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目的:探讨心梗后(PMI)患者递增负荷运动中生理反应与心电图ST段水平变化的关系,旨在根据服用和不服用β-受体阻滞剂患者的不同反应,为心脏康复中适宜运动强度的制定提供依据。方法:46名服用β-受体阻滞剂的和55名不服用β-受体阻滞剂的男性PMI患者,依据改良布鲁斯方案在活动跑台上进行递增负荷运动试验。运动中每30s测量一次摄氧量(VO2)和通气量(VE),每3min记录一次心率血压乘积(RPP)和血乳酸浓度(BL),并连续监测12导心电图。结果:(1)ST段下降水平与VO2、VE和BL的关系,两组患者间无显著差异(P>0.05)。但两组在相同RPP时,其ST段水平却存在显著差异(P<0.01);(2)ST段下降1mm时,患者的VO2、VE和BL分别约为30ml.kg-1.min-1、63L.min-1和5.3mmol.L-1;(3)ST段下降1mm时,服用和不服用β-受体阻滞剂患者的RPP分别为190beats.mmHg.100-1和230 beats.mmHg.100-1。结论:为了减少心肌缺血的发生,结果(2)和(3)中生理指标的数值,应被作为心脏康复中PMI患者运动强度的上限。
OBJECTIVE: To investigate the relationship between the physiological responses during progressive load exercise and changes of ST segment of ECG in patients with post-MI (PMI). The aim is to provide appropriate exercise for cardiac rehabilitation according to the different responses of patients taking and not taking beta-blockers Strength to provide the basis for the formulation. METHODS: Forty-six men with P-blockers and 55 men without P-blockers underwent an incremental load exercise test on a treadmill in accordance with the modified Bruce’s protocol. VO2 and VE were measured every 30s during exercise. Heart rate blood pressure (RPP) and blood lactate concentration (BL) were recorded every 3 minutes, and 12-lead electrocardiogram was continuously monitored. Results: (1) The relationship between the level of ST segment depression and VO2, VE and BL had no significant difference between the two groups (P> 0.05). However, there was a significant difference in ST segment between the two groups (P <0.01) at the same RPP. (2) The VO2, VE and BL were about 30ml.kg-1.min-1 , 63L.min-1 and 5.3mmol.L-1; (3) When the ST segment was decreased by 1mm, the RPP was 190beats.mmHg.100-1 and 230beats respectively with and without β-blocker. mmHg.100-1. CONCLUSIONS: In order to reduce the occurrence of myocardial ischemia, the values of the physiological indicators in results (2) and (3) should be used as the upper limit of exercise intensity in PMI patients during cardiac rehabilitation.