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背景:目前国内慢性心力衰竭患者康复治疗虽有一个较为固定的运动方案,但因运动量过大或过小、依从性差等,不适用于老年及病情稍重的慢性心力衰竭患者。临床工作中需要具有依从性好、运动量适中和可重复性的运动方案。目的:观察慢性心力衰竭患者经运动训练干预后,运动耐量和心功能指标的变化。设计:随机对照的对比观察。对象:选择2002-8/2003-10湖北武汉协和医院老年病科住院的慢性心力衰竭患者70例。患者均知情同意,纽约心脏病协会心功能分级为(2.69±0.13)级,心力衰竭病程均>6个月。随机将患者分为运动组(n=34)和对照组(n=36)。运动组男19例,女15例,心功能分级为(2.68±0.12)级;对照组(n=36),男19例,女17例。方法:运动组患者进行为期3周的自行车测力计训练、平板步行训练和徒步行走训练;对照组患者限制活动3周。所有患者试验前后在自觉劳累程度记分相同的状态下进行6min步行试验;实验前后于清晨空腹抽取肘前静脉血5mL,测定血浆白细胞介素6、去甲肾上腺素水平,并测定左室射血分数。主要观察指标:两组患者干预前后6min步行距离、血浆白细胞介素6、去甲肾上腺素水平及左室射血分数和心功能级别比较。结果:最终进入结果分析慢性心力衰竭患者70例。运动组干预后6min步行距离、左室射血分数明显长于或高于对照组和干预前[385±30)m,(43±5)%;(324±35)m,(39±6)%;(292±30)m,(35±4)%,P<0.05]。运动组干预后血浆白细胞介素6,去甲肾上腺素水平及心功能级别明显低于对照组和干预前[0.86±0.25)pmol/L,(2.05±0.48)nmol/L,(1.89±0.11)级;(1.00±0.25)pmol/L,(2.21±0.47)nmol/L,(2.45±0.12)级;(1.12±0.23)pmol/L,(2.46±0.53)nmol/L,(2.68±0.12)级,P<0.05～0.01]。结论:本文中制定的运动训练方案能改善慢性心力衰竭患者的运动耐力及心功能,具有较好的个体依从性。
BACKGROUND: At present, although there is a relatively fixed exercise program for the rehabilitation of patients with chronic heart failure in China, it is not suitable for elderly and moderately severe patients with chronic heart failure due to over or under exercise and poor compliance. Clinical work needs to have good compliance, exercise moderate and reproducible exercise program. Objective: To observe the changes of exercise tolerance and cardiac function in patients with chronic heart failure after exercise training intervention. Design: Randomized controlled comparison. PARTICIPANTS: Selective 70 patients with chronic heart failure admitted to Department of Geriatrics, Peking Union Medical College Hospital from August 2002 to October 2003. Patients were informed consent, New York Heart Association cardiac function rating (2.69 ± 0.13) grade, duration of heart failure were> 6 months. Patients were randomly divided into exercise group (n = 34) and control group (n = 36). There were 19 males and 15 females in the exercise group, and the heart function was graded as (2.68 ± 0.12). In the control group (n = 36), there were 19 males and 17 females. Methods: The patients in exercise group received bicycle force gauge training, flat walking training and walking training for 3 weeks. The control group patients restricted activity for 3 weeks. All patients before and after the test in the same state of conscious degree of fatigue 6min walking test; before and after the experiment in the morning fasting elbow vein 5mL, determination of plasma interleukin 6, norepinephrine levels, and determination of left ventricular ejection fraction . MAIN OUTCOME MEASURES: The walking distance, plasma interleukin 6, norepinephrine level, left ventricular ejection fraction and cardiac function level in both groups before and after intervention were compared. Results: The final entry into the analysis of 70 patients with chronic heart failure. The walking distance and the left ventricular ejection fraction in the exercise group were significantly longer than or higher than those in the control group and before the intervention (385 ± 30) m, (43 ± 5)%; (324 ± 35) m, (39 ± 6)%, ; (292 ± 30) m, (35 ± 4)%, P <0.05]. The levels of plasma interleukin 6, norepinephrine and cardiac function in exercise group were significantly lower than those in control group and before intervention [(0.86 ± 0.25) pmol / L, (2.05 ± 0.48) nmol / L, (1.89 ± 0.11) (1.12 ± 0.23) pmol / L, (2.46 ± 0.53) nmol / L, (2.68 ± 0.12) Grade, P <0.05 ~ 0.01]. Conclusion: The exercise training program developed in this paper can improve exercise endurance and cardiac function in patients with chronic heart failure and has good individual compliance.