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目的探讨稳定型慢性心力衰竭患者实施康复运动的安全性及疗效。方法 106稳定型慢性心力衰竭患者,随机分成对照组(52例,常规治疗)和运动康复组(54例,在常规治疗基础上接受运动训练)。观察并比较两组患者超声心动图测定左室射血分数(LVEF)和左室舒张末期内径(LVEFd),同时测定6 min步行距离(6MWD),血浆脑钠肽(BNP)水平,最大摄氧量(VO_2max),记录10个月内的再入院率和死亡率。结果运动康复组与对照组相比,LVEF[(63.4±2.7)%VS(52.5±3.2)%]、LVEDd[(39.2±4.3)mmlVS(50.6±3.3)mm]改善更显著,差异有统计学意义(P<0.05);6MWD[(177.6±5.7)mlVS(132.5±5.2)m]明显增加(P<0.01);血浆BNP水平[(30.4±4.9)pg/ml VS(41.4±4.8)pg/ml]明显降低(P<0.05);VO2max[(27.3±1.1)ml/(kg·min)VS(20.3±2.1)ml/(kg·min)]改善更显著(P<0.05)。随访10个月,运动康复组患者的心力衰竭再发率为40.74%,对照组为57.69%,两组比较差异有统计学意义(P<0.05);运动康复组心肌梗死率为37.04%,对照组为50.00%,两组比较差异有统计学意义(P<0.05);运动康复组猝死率为20.37%,对照组为36.54%,两组比较差异有统计学意义(P<0.05)。结论稳定型慢性心力衰竭患者实施运动康复治疗安全有效,可以明显改善心力衰竭患者的预后,值得临床推广与应用。
Objective To investigate the safety and efficacy of rehabilitation exercise in patients with stable chronic heart failure. Method 106 patients with stable chronic heart failure were randomly divided into control group (52 cases, routine treatment) and sports rehabilitation group (54 cases, receiving exercise training on the basis of routine treatment). The left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEFd) were measured and compared by echocardiography. The 6-minute walking distance (6MWD), plasma BNP level and maximum oxygen uptake Volume (VO_2max), recording readmissions and death rates within 10 months. Results Compared with the control group, LVEF (63.4 ± 2.7)% VS (52.5 ± 3.2)% and LVEDd [(39.2 ± 4.3) mmlVS (50.6 ± 3.3) mm] improved more significantly in the sports rehabilitation group (P <0.01). The level of BNP in plasma [(30.4 ± 4.9) pg / ml vs (41.4 ± 4.8) pg / ml] (P <0.05); VO2max [(27.3 ± 1.1) ml / (kg · min) vs (20.3 ± 2.1) ml / (kg · min)] improved more significantly (P <0.05). After 10 months of follow-up, the recurrence rate of heart failure was 40.74% in exercise rehabilitation group and 57.69% in control group, the difference was statistically significant (P <0.05). The rate of myocardial infarction in exercise rehabilitation group was 37.04% (P <0.05). The rate of sudden death in sports rehabilitation group was 20.37%, while the control group was 36.54%. The difference between the two groups was statistically significant (P <0.05). Conclusion Patients with stable chronic heart failure exercise rehabilitation exercise safe and effective, can significantly improve the prognosis of patients with heart failure, it is worth clinical promotion and application.