运动康复对急性心肌梗死患者左室重构和功能的影响  

The impact of exercise rehabilitation on left ventricular remodeling and systolic function in acute myocardial infarction patients

作　　者：江鳌峰[1] 张福春[1] 高炜[1] 李昭屏[1] 赵威[1] 李筱雯[2] 王晓红[2] 张宝慧[2] 

机构地区：[1]北京大学第三医院心内科,100083 [2]北京大学第三医院康复科,100083

出　　处：《中华内科杂志》2006年第11期904-906,共3页Chinese Journal of Internal Medicine

基　　金：卫生部部属(管)医院临床学科重点项目(2004-00301);北京大学"十五";"211"工程重点学科建设项目(93000-246156076)

摘　　要：目的探讨有指导的运动康复对急性心肌梗死(AMI)患者左室重构和收缩功能的影响。方法64例无并发症首发AMI患者随机分为运动组与对照组,对运动组患者进行个体化的运动锻炼指导。采用超声心动图、血N-末端脑钠肽前体(NT-proBNP)及心肺运动试验检测。结果两组患者随访终点时运动组NTpro-BNP水平较基线值下降[(335.64±246.14)ng/L比(845.29±93.48)ng/L,P<0.05],并显著低于对照组[(1099.83±168.75)ng/L];左室射血分数(LVEF)增加[(60.0±8.0)%比(55.0±8.6)%,P<0.05],对照组NT-proBNP及LVEF与基线值比较无统计学意义(P>0.05);运动组患者心室舒张末径(LVDd)无明显变化[(50.3±3.9)mm比(50.7±4.5)mm,P>0.05],而对照组LVDd则较心肌梗死早期增大[(52.6±5.4)mm比(50.9±5.8)mm,P<0.05]。结论运动康复锻炼可改善无并发症AMI患者心脏收缩功能,限制左室的异常重构。Objective To investigate the influence of rehabilitation on left ventricular remodeling and systolic function in acute myocardial infarction patients. Methods Patients meeting the inclusion criteria with uneventful clinical course after a first myocardial infarction were randomly assigned to a 3-month exercise training period （exercise group, n = 35） or a control group （ n = 29）. Before randomization, all patients underwent NT-proBNP test, 2-dimensional echocardiography, and submaximal exercise test. Results （ 1 ） At baseline, there were no significant differences in NT-proBNP, left ventricular end-diastolic diameter （LVDd） and left ventricular ejection fraction （LVEF） between the exercise and control groups. After 3 months, a significant decrease in NT-proBNP was observed only in the exercise group [ from （845.29 ±93.48）ng/L to （335.64 ± 246. 14） ng/L, P 〈0.05], but not in the control group [from （ 1091.62 ±101.78） ng/L to （ 1099. 83 ± 168. 75） ng/L, P 〉0.05） and there was significant difference in NT-proBNP level between the two groups after 3 months （ P 〈 0.01 ）. The LVDd increased in the control group [ from （ 50.9 ± 5. 8 ） to （ 52. 6 ± 5.4） ram, P 〈 0.05 ] but not in the exercise group [ from （50. 7 ± 4. 5） to （ 50. 3 ±3.9 ） mm, P 〉 0. 05 ] and there was significant difference in LVDd between the two groupsafter 3 months （ P 〈 0.05 ）. Conversely, LVEF improved in the exercise group[ from （ 55.0 ± 8.6） % to （60. 0 ± 8.0） % , P 〈 0. 05 ] but not in the control group （ P 〉 0. 05 ） and there was significant difference in LVEF between the two groups after 3 months （ P 〈 0. 05 ）. （ 2 ） NT-proBNP was inversely correlated with LVEF. Conclusions Rehabilitation exercise training under instructions based on family condition in the early and recovery stage of AMI can lower the NT-proBNP level, improve ejection fraction, and prevent the increase of left ventricular end-diastolic diameter. Therefore, it may reduce

关 键 词：心肌梗塞 康复 运动 心室功能 

分 类 号：R542.22[医药卫生—心血管疾病]