不同类型急性冠状动脉综合征患者经皮冠状动脉介入治疗后心肺耐力特征分析  

Characteristic of cardiopulmonary fitness in patients with different types of acute coronary syndrome undergoing percutaneous coronary intervention

作　　者：桂沛君 吴坚[1] 张勃[1] 聂姗[2] 贾楠[2] 周力[3] 姚道阔[3] 谢瑛[1] GUI Peijun;WU Jian;ZHANG Bo;NIE Shan;JIA Nan;ZHOU Li;YAO Daokuo;XIE Ying(Department of Rehabilitation Medicine,Capital Medical University Affdialed Beijing Friendship Hospital,Beijing 100050,China)

机构地区：[1]首都医科大学附属,北京友谊医院康复医学科,100050 [2]首都医科大学附属,北京友谊医院呼吸内科,100050 [3]首都医科大学附属,北京友谊医院心内科,100050

出　　处：《心肺血管病杂志》2019年第10期1005-1011,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市卫生系统高层次卫生技术人才培养项目资助(2015-3-004);“友谊种子计划”人才项目(YYZZ2017A29)

摘　　要：目的:探讨不同类型急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后心肺功能差异。方法:采用回顾性研究方法,连续入选首都医科大学附属北京友谊医院,心脏康复数据库中2017年5月至2018年12月,行PCI术的ACS患者48例,根据临床诊断分为ST段抬高型心肌梗死(STEMI)组和非ST段抬高型急性冠状动脉综合征(NSTE-ACS)组,通过心肺运动负荷试验和6 min步行距离评估其心肺功能特点。结果:与STEMI组患者相比,NSTE-ACS组既往心绞痛病史的比例更多(62.9%vs.23.1%,P=0.01),支架置入数更多(P=0.03),LVEF更高[(65.4±5.9)%vs.(57.4±5.6)%,P<0.05],而STEMI组行急诊PCI以及室壁运动异常的比例均显著高于NSTE-ACS组(76.9%vs.零,P=0.00;84.6%vs.28.6%,P=0.001)。STEMI组和NSTE-ACS组在心肺运动负荷试验各个指标以及6 min步行距离结果,差异无统计学意义(P>0.05)。STEMI组和NSTE-ACS组患者的峰值公斤耗氧量占预计值的百分比分别为(67.23±15.50)%和(68.74±11.57)%,提示ACS患者心肺耐力下降。两组患者的峰值负荷占预计值的百分比分别为(66.54±14.23)%和(75.11±20.08)%,提示ACS患者运动能力减退。此外,NSTE-ACS组患者的峰值耗氧量、峰值负荷量均与6 min步行距离间存在显著的正相关(r=0.42,P=0.01;r=0.45,P=0.004),而STEMI组患者上述参数间无显著相关性(P>0.05)。不管是NSTE-ACS组还是STEMI组,其峰值耗氧量与LVEF之间均没有显著的线性关系(P>0.05)。结论:单中心回顾性分析显示,PCI术后的ACS患者,不论是STEMI组还是NSTE-ACS组,均表现为心肺耐力和运动能力的下降。NSTE-ACS组患者的峰值耗氧量与6 min步行距离呈正相关。在临床上,特别是对于NSTE-ACS患者而言,6 min步行试验可能是一个有效便捷的评估手段,用以指导和制定心脏康复处方,以便更好地开展和推广心脏康复。Objective:To investigate the difference of cardiopulmonary function in patients with different types of acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Methods:A retrospective study was conducted on 48 ACS patients who underwent PCI in the cardiology center from May 2017 to December 2018 in the Cardiac Rehabilitation Database of Beijing Friendship Hospital affiliated to Capital Medical University.According to the clinical diagnosis,they were divided into ST-segment elevation myocardial infarction(STEMI)group(n=13)and non-ST-segment elevation acute coronary syndrome(NSTEACS)group(n=35).Cardiopulmonary exercise test and 6-minute walking test were used to evaluate cardiopulmonary function.Results:Compared with STEMI group,NSTE-ACS group had more patients with previous angina pectoris(62.9%vs.23.1%,P=0.01),more stents implantation(P=0.03)and higher left ventricular ejection fraction[(65.4±5.9)%vs.(57.4±5.6)%,P<0.05],while STEMI group had significantly higher proportion of emergency PCI and wall motion abnormality than NSTE-ACS group(76.9%vs.0.0%,P=0.00;84.6%vs.28.6%,P=0.001).By comparing the result of cardiopulmonary exercise test and 6-minute walking distance,we found that there was no significant difference in the above indexes between STEMI group and NSTE-ACS group(P>0.05).The percentage of peak oxygen consumption per kilogram to the predicted value in STEMI group and NSTE-ACS group was(67.2±15.5)%and(68.7±11.6)%respectively,suggesting a decrease in cardiopulmonary fitness in ACS patients.The percentage of peak load to the predicted value in STEMI group and NSTE-ACS group was(66.5±14.2)%and(75.1±20.1)%respectively,suggesting that the exercise tolerance of ACS patients decreased.In addition,there was a significant positive correlation between peak oxygen consumption,peak load and 6-minute walking distance in NSTE-ACS patients(r=0.42,P=0.01;r=0.45,P=0.004),while no significant linear relationships were found in STEMI patients.There was no significant linear relationship between p

关 键 词：急性冠状动脉综合征 经皮冠状动脉介入术 心功能 心肺耐力 

分 类 号：R54[医药卫生—心血管疾病]