老年慢性心力衰竭合并肌少症患者抗阻运动的疗效观察  

Therapeutic effect of resistance exercise in elderly patients with chronic heart failure combined with sarcopenia

作　　者：王增帅[1] 刘雅楠[1] 李玉兰 冯彩霞[1] Wang Zengshuai;Liu Yanan;Li Yulan;Feng Caixia(The Second Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou 014030,China)

机构地区：[1]内蒙古科技大学包头医学院第二附属医院,包头014030

出　　处：《中华老年医学杂志》2024年第9期1107-1113,共7页Chinese Journal of Geriatrics

基　　金：内蒙古自治区自然科学基金项目(2021LHMS08011);2022年度自治区卫生健康科技计划项目(202202255)。

摘　　要：目的探讨中低强度抗阻运动对老年慢性心力衰竭(CHF)合并肌少症患者的疗效及安全性。方法随机对照研究,选取2020年10月至2022年8月至包头医学院第二附属医院心脏内科住院治疗的老年CHF合并肌少症患者100例,按照随机数字量表法分为对照组和干预组,对照组常规给予血管紧张素转化酶抑制剂/血管紧张素受体抑制剂、β受体拮抗剂、利尿剂等标准心力衰竭药物治疗及营养支持、健康教育指导;干预组在对照组治疗的基础上予中低强度抗阻运动。2组均于治疗前及治疗12周后,评估纽约心脏病学会(NYHA)心功能分级、握力、5次起坐时间、6 m步行时间、血清B型利尿钠肽水平;采用人体成分分析仪测定四肢骨骼肌质量指数(ASMI)、内脏脂肪面积、细胞外水分比率;心脏超声测定右心室内径、左心房内径、左心室舒张末期内径、左心室射血分数(LVEF)。比较2组患者治疗前后各指标的变化。12周内每间隔4周通过门诊随访或电话随访训练相关的严重心血管不良事件。结果30例患者因不能坚持运动或者不能按时随访脱落,最终70例患者纳入研究,其中对照组27例、干预组43例。与治疗前比较,干预组12周后握力[(17.73±4.54)kg比(17.00±4.32)kg,t=8.969]、四肢骨骼肌量[(17.57±3.41)kg比(17.24±3.34)kg,t=7.170]、ASMI[(6.02±0.72)kg/m 2比(5.85±0.67)kg/m 2,t=6.866]升高(均P<0.05);5次起坐时间[(14.54±3.21)s比(16.17±3.25)s,t=12.808]、6 m行走时间[(10.76±3.14)s比(12.30±3.24)s,t=9.391]缩短(均P<0.05)。与治疗前比较,干预组12周后左心室舒张末期内径[(58.48±9.71)mm比(59.62±9.07)mm,t=4.552]缩小、LVEF[(35.88±7.92)%比(34.69±7.93)%,t=4.752]升高、细胞外水分比率[(38.92±7.41)%比(39.27±7.74)%,t=6.058]下降(均P<0.05)。随访12周,干预组未发生与训练相关的严重不良事件。两组患者(3.70%比2.33%)严重心血管不良事件发生率差异无统计学意义(P>0.05)。结论结合�ObjectiveTo explore the efficacy and safety of low-and medium-intensity resistance exercise in patients with chronic heart failure(CHF)combined with sarcopenia.MethodsIn the randomized controlled study,100 elderly patients with CHF combined with sarcopenia who were hospitalized in the Department of Cardiology of the Second Affiliated Hospital of Baotou Medical College from October 2020 to August 2022 were selected and divided into the control group and the intervention group according to the randomized numerical scale method.In the control group,angiotensin-converting enzyme inhibitors/angiotensin receptor inhibitors,β receptor antagonists,diuretics and other standard heart failure medications were routinely given,as well as nutritional support,health education and guidance;in the intervention group,low-intensity resistance exercise was given in addition to the treatment of the control group,and the two groups were evaluated for the NYHA cardiac function classification,grip strength,5 times sitting time,6-meter walking time,serum B-type natriuretic peptide level before and after 12 weeks of treatment;limb skeletal muscle mass index(ASMI),visceral fat area,extracellular water ratio were measured by body composition analyzer;right ventricular internal diameter,left atrial internal diameter,left ventricular end-diastolic internal diameter,left ventricular ejection fraction(LVEF)were measured by echocardiography.Changes in each index before and after treatment were compared between the 2 groups.Serious adverse cardiovascular events related to training were followed up by outpatient clinic visits or telephone at 4-week interval over 12 weeks.Results30 cases were dislodged because they could not adhere to the exercise or could not follow up on time,and finally 70 patients were included,27 in the control group and 43 in the intervention group.Compared with pre-treatment,grip strength[(17.73±4.54)kg vs.(17.00±4.32)kg,t=8.969],limb skeletal muscle mass[(17.57±3.41)kg vs.(17.24±3.34)kg,t=7.170],and ASMI[(6.02±0.72)kg

关 键 词：心力衰竭 运动疗法 肌少症 抗阻力训练 

分 类 号：R541.6[医药卫生—心血管疾病] R685[医药卫生—内科学]