步行运动训练对慢性充血性心衰患者左室结构和血浆B型脑利钠肽水平的影响  

Influence of walking exercise training on heart function, left heart ventricle structure and plasma brain natriureticpeptide concentration in patients with chronic heart failure

作　　者：严华[1] 符春晖[1] 邹恩飞 符允衡 陈丽媛[1] 何东明[1] 黄军章[1] 赵志梅[1] 黄春燕[1] 

机构地区：[1]广西钦州市 第二人民医院心内科,钦州535000 [2]广西钦州市 钦北区人民医院 [3]广西浦北县人民医院

出　　处：《中华物理医学与康复杂志》2011年第5期368-370,共3页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：广西科学研究与技术开发计划项目（桂科攻0592007-2）

摘　　要：目的观察步行运动训练对慢性充血性心衰（CHF）患者左心室结构和血浆B型脑利钠肽（BNP）水平的影响，探寻运动训练的意义。方法将223例心功能分级Ⅱ～Ⅲ级的CHF患者分为处方康复组、非处方康复组和对照组，均给予基础药物治疗，处方康复组和非处方康复组按不同的要求进行康复训练。入选时及6个月随访时对各组进行血压测量、6min步行距离测量和血浆BNP水平测定，并进行心脏超声检查观察左室射血分数（LVEF）和左室舒张末期内径（LVEDd）的变化。结果入选时，各组血压、6min步行距离、左室功能及血浆BNP水平比较，差异均无统计学意义。6个月随访时，处方康复组再次住院例次和其中因心功能恶化再次住院比率明显低于非处方康复组和对照组（P〈0．05）；与运动训练前及其他2组比较，血浆BNP水平明显下降，6min步行距离和LVEF明显提高（P〈0．01），LVEDd则无明显变化。结论步行运动训练可改善CHF患者的运动耐力，降低血浆BNP水平，且安全性好，但短期内对左室的重构尚无积极影响。Objective To study the influence of walking exercise training on heart function, left heart ventricle structure and plasma brain natriuretic peptide （BNP） concentration in patients with chronic heart failure （CHF） , to explore the sense of exercise training. Methods A total of 223 CHF patients were randomly assigned to a guided rehabilitation group, a nonguided rehabilitation group and a control group. All patients were given basic medicine treatment, and the guided rehabilitation group was administered guided walking exercise training program, while the non-guided rehabilitation group was encouraged to do exercise freely but with no guidance. Blood pressure, 6 min walking distance test, plasma concentration of BNP and echocardiography were measured in all patients before and after exercise training. Results At entry to the study, there was no significant difference among the 3 groups with regard to blood pressure, 6 min walking distance and BNP level as well as eehocardiographic parameters including left ventricular ejection fraction （LVEF） and left ventrieular end-diastolic diameter （LVEDd）. A follow-up at the 6th month after intervention, the amount of readmission patients in guided rehabilitation group were significantly less than those in non-guided rehabilitation and control groups （P 〈 0.05）. It was also revealed that the plasma concentration of BNP decreased significantly （ P 〈 0.01 ） ; LVEF and 6 rain walking distance improved significantly （ P 〈 0.01 ） in the guided rehabilitation group when compared with baseline and 6-month follow-up of the non-guided rehabilitation and control groups. However, there observed no significant change with regard to LVEDd. Conclusion Walking exercise training can improve exercise endurance in CHF patients and is safety; but has no influence on left heart ventricular structure in short time.

关 键 词：步行运动训练 慢性心功能不全 脑利钠肽 

分 类 号：R541.6[医药卫生—心血管疾病]