吸烟对老年男性冠心病患者自主神经功能康复的影响

关键词：吸烟  冠心病  运动心脏康复程序  心率变异性  自主神经功能

Keywords:smoking  coronary heart disease  exercise-based cardiac rehabilitation program  heart rate variability  autonomic nerve function

摘要：

      摘要 目的：探索吸烟对老年冠心病患者自主神经功能康复的影响。 方法：33例男性冠心病患者，根据吸烟情况分为吸烟组、不吸烟组，为了能针对吸烟对冠心病患者自主神经功能影响进行定量的分析，本研究又进一步根据吸烟的数量将吸烟组分为轻度亚组（≤20支/日）和重度亚组（＞20支/日）[1]。在心脏康复程序前后对他们进行了运动前（安静时）和递增负荷运动实验后（运动后）的心率变异性（HRV）指标以及辅助指标的测定，其中包括低频功率（LF）、高频功率（HF）、低高频功率比值（LF/HF）、总功率（TP）、心肌缺血（ST段）和心率收缩压双乘积（RPP）。 结果：①康复程序前安静时两组患者间的LF、HF、LF/HF、TP、ST段、RPP未显示出显著性差异；②康复程序前运动后两组患者LF、LF/HF、RPP有升高的趋势，HF、TP、ST段有降低的趋势；③康复程序后安静时，与康复前相比两组患者HF和TP有显著性增高（P＜0.05，P＜0.01），但吸烟组HF、TP的改善程度小于不吸烟组，二者间有显著性差异（P＜0.05），吸烟组的重度亚组HF、TP的改善小于轻度亚组，亚组间有显著性差异（P＜0.05）；④康复程序后运动后，与康复前相比两组患者HF有显著性增高（P＜0.05，P＜0.01），ST段降低显著减少（P＜0.05），LF/HF、RPP有显著性下降（P＜0.05，P＜0.01），吸烟组HF、RPP的改善程度小于不吸烟组，二者间有显著性差异（P＜0.05），吸烟组的亚组间HF有显著性差异（P＜0.05）。 结论：12周运动心脏康复能提高冠心病患者自主神经的调节功能，但是吸烟将降低心脏自主神经功能的恢复效果。

Abstract:

      Abstract Objective： To explore the effects of smoking on rehabilitation of autonomic nerve function in older male patients with coronary heart disease. Method： Thirty-three male patients with coronary heart disease based on smoking or not were divided into two groups. According to number of cigarettes smoking, the smoking group was further divided into two subgroups, relatively mild (≤20/day) and severe (＞20/day) smoking. Then, the subjects undertook a graded exercise test both pre and post the cardiac rehabilitation program, during which time variables of heart rate variability, including low-frequency power (LF), high frequency (HF), low power high frequency power ratios (LF/HF) and total power (TP), ST segment (ST) and rate pressure product (RPP) were measured before and after the tests. Result： ①A non significant difference existed between the two groups for any variables measured at rest pre the program. ②The LF, LF/HF and RPP showed a increasing tendency for both groups after the exercise test pre the program, whereas the HF, TP and ST segment depression demonstrated a decreasing tendency at the same time. ③The HF and TP of the two groups increased significantly (P＜0.05, P＜0.01) at rest post the program compared with those measured pre the program, however the positive effect of this change in smoking group was inferior to that of non smoking group (P＜0.05). This tendency was also showed between the severe smoking subgroup mild smoking subgroup (P＜0.05). ④Compared with values measured pre the program, the HF increased significantly, the LF/HF, RPP and ST depression decreased significantly (P＜0.05, P＜0.01) after the exercise test for both groups post the program. Again, smoking compromised the positive effect of HF and RPP changing during the cardiac rehabilitation program, and a significant difference in HF was observed between the two smoking subgroups (P＜0.05). Conclusion： The function of autonomic nervous in patients with coronary heart disease can be improved through a 12-week exercise based cardiac rehabilitation program, but the recovery effects will be compromised by continuing smoking.