Effects of exercise rehabilitation on cardiopulmonary function and outcomes in patients after PCI
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摘要: 目的 观察心脏运动康复对冠心病患者经皮冠状动脉介入治疗(PCI)术后心肺功能及预后的影响。方法 纳入2019年11月—2021年7月在上海中医药大学附属普陀医院心内科接受PCI术的患者103例，在对患者进行心脏康复教育的基础上，根据患者的意愿分为自我锻炼组(51例)和运动指导组(52例)，时间3个月。对比治疗前后及组间临床指标、有氧运动能力评估[心肺运动试验(CPET)]及心血管事件发生情况统计，并比较血脂、血糖、左心室射血分数以及代谢当量、最大公斤摄氧量、无氧阈等变化。结果 与干预前相比，自我锻炼组患者干预后最大运动负荷增加，最大公斤摄氧量、代谢当量和氧脉搏差异降低(P< 0.05)。与干预前相比，运动指导组患者干预后最大运动负荷、最大公斤摄氧量、代谢当量、无氧阈、氧脉搏差异和峰值心率均升高(P< 0.05)。与自我锻炼组相比，运动指导组最大运动负荷、最大公斤摄氧量、代谢当量、无氧阈、氧脉搏差异和峰值心率均升高(P< 0.05)。结论 运动康复治疗可明显提升PCI术后患者的心肺功能，从而提高生活质量。Abstract: Objective To observe the effect of cardiac exercise rehabilitation on cardiopulmonary function and prognosis in patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods A total of 103 patients who underwent PCI were included in Putuo Hospital from November 2019 to July 2021. On the basis of cardiac rehabilitation education for patients, they were divided into self-exercise group according to their wishes(51 cases) and exercise instruction group(52 cases) for 3 months. The clinical indicators, aerobic exercise capacity assessment(cardiopulmonary exercise test CPET) and the incidence of cardiovascular events were compared before and after treatment.Results Compared with before the intervention, the maximum exercise load of the patients in the self-exercise group increased after the intervention, and the difference in the maximum kilogram oxygen uptake, metabolic equivalent and oxygen pulse decreased(P< 0.05). Compared with before intervention, the maximum exercise load, maximum kg oxygen uptake, metabolic equivalent, anaerobic threshold, oxygen pulse difference and peak heart rate of patients in the exercise instruction group increased after intervention(P< 0.05). Compared with the self-exercise group, the maximum exercise load, maximum kg oxygen uptake, metabolic equivalent, anaerobic threshold, oxygen pulse difference and peak heart rate were all increased in the exercise instruction group(P< 0.05).Conclusion Exercise rehabilitation therapy can significantly improve the cardiopulmonary function of patients after PCI, thereby improve the quality of life.
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表 1 两组基线资料的比较
Table 1. General data
X±S 项目 自我锻炼组(51例) 运动指导组(52例) P值 男/例(%) 42(82.4) 43(82.7) 0.964 年龄/岁 63.90±8.08 60.00±8.08 0.365 BMI/(kg·m-2) 24.82±2.95 25.28±3.07 0.697 吸烟史/例(%) 27(52.9) 31(59.6) 0.495 合并高血压/例(%) 39(76.5) 32(61.5) 0.102 合并糖尿病/例(%) 20(38.5) 17(32.7) 0.490 病变血管数/例(%) 0.960 1支 21(41.2) 22(42.3) 2支 13(25.5) 14(26.9) ≥3支 17(33.3) 16(30.8) 置入支架数/例(%) 0.539 1枚 33(64.7) 29(55.8) 2枚 9(17.6) 15(28.8) ≥3枚 9(17.6) 8(15.4) 
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表 2 两组干预前后临床及心肺功能指标的比较
Table 2. Comparison of clinical and cardiopulmonary function indexes before and after the intervention in the two groups
项目 自我锻炼组(51例) 运动指导组(52例) 干预前 干预后 干预前 干预后 LVEF/% 60.00±7.48 59.50±7.19 58.10±8.92 58.10±7.67 总胆固醇/(mmol·L-1) 3.81±0.96 3.77±0.93 4.11±1.00 3.90±0.95 甘油三酯/(mmol·L-1) 1.51±0.71 1.43±0.61 1.60±0.85 1.43±0.61 低密度脂蛋白/(mmol·L-1) 2.44±0.77 2.35±0.72 2.71±0.80 2.52±0.75 高密度脂蛋白/(mmol·L-1) 1.12±0.24 1.12±0.24 1.09±0.21 1.11±0.27 血糖/(mmol·L-1) 6.46±2.01 6.48±1.91 6.29±2.04 6.61±2.49 最大运动负荷/W 77.49±22.30 81.51±23.671) 80.52±29.56 89.54±28.742)3) 最大公斤摄氧量/(mL·min-1·kg-1) 16.13±3.26 15.01±2.332) 15.78±3.40 18.10±3.522)3) 代谢当量 4.62±0.93 4.29±0.672) 4.50±0.97 5.17±1.002)3) 无氧阈/(mL·min-1·kg-1) 10.17±2.30 9.78±1.59 9.77±2.22 11.67±2.142)3) 氧脉搏/(mL·beat-1) 10.25±2.24 9.63±2.121) 10.05±1.81 10.82±2.172)3) 峰值心率/(次·min-1) 112.84±17.70 112.49±18.25 112.35±17.84 119.90±15.672)3) 二氧化碳通气当量 31.68±3.69 32.12±3.43 30.67±3.95 30.42±3.88 与干预前比较，1)P < 0.05，2)P < 0.01；两组之间干预前后指标差值比较，3)P < 0.01。
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表 3 两组干预3个月内心血管事件发生情况比较
Table 3. Comparison of cardiovascular events within three months intervention in the two groups
例(%) 组别 心绞痛复发 心力衰竭 再发心梗 死亡 自我锻炼组(51例) 3(0.06) 1(0.02) 0(0) 0(0) 运动指导组(52例) 0(0) 3(0.06) 0(0) 0(0)
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