008

运动康复治疗对射血分数保存心力衰竭患者运动耐力、舒张功能和生活质量的影响

- 云南省第一人民医院心内科(昆明, 650032)

详细信息

通讯作者: 丁立群, E-mail:dingliqunkm@sina.com

中图分类号: R541.6

收稿日期: 2017-03-03

Effects of exercise training on exercise capacity,diastolic function and quality of life in patients with heart failure and preserved ejection fraction

- Department of Cardiology, the First People's Hospital of Yunnan Province, Kunming, 650032, China

More Information

Corresponding author: DING Liqun, E-mail: dingliqunkm@sina.com

Received Date: 03 March 2017

摘要

摘要: 目的:探讨运动康复治疗对射血分数保存心力衰竭(心衰)患者运动耐力、舒张功能和生活质量的影响。方法:入选了100例NYHA心功能Ⅱ^Ⅲ级,左室射血分数(LVEF)保存心衰患者,在药物治疗基础上,根据患者意愿分为运动康复组和对照组。运动康复组采用踏车运动康复,训练强度为基线水平症状限制性心肺运动试验测得的峰值氧耗量(peak VO₂)50%⁸0%。每周运动3次,每次40min。在基线及12周随访结束时通过心肺运动试验测peak VO₂,二氧化碳通气当量斜率(VE/VCO2slop),无氧阈氧耗量(VO₂AT),最大运动功率和最大运动时间;超声心动图仪检测并计算舒张早期二尖瓣血流速度与舒张早期二尖瓣环运动速度比(E/e'),左房容积指数(LAVI),左室肌重量指数(LVMI),LVEF;测试6 min步行距离;测血浆N端B型脑钠肽前体(NTproBNP);通过明尼苏达心衰生活质量问卷表(MLWHFQ)评估生活质量。并对上述指标进行组内及组间比较。结果:运动康复组及对照组随访12周后peak VO₂、VO₂AT、最大运动功率、最大运动时间及6min步行距离均较前增加(P<0.05);VE/VCO2slop、E/e'、LAVI及MLWHFQ总分均较前下降(P<0.05),但运动康复组优于对照组(P<0.05)。LVMI、LVEF及NT-proBNP组内比较及组间比较差异无统计学意义(P>0.05)。结论:运动康复治疗改善了LVEF保存心衰患者的运动耐力、左室舒张功能及生活质量。
- 运动康复 /
- 射血分数保存心力衰竭 /
- 运动耐力 /
- 左室舒张功能 /
- 生活质量
Abstract: Objective:To evaluate the effects of exercise training (ET) on exercise capacity, diastolic function and quality of life (QoL) in patients with heart failure and preserved ejection fraction (HFpEF).Method:A total of 100 patients with HFpEF were assigned to exercise training (ET) group (n=42) and control group (n=58) according to the willingness of patients.Patients in ET participated in supervised endurance exercise training program for 12 weeks.Training intensity was tailored individually 50% to 80% of peak oxygen uptake (peak VO₂) during baseline cardiopulmonary exercise testing (CPET).Patients in ET exercised 3 times a week and for 40 minutes each.Measurements were performed before and after 12-week study period.The variables of peak VO₂, VE/VCO2 slop, anaerobic threshold (VO₂AT), maximum workload and maximum exercise time were measured by CPEX.The variables of E/e', left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), and left atrial volume index (LAVI) was performed by echocardiography.Blood samples were taken for measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP).Patients underwent 6-min walk test, and QoL was assessed by the Minnesota Living With Heart Failure Questionnaire (MLWHFQ).Result:After following 12 weeks, peak VO₂, VO₂ AT, maximum workload, maximum exercise time and 6-min walk distance increased significantly;and VE/VCO2 slop, E/e', LAVIand MLWHFQ decreased significantly in both groups, but the changes ofthese variables were even more in ET group than in control group.However, The change of LVMI, LVEF and NT-proBNP was not significant between ET group and control group after following 12 week.Conclution:Exercise training improves exercise capacity, diastolic function and quality of life in patients with HFpEF.
- exercise training /
- heart failure with preserved ejection fraction /
- diastolic function /
- quality of life /

HTML全文

参考文献(15)

[1]	OWAN T E, HODGE D O, HERGES R M, et al.Trends in prevalence and outcome of heart failure with preserved ejection fraction[J].N Engl J Med, 2006, 355:251-259.
[2]	BHATIA R S, TU J V, LEE D S, et al.Outcome of heart failure with preserved ejection fraction in a population-based study[J].N Engl J Med, 2006, 355:260-269.
[3]	PONIKOWSKI P, VOORS A A, ANKER S D, et al.2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure:The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC[J].Eur Heart J, 2016, 37, 2129-2200.
[4]	YANCY C W, JESSUP M, BOZKURT B, et al.2013 ACCF/AHA Guidelines for the management of heart failure:executive summary[J].Circulation, 2013, 128:1810-1852.
[5]	中国康复医学会心血管病专业委员会, 中国老年学学会心脑血管病专业委员会.慢性稳定性心力衰竭运动康复中国专家共识[J].中华心血管病杂志, 2014, 42 (9):714-720.
[6]	RECTOR T S, KUBO S H, COHN J N, et al.Patients self-assessment of their congestive heart failure, part2:content, reliability and validity of a new measure the Minnesota living with heart failure questionnaire[J].Heart Failure, 1987:198-190.
[7]	TAYLOR R S, SAGAR V A, DAVIES E J, et al.Exercise-based rehabilitation for heart failure[J].Cochrane Database Syst Rev, 2014, 4:CD003331.
[8]	MALFATTO G, BRANZI G, OSCULATI G, et al.Improvement in left ventricular diastolic stiffness induced by physical training in patients with dilated cardiomyopathy[J].J Card Fail, 2009, 15:327-333.
[9]	RITT L E, MYERS J, STEIN R, et al.Additive prognostic value of a cardiopulmonary exercise test score in patients with heart failure and intermediate risk[J].Int J Cardiol, 2015, 178:262-264.
[10]	ARENA R, MYERS J, ABELLA J, et al.Development of a ventilatory classification system in patients with heart failure[J].Circulation, 2007, 115:2410-2417.
[11]	JAUSSAUD J, AIMABLE L, DOUARD H.The time for a new strong functional parameter in heart failure:the VE/VCO2 slope[J].Int J Cardiol, 2011, 147:189-190.
[12]	CORNELIS J, TAEYMANS J, HENS W, et al.Prognostic respiratory parameters in heart failure patients with and without exercise oscillatory ventilation-a systematic review and descriptive meta-analysis[J].Int J Cardiol, 2015, 182:476-486.
[13]	EDELMANN F, GELBRICH G, DÜNGEN H D, et al.Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction[J].JACC, 2011, 58, 1780-1791.
[14]	LEWIS E F, LAMAS G A, O'MEARA E, et al.CHARM Investigators:characterization of health-related quality of life in heart failure patients with preserved versus low ejection fraction in CHARM[J].Eur J Heart Fail, 2007, 9:83-91.
[15]	NOLTE K, HERRMANN-LINGEN C, WACHTER R, et al.Effects of exercise training on different quality of life dimensions in heart failure with preserved ejection fraction:the Ex-DHF-P trial[J].Eur J Prev Cardiol, 2015, 22, 582-593.