摘要
目的:探究多维度康复措施对急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)术后的恢复效果.方法:选择2021年6月～2022年9月溧阳市人民医院收治的96例行PCI术的AMI患者,按照随机数字表分为常规康复组(术后常规康复治疗)与多维度康复组(在常规康复组基础上加以多维度康复治疗),每组48例.训练2周后,比较两组心功能、相关生化指标、运动能力、心理弹性、生活质量及心脏不良事件情况.结果:干预2周后,与常规康复组相比,多维度康复组患者左室射血分数(LVEF)[(55.46±2.12)％比(58.59±1.85)％]和超氧化物歧化酶(SOD)[(84.37±2.77)U/ml 比(92.92±2.96)U/ml]、总抗氧化能力(T-AOC)[(12.06±1.54)U/ml 比(15.45±1.50)U/ml]、分泌型卷曲相关蛋白 5(SFRP5)[(3.14±0.37)μg/L 比(4.13±0.33)μg/L]水平均显著提高(P均＜0.001),左心室收缩末期内径(LVESd)[(40.72±1.20)mm比(38.95±1.12)mm]和左心室舒张末期内径(LVEDd)[(51.45±2.10)mm比(49.93±1.63)mm]显著减小,丙二醛(MDA)[(4.14±0.21)nmol/L 比(3.76±0.18)nmol/L]、平均血小板体积/淋巴细胞比值(MPVLR)[(6.22±0.59)比(5.17±0.61)]水平均显著降低(P均＜0.001),运动持续时间(ED)[(408.19±28.42)s 比(433.20±29.53)s]、最大摄氧量(VO2 max)[(13.24±2.25)ml·kg-1·min-1 比(17.57±2.39)ml·kg-1·min-1]、无氧阈(AT)[(11.64±0.87)ml·kg-1·min-1 比(14.15±0.90)ml·kg-1·min-1]、6min 步行距离(6MWD)[(474.33±17.93)m 比(523.55±22.56)m]、心理弹性量表(CD-RISC)评分[(56.22±2.88)分比(61.96±2.87)分]、健康状况调查简表(SF-36)评分[(562.50±13.10)分比(639.58±15.50)分]均显著增加(P均＜0.001),心脏不良事件发生率(43.75％比20.83％)显著降低(P=0.016).结论:对AMI患者PCI术后进行及时的心脏康复运动和支持性心理干预,可有效改善患者的心脏功能和运动能力,减少心脏不良事件发生,增强患者的心理弹性,改善生活质量,值得推广.
Abstract
Objective:To explore the recovery effect of multidimensional rehabilitation measures on patients with a-cute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods:This randomized con-trolled study enrolled 96 AMI patients undergoing PCI admitted Liyang People's Hospital between June 2021 and Sep-tember 2022.They were divided into routine rehabilitation group(RR group,n=48,routine rehabilitation therapy after PCI)and multidimensional rehabilitation group(MR group,n=48,multidimensional rehabilitation therapy based on RR group).After 2-week training,cardiac function,related biochemical indicators,exercise ability,psychological resilience,quality of life and incidence of adverse cardiac events were compared between two groups.Results:After 2-week training,compared with patients in RR group,those in MR group had significant higher left ventricular ejection fraction(LVEF)[(55.46±2.12)％vs.(58.59±1.85)％],superoxide dismutase(SOD)[(84.37±2.77)U/ml vs.(92.92±2.96)U/ml],total antioxidant capacity(T-AOC)[(12.06±1.54)U/ml vs.(15.45±1.50)U/ml],secreted frizzled-related protein 5(SFRP5)[(3.14±0.37)μg/L vs.(4.13±0.33)μg/L](P＜0.001 all),significant lower left ventricular end-systolic diameter(LVESd)[(40.72±1.20)mm vs.(38.95±1.12)mm],left ventricular end-diastolic diameter(LVEDd)[(51.45±2.10)mm vs.(49.93±1.63)mm],malondialdehyde(MDA)[(4.14±0.21)nmol/L vs.(3.76±0.18)nmol/L],mean platelet volume-to-lympho-cyte ratio(MPVLR)[(6.22±0.59)vs.(5.17±0.61)](P＜0.001 all),and significant higher exercise duration(ED)[(408.19±28.42)s vs.(433.20±29.53)s],maximum oxygen uptake(VO2max)[(13.24±2.25)ml·kg-1·min-1 vs.(17.57±2.39)ml·kg-1·min-1],anaerobic threshold(AT)[(11.64±0.87)ml·kg-1·min-1 vs.(14.15±0.90)ml·kg-1·min-1],6min walking distance(6MWD)[(474.33±17.93)m vs.(523.55±22.56)m],scores of Connor-Davidson resilience scale(CD-RISC)[(56.22±2.88)points vs.(61.96±2.87)points]and medical outcomes study 36-item short form health survey(SF-36)[(562.50±13.10)points vs.(639.58±15.50)points](P＜0.001 all).We detected significant lower incidence of adverse cardiac events(43.75％vs.20.83％)in MR group compared with RR group(P=0.016).Conclusion:Timely cardiac rehabilitation exercise and supportive psychological intervention can effectively improve cardiac function and exercise capacity,reduce the inci-dence of adverse cardiac events,enhance psychological resilience and improve quality of life in AMI patients after PCI,which is worthy of clinical promotion.
维普
万方数据