心肺联合运动试验在冠心病患者支架植入术后心脏康复中的指导作用  

The guiding effect of cardiopulmonary exercise test on cardiac rehabilitation of patients with coronary heart disease after stent implantation

作　　者：章慧慧[1] 袁红[1] 屠思佳 何海英[1] 沈超峰 李彩荣 张妙林[1] ZHANG Huihui;YUAN Hong;TU Sijia;HE Haiying;SHEN Chaofeng;LI Cairong;ZHANG Miaolin(Cardiac Department of Cardiology,First People's Hospital of Yuhang District,Hangzhou 311100,China)

机构地区：[1]杭州市余杭区第一人民医院心内科,311100

出　　处：《心电与循环》2020年第5期453-456,462,共5页Journal of Electrocardiology and Circulation

基　　金：杭州市科技发展计划项目(173090)。

摘　　要：目的评估心肺联合运动试验(CPET)在冠心病患者冠状动脉支架植入(CSI)后心脏康复中的指导作用。方法将2018年1月至2019年6月余杭区第一人民医院150例CSI患者分为观察组(78例)及对照组(72例)。除常规治疗外,观察组根据CPET结果指导心脏康复锻炼,随访半年。比较两组患者CPET指标、超声心动图、6min步行距离、血脂、血压、血糖以及冠状动脉再狭窄率、再入院率、主要不良心血管事件(MACE)发生率。结果观察组峰值氧耗量、无氧阈氧耗量、运动能量、代谢当量[(23.7±5.3)mL·min^-1·kg^-1,(15.3±4.1)mL·min^-1·kg^-1,(109.1±9.5)W,7.1±1.3]均优于对照组[(20.4±5.1)mL·min^-1·kg^-1,(13.2±3.5)mL·min^-1·kg^-1,(100.6±8.9)W,6.2±1.1],差异均有统计学意义(均P<0.05),左心室射血分数、6 min步行试验距离[(68.5±8.2)%,(465.2±26.8)m]均优于对照组[(61.4±7.2)%,(437.9±23.5)m],差异均有统计学意义(均P<0.05)。观察组血脂、血压、血糖控制率、再入院率、MACE发生率(88.5%,92.3%,94.9%,6.4%,2.6%)亦优于对照组(72.2%,80.6%,86.1%,16.7%,13.9%),差异均有统计学意义(均P<0.05)。结论应用CPET指导心脏康复可以增加CSI术后患者的活动耐力并改善近期预后。Objective To evaluate the guiding effect of cardiopulmonary exercise test(CPET)on cardiac rehabilitation of patients with coronary heart disease(CHD)after stent implantation.Methods 150 CHD patients with stent implantation were divided into observation group(n=78)and control group(n=72).CPET was performed to guiding rehabilitation in observation group in addition to regular treatment for both groups.They were followed up 6 months.CPET parameters,echocardiography,6-minute walking distance,blood lipid,blood sugar,coronary restenosis rate,readmission rate and main adverse cardiovascular events(MACE)were compared between the two groups.Results Peak oxygen consumption,anaerobic threshold oxygen consumption,exercise power,and metabolic equivalent,as well as left ventricular ejection fraction and 6-minute walking distance were significantly higher in observation group[(23.7±5.3)mL·min^-1·kg^-1,(15.3±4.1)mL·min^-1·kg^-1,(109.1±9.5)W,7.1±1.3,(68.5±8.2)%,(465.2±26.8)m]than in control group[(20.4±5.1)mL·min^-1·kg^-1,(13.2±3.5)mL·min^-1·kg^-1,(100.6±8.9)W,6.2±1.1,(61.4±7.2)%,(437.9±23.5)m].The attainment rate of blood lipid,blood sugar and blood pressure were significantly higher,and readmission rate and MACE incidence were significantly lower in observation than in control group(P<0.05).Conclusion CPET guiding cardiac rehabilitation may improve exercise endurance and short-term prognosis of CHD patients with stent implantation.

关 键 词：心肺联合运动试验 冠心病 心脏康复 主要不良心血管事件 

分 类 号：R654.2[医药卫生—外科学]