康复运动对老年急性心肌梗死患者心率减速力及连续心率减速力的影响及临床价值研究  

The impact and clinical value of rehabilitation exercise on deceleration capacity of rate and heart rate deceleration runs in elderly patients with acute myocardial infarction

作　　者：闫菲[1] 吴蕊[1] 韩雅琪 王文涛[1] 林松 Yan Fei;Wu Rui;Han Yaqi;Wang Wentao;Lin Song(Heart Center of Henan Provincial People's Hospital,Central China Fuwai Hospital,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou,450008,China;不详)

机构地区：[1]华中阜外医院,河南省人民医院心脏中心,郑州大学华中阜外医院心肺功能科,郑州450008

出　　处：《中国循证心血管医学杂志》2024年第3期300-303,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河南省医学科技攻关项目(LHGJ20200089,LHGJ20190782,LHGJ20220119)。

摘　　要：目的探讨康复运动对老年急性心肌梗死患者心率减速力(DC)和连续心率减速力(DRs)的影响及临床价值。方法选择2021年1月1日至2022年1月1日于华中阜外医院就诊的老年AMI患者62例,剔除失访者2例,最终纳入60例,年龄60~75岁,所有入选患者均行经皮冠状动脉介入治疗(PCI),且术后无严重并发症,采用数字表法随机分为对照组和研究组,每组各30例,两组均按常规采用“药物+PCI”治疗方案,研究组在此基础上由专业的心脏康复医师评定后,给予为期6个月的康复运动治疗,分别于康复治疗前后行24 h动态心电图检查。比较康复运动前后两组患者DC、DRs及心率变异性(HRV)指标的变化,同时观察各组不良心血管事件(MACE)的发生率。结果康复运动前两组24h R-R间期标准差(SDNN)、24h R-R间期平均值的标准差(SDANN)、24h R-R间期差的均方根(RMSSD)、DC、DRs指标比较,差异均无统计学意义(P>0.05),康复运动后研究组SDNN、RMSSD、DC、DR2、DR4值均明显高于对照组,差异有统计学意义(P<0.05)。将两组患者DR8值治疗前后的差值进行比较,研究组DR8差值高于对照组,差异有统计学意义(P<0.05)。随访期间两组均无MACE事件发生。结论心脏康复运动能显著提高老年AMI患者PCI术后DC与DRs值,改善其自主神经功能,相对安全有效,值得临床推广。Objective To explore the impact and clinical value of cardiac rehabilitation exercise on deceleration capacity of rate and heart rate deceleration runs in elderly patients with acute myocardial infarction.Methods A total of 62 elderly AMI patients treated by PCI were selected in Central China Fuwai Hospital from January 1,2021,to January 1,2022,of which two cases of loss to follow-up were excluded and 60 cases were finally included in the analysis,aged 60~75 years.They were divided into a control group(n=30)and a study group(n=30)according to the random number table method.The control group received conventional drug treatment.On this basis,the study group was given rehabilitation exercise therapy for six months after being evaluated by a rehabilitation physician.The study group received rehabilitation exercise training based on the treatment plan of the control group.Both groups of patients underwent 24-hour Holter ECG before and after rehabilitation exercise.The changes in DC,DRs and heart rate variability(HRV)in two groups of patients before and after rehabilitation exercises were compared,and the incidence of major adverse cardiovascular events(MACE)in each group was observed.Results There was no significant difference between SDNN,SDANN,RMSSD,DC and DRs in the two groups before the rehabilitation exercise(P>0.05).The SDNN,RMSSD,DC,DR2,and DR4 values of the study group after the rehabilitation exercise were significantly higher than those of the control group.Compared to the D-value of DR8 between the two groups before and after treatment,the DR8 values in the study group were higher than those in the control group,and the difference was statistically significant(P<0.05).The incidence rate of MACE in the two groups was zero during the follow-up period.Conclusion Rehabilitation exercise training can significantly improve the values of HRV,DC,and DRs in elderly AMI patients after PCI,improve their autonomic nervous function,and be relatively safe and effective,which is worthy of clinical promotion.

关 键 词：急性心肌梗死 心率减速力 心率变异性 

分 类 号：R542.22[医药卫生—心血管疾病]