CAJ | 학술논문

目的观察步行运动训练对慢性充血性心衰(CHF)患者左心室结构和血浆B型脑利钠肽(BNP)水平的影响,探寻运动训练的意义.方法将223例心功能分级Ⅱ～Ⅲ级的CHF患者分为处方康复组、非处方康复组和对照组,均给予基础药物治疗,处方康复组和非处方康复组按不同的要求进行康复训练.入选时及6个月随访时对各组进行血压测量、6 min步行距离测量和血浆BNP水平测定,并进行心脏超声检查观察左室射血分数(LVEF)和左室舒张末期内径(LVEDd)的变化.结果入选时,各组血压、6 min步行距离、左室功能及血浆BNP水平比较,差异均无统计学意义.6个月随访时,处方康复组再次住院例次和其中因心功能恶化再次住院比率明显低于非处方康复组和对照组(P<0.05);与运动训练前及其他2组比较,血浆BNP水平明显下降,6 min步行距离和LVEF明显提高(P<0.01),LVEDd则无明显变化.结论步行运动训练可改善CHF患者的运动耐力,降低血浆BNP水平,且安全性好,但短期内对左室的重构尚无积极影响.
목적 관찰보행운동훈련대만성충혈성심쇠(CHF)환자좌심실결구화혈장B형뇌리납태(BNP)수평적영향,탐심운동훈련적의의.방법 장223례심공능분급Ⅱ～Ⅲ급적CHF환자분위처방강복조、비처방강복조화대조조,균급여기출약물치료,처방강복조화비처방강복조안불동적요구진행강복훈련.입선시급6개월수방시대각조진행혈압측량、6 min보행거리측량화혈장BNP수평측정,병진행심장초성검사관찰좌실사혈분수(LVEF)화좌실서장말기내경(LVEDd)적변화.결과 입선시,각조혈압、6 min보행거리、좌실공능급혈장BNP수평비교,차이균무통계학의의.6개월수방시,처방강복조재차주원례차화기중인심공능악화재차주원비솔명현저우비처방강복조화대조조(P<0.05);여운동훈련전급기타2조비교,혈장BNP수평명현하강,6 min보행거리화LVEF명현제고(P<0.01),LVEDd칙무명현변화.결론 보행운동훈련가개선CHF환자적운동내력,강저혈장BNP수평,차안전성호,단단기내대좌실적중구상무적겁영향.
Objective To study the influence of walking exercise training on heart function, left heart ventricle structure and plasma brain natriuretie peptide (BNP) concentration in patients with chronic heart failure ( CHF), to explore the sense of exercise training.Methods A total of 223 CHF patients were randomly assigned to a guided rehabilitation group, a non-guided rehabilitation group and a control group.All patients were given basic medicine treatment, and the guided rehabilitation group was administered guided walking exercise training program, while the non-guided rehabilitation group was encouraged to do exercise freely but with no guidance.Blood pressure, 6 min walking distance test, plasma concentration of BNP and echocardiography were measured in all patients before and after exercise training.Results At entry to the study, there was no significant difference among the 3 groups with regard to blood pressure, 6 rain walking distance and BNP level as well as echocardiographic parameters including left ventrieular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDd).A follow-up at the 6th month after intervention, the amount of readmission patients in guided rehabilitation group were significantly less than those in non-guided rehabilitation and control groups ( P < 0.05 ).It was also revealed that the plasma concentration of BNP decreased significantly ( P < 0.01 ) ; LVEF and 6 min walking distance improved significantly ( P < 0.01 ) in the guided rehabilitation group when compared with baseline and 6-month follow-up of the non-guided rehabilitation and control groups.However, there observed no significant change with regard to LVEDd.Conclusion Walking exercise training can improve exercise endurance in CHF patients and is safety; but has no influence on left heart ventricular structure in short time.