不同强度呼吸肌训练联合“七步法”康复训练对老年急性心肌梗死患者PCI后肺功能及运动耐力的影响  

Effect of Different Intensities of Respiratory Muscle Training Combined with"Seven-Step"Rehabilitation Raining on Pulmonary Function and Exercise Endurance in Elderly Patients with Acute Myocardial Infarction after PCI

作　　者：刘欣源 积腾飞 刘丹[1] 陈素珲 张娟丽[1] 薛嘉虹 LIU Xinyuan;JI Tengfei;LIU Dan;CHEN Suhui;ZHANG Juanli;XUE Jiahong(Department of Cardiovascular Medicine,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710015,China)

机构地区：[1]西安交通大学第二附属医院心血管内科,陕西省西安市710015

出　　处：《实用心脑肺血管病杂志》2025年第1期103-107,113,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：国家自然科学基金资助项目(82360608);陕西省重点研发计划项目(2024SF-YBXM-014)。

摘　　要：目的探讨不同强度呼吸肌训练(RMT)联合“七步法”康复训练对老年急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后肺功能及运动耐力的影响。方法前瞻性选取2022年4月—2024年1月在西安交通大学第二附属医院心血管内科就诊的老年AMI患者90例。依据患者意愿将其分为传统组(n=25)和联合组(n=65),采用随机数字表法将联合组患者进一步分为低强度RMT组(n=32)和高强度RMT组(n=33)。传统组患者接受“七步法”康复训练,联合组患者在传统组的基础上接受不同强度的RMT,其中低强度RMT组初始最大吸气压(MIP)强度设置为30%,每周递增5%;高强度RMT组初始MIP强度设置为60%,每周递增5%。三组患者均训练1个月。比较三组干预前后肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)/FVC、最大呼气中期流量(MMEF)、MIP],干预后运动耐力指标[无氧阈摄氧量(VO_(2)@AT)、摄氧效率斜率(OUES)],干预前后改良呼吸困难指数(mMRC)量表评分、功能独立性测量量表(FIM)评分。结果干预后低强度RMT组、高强度RMT组FVC、MIP分别高于本组干预前,干预后三组MMEF分别高于本组干预前(P<0.05)。干预后,高强度RMT组FVC、MIP高于传统组(P<0.05)。干预后,高强度RMT组VO_(2)@AT高于传统组,低强度RMT组和高强度RMT组OUES高于传统组(P<0.05)。干预后低强度RMT组和高强度RMT组mMRC量表评分分别低于本组干预前,FIM评分分别高于本组干预前(P<0.05)。干预后,低强度RMT组和高强度RMT组FIM评分高于传统组(P<0.05)。结论低强度RMT联合“七步法”康复训练可提高老年AMI患者PCI后运动耐力及生活独立性;高强度RMT联合“七步法”康复训练可提高老年AMI患者PCI后肺功能、运动耐力及生活独立性。Objective To investigate the effect of different intensities of respiratory muscle training(RMT)combined with"seven-step"rehabilitation training on pulmonary function and exercise endurance in elderly patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods A total of 90 elderly patients with AMI admitted to the Department of Cardiovascular Medicine of the Second Affiliated Hospital of Xi'an Jiaotong University from April 2022 to January 2024 were prospectively selected.Based on the preferences of the patients,they were divided into traditional group(n=25)and combined group(n=65).The combined group was further divided into low-intensity RMT group(n=32)and high-intensity RMT group(n=33)by random number table method.The traditional group underwent"seven-step"rehabilitation training,while the combined group received different intensities of RMT on the basis of the traditional group:the initial maximum inspiratory pressure(MIP)intensity of the low-intensity RMT group was set at 30%,with a weekly increment of 5%;the initial MIP intensity of the high-intensity RMT group was set at 60%,with a weekly increment of 5%.All three groups of patients were trained for 1 month.The pulmonary function indexes[forced vital capacity(FVC),forced expiratory volume in one second(FEV1)/FVC,maximal mid-expiratory flow(MMEF),MIP]before and after intervention,exercise endurance indexes[oxygen uptate per kilogram at anaerobic threshold(VO_(2)@AT)and oxygen uptake efficiency slope(OUES)]after intervention,as well as the modified Medical Research Council(mMRC)scale score and Functional Independence Measure(FIM)score before and after intervention were compared among the three groups.Results After intervention,FVC and MIP in the low-intensity RMT group and the high-intensity RMT group were higher than those before intervention,and the MMEF in the three groups was higher than that before intervention,respectively(P<0.05).After intervention,FVC and MIP were higher in the high-intensity RMT group than in

关 键 词：心肌梗死 老年人 经皮冠状动脉介入治疗 呼吸锻炼 运动疗法 呼吸功能试验 身体耐力 

分 类 号：R542.22[医药卫生—心血管疾病]