冠脉多支病变部分血运重建术后心脏康复的疗效及其可能的作用机制  

Effect of cardiac rehabilitation after partial revascularization in patients with multivessel coronary disease and its possible mechanism

作　　者：高扬 郝文君[1] 夏霏[1] 张晓娇 肖美玲 栾波[1] 苗志林[1] GAO Yang;HAO Wen-jun;XIA Fei;ZHANG Xiao-jiao;XIAO Mei-ling;LUAN Bo;MIAO Zhi-lin(Department of Cardiology,People's Hospital of Liaoning Province,Shenyang,Liaoning,110016,China)

机构地区：[1]辽宁省人民医院心血管内科,辽宁沈阳110016 [2]辽宁省人民医院康复科,辽宁沈阳110016

出　　处：《心血管康复医学杂志》2021年第6期637-642,共6页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：辽宁省自然科学基金指导计划(20170540539)。

摘　　要：目的:观察心脏康复(CR)对冠脉多支病变进行部分血运重建术的冠心病(CHD)患者的疗效并探讨其可能的作用机制。方法:2017年3月至2018年11月195例多支病变的CHD患者被随机分为完全血运重建组(98例,主要冠脉血管病变完全处理,接受常规治疗和宣教)和部分血运重建康复干预组(CR组,97例,对主要冠脉血管病变作部分处理,其余同完全血运重建组,并接受CR运动处方),两组均干预1年。观察比较两组干预前、1年后左室舒张末内径(LVEDd)、LVEF、6min步行距离(6MWD)、健康状况调查简表12项(SF-12)评分、血清一氧化氮(NO)、一氧化氮合酶(NOS)、超氧化物歧化酶(SOD)和血管内皮生长因子(VEGF)水平。结果:与完全血运重建组比较,干预1年后CR组6MWD[(418.80±24.42)m比(556.70±55.67)m]、SF-12的生理总评分[(55.27±7.86)分比(78.91±16.89)分]、心理总评分[(55.50±11.95)分比(80.75±6.34)分]、血清NO[(78.80±3.94)μmol/L比(104.80±6.80)μmol/L]、NOS[(68.90±2.42)U/ml比(87.70±5.58)U/ml]、SOD[(101.00±2.98)U/ml比(113.80±5.57)U/ml]水平均显著升高,血清VEGF水平[(280.10±24.76)ng/L比(223.10±12.07)ng/L]显著降低,P均<0.01。结论:对于多支冠脉病变行部分血运重建术患者心脏康复是有效的,它可通过改善一氧化氮合酶系统与抗氧化系统并降低血管内皮生长因子水平发挥作用。Objective:To observe therapeutic effect of cardiac rehabilitation(CR)on patients with coronary heart disease(CHD)who underwent partial revascularization for multivessel coronary disease and explore its possible mechanism.Methods:A total of 195 CHD patients with multivessel coronary disease from Mar 2017 to Nov 2018 were randomly divided into complete revascularization group(n=98,received complete treatment of major coronary lesion,and routine treatment and education)and partial revascularization rehabilitation intervention group(CR group,n=97,received partial treatment of major coronary lesion,the rest were the same as complete revascularization group,but they received CR exercise prescription),both groups were intervened for one year.Left ventricular end-diastolic dimension(LVEDd),LVEF,6min walking distance(6MWD),score of 12-item short form health survey(SF-12),serum levels of nitric oxide(NO),nitric oxide synthase(NOS),superoxide dismutase(SOD)and vascular endothelial growth factor(VEGF)were observed and compared between two groups before and one year after intervention.Results:Compared with complete revascularization group after one-year intervention,there were significant rise in 6MWD[(418.80±24.42)m vs.(556.70±55.67)m],total physiological score[(55.27±7.86)scores vs.(78.91±16.89)scores],total psychological score[(55.50±11.95)scores vs.(80.75±6.34)scores]of SF-12,serum levels of NO[(78.80±3.94)μmol/L vs.(104.80±6.80)μmol/L],NOS[(68.90±2.42)U/ml vs.(87.70±5.58)U/ml]and SOD[(101.00±2.98)U/ml vs.(113.80±5.57)U/ml],and significant reduction in serum VEGF level[(280.10±24.76)ng/L vs.(223.10±12.07)ng/L]in CR group,P<0.01 all.Conclusion:Cardiac rehabilitation is effective for patients with multivessel coronary disease and receive partial revascularization.It may play role by improving nitric oxide synthase system and antioxidant system and reducing VEGF level.

关 键 词：冠心病 心肌血管重建术 康复 

分 类 号：R541.409[医药卫生—心血管疾病]