摘要
目的:探讨心肺运动测试(Cardiopulmonary exercise test,CPET)指导下心脏康复治疗对老年冠心病射血分数保留型心力衰竭(HFpEF)患者心肺功能、运动耐量及生活质量的影响.方法:回顾性分析昆明市第二人民医院2020 年6 月至2022 年5 月收治的103 例老年冠心病HFpEF患者的临床资料,按治疗方式不同分为对照组(51 例)、观察组(52 例),对照组予以常规对症治疗,观察组在此基础上予以CPET指导下心脏康复治疗,持续治疗12 周.比较两组治疗前后心肺功能[无氧阈(AT)、峰值氧耗量(VO2 peak)、运动持续时间(ED)、通气二氧化碳斜率(VE/VCO2 slop)]、心肌酶谱[肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)、乳酸脱氢酶(LDH)]、N-末端前体脑利钠肽(NT-proBNP)、运动耐量[6 min步行距离(6 MWT)]、明尼苏达心力衰竭生活质量表(LHFQ)评分、预后情况(1 年再住院率、1 年内死亡率).结果:治疗后观察组AT、VO2 peak、ED分别为(14.65±2.03)(mL·kg-1·min-1)、(25.32±2.57)(mL·kg-1·min-1)、(436.89±46.85)s高于对照组的(11.24±1.95)(mL·kg-1·min-1)、(21.65±2.49)(mL·kg-1·min-1)、(378.46±46.18)s,VE/VCO2 slop 为(30.27±2.75)mmoL/L低于对照组的(35.05±2.80)mmoL/L,差异具有统计学意义(P＜0.05);治疗后观察组 CK-MB、CK、LDH、NT-proBNP 分别为(136.84±24.35)IU/L、(28.48±4.29)IU/L、(26.48±5.85)IU/L、(1535.25±32.09)pg/mL 低于对照组的(325.45±35.48)IU/L、(56.26±5.84)IU/L、(49.32±6.88)IU/L、(1716.73±39.42)pg/mL,差异具有统计学意义(P＜0.05);治疗后观察组 6 MWT 为(405.46±52.28)m 大于对照组的(345.19±48.64)m,差异具有统计学意义(P＜0.05);治疗后观察组 LHFQ 量表情绪领域、身体领域、其他领域及总分分别为(8.26±1.95)分、(22.49±3.68)分、(21.58±3.39)分、(56.29±5.39)分低于对照组的(11.38±2.26)分、(25.55±3.80)分、(24.68±3.97)分、(63.45±6.98)分,差异具有统计学意义(P＜0.05);观察组1年再住院率15.38%、1 年内死亡率 5.77%与对照组 31.37%、15.69%比较,差异无统计学意义(P＞0.05).结论:CPET指导下心脏康复治疗可抑制老年冠心病 HFpEF 患者心肌酶谱水平,改善其心肺功能,有利于提高患者运动耐量及生活质量.
Abstract
Objective:To explore the effects of cardiopulmonary exercise testing(CPET)-guided cardi-ac rehabilitation on cardiorespiratory function,exercise tolerance,and quality of life in elderly patients with coronary heart disease(CHD)and heart failure with preserved ejection fraction(HFpEF).Methods:A retro-spective analysis was conducted on the clinical data of 103 elderly patients with coronary heart disease and HF-pEF admitted to Kunming Second People's Hospital from June 2020 to May 2022.Patients were divided into two groups:the control group(51 cases)and the observation group(52 cases).The control group received conventional symptomatic treatment,while the observation group received CPET-guided cardiac rehabilitation in addition to the conventional treatment for 12 weeks.Changes in cardiorespiratory function[anaerobic threshold(AT),peak oxygen consumption(VO2 peak),exercise duration(ED),and ventilatory equivalent for carbon dioxide slope(VE/VCO2 slope)],myocardial enzyme levels[creatine kinase-MB(CK-MB),creatine kinase(CK),and lactate dehydrogenase(LDH)],N-terminal pro-brain natriuretic peptide(NT-proBNP),exercise tolerance[6-minute walk test(6 MWT)],Minnesota Living with Heart Failure Question-naire(LHFQ)scores,and prognosis(1-year readmission rate and 1-year mortality rate)were compared be-fore and after treatment.Results:After treatment,the observation group showed significantly higher AT 14.65±2.03mL·kg-1·min-1,VO2 peak mL·kg-1·min-1,and ED[(436.89±46.85)s]compared to the con-trol group(11.24±1.95)mL·kg-1·min-1,(21.65±2.49)mL·kg-1·min-1,and(378.46±46.18)s,re-spectively.The VE/VCO2 slope in the observation group(30.27±2.75)mmoL/L was lower than in the con-trol group(35.05±2.80)mmoL/L,with statistically significant differences(P＜0.05).The observation group also had lower levels of CK-MB(136.84±24.35)IU/L,CK(28.48±4.29)IU/L,LDH(26.48±5.85)IU/L,and NT-proBNP(1535.25±32.09)pg/mL compared to the control group(325.45±35.48)IU/L,(56.26±5.84)IU/L,(49.32±6.88)IU/L,and(1716.73±39.42)pg/mL respectively,with statistically signifi-cant differences(P＜0.05).The 6 MWT in the observation group[(405.46±52.28)m]was greater than in the control group[(345.19±48.64)m],with a statistically significant difference(P＜0.05).LHFQ scores for emotional,physical,and other domains,as well as the total score,were significantly lower in the observa-tion group[(8.26±1.95)points,(22.49±3.68)points,(21.58±3.39)points,and(56.29±5.39)points]compared to the control group[(11.38±2.26)points,(25.55±3.80)points,(24.68±3.97)points,and(63.45±6.98)points],with statistically significant differences(P＜0.05).The 1-year readmis-sion rate and 1-year mortality rate in the observation group were 15.38%and 5.77%,respectively,compared to 31.37%and 15.69%in the control group,with no statistically significant difference(P＞0.05).Conclu-sion:CPET-guided cardiac rehabilitation can suppress myocardial enzyme levels,improve cardiorespiratory function,and enhance exercise tolerance and quality of life in elderly patients with coronary heart disease and HFpEF.
基金项目
昆明市卫生科技人才培养项目医学科技学科后备人才(千工程)培养计划(2023-SW后备-74)
国家科技期刊平台
NSTL
万方数据