12周运动康复对冠心病患者心脏变时性功能和心率恢复值的影响

关键词：冠心病  运动心脏康复  心脏变时性功能  心率恢复  自主神经功能

Keywords:coronary heart disease  exercise-based cardiac rehabilitation  heart chronotropic response  heart rate recovery  autonomic nervous function

摘要：

      摘要 目的：探讨12周运动康复对冠心病患者心脏变时性功能和心率恢复值（HRR1）的影响。 方法：对30例男性冠心病患者进行递增负荷运动试验，根据实验结果将其分为两组，变时性功能正常组（G1，n=19，HRR%≥0.8）；变时性功能不全组（G2，n=11，HRR%＜0.8），并测定受试者运动前、运动中和运动后心率（HR）、摄氧量（VO2）、ST段下降数值和血压。12周运动康复后再次进行递增负荷运动实验，对患者的运动能力和上述指标进行测定分析。 结果：与康复程序前相比，12周康复程序后，G1和G2组的VO2peak、HRR1均有显著增加（G1，8%，P＜0.01；G2，4%，P＜0.05）、（G1，18.6±3.3—23.8±4.5，P＜0.01；G2，12.8±4.2—13.7±3.5，P＜0.05），而G1比G2提高的更加明显。ST段降低显著改善（G1，-0.7±0.5— -0.2±0.5，P＜0.05；G2，-0.9±0.5— -0.3±0.6，P＜0.05）。HRR%有显著增加（G1，84.2±2.5—88.9±6.1，P＜0.05；G2，60.2±8.3—75.8±3.8，P＜0.05）。 结论：12周运动康复可以改善冠心病患者（包括变时性功能正常者和变时性功能不全者）的运动能力，提高冠心病患者运动时自主神经的调节功能，上述积极作用对变时性功能正常者的体现则更为明显。

Abstract:

      Abstract Objective: To study the effects of 12 weeks exercise-based rehabilitation on chronotropic response and heart rate recovery（HRR1） in of coronary heart disease（CHD） patients. Method: Thirty male CHD patients performed a graded exercise test on treadmill. Then, according to the results of exercise test, they were categorized into two groups: chronotropic competence (G1, n=19, HRR%≥0.8), and chronotropic incompetence (G2, n=11, HRR%＜0.8). Heart rate, VO2, ST level and blood pressure were measured before, during and after the exercise test. Each subject was re-tested using the same protocol after 12 week exercise-based cardiac rehabilitation program. Result: After the completion of rehabilitation program there was significant increase of VO2peak and HRR1 for the patients by 8% （P＜0.01） in group G1 and by 4%, （P＜0.05） in group G2, (G1, 18.6±3.3—23.8±4.5, P＜0.01; G2, 12.8±4.2—13.7±3.5, P＜0.05). ST-segment changes improved significantly (G1, -0.7±0.5— -0.2±0.5, P＜0.05; G2, -0.9±0.5— -0.3±0.6, P＜0.05). Both group G1 and group G2 had significant increases in HRR% (G1, 84.2±2.5—88.9±6.1, P＜0.05; G2, 60.2±8.3—75.8±3.8, P＜0.05). Conclusion: Twelve weeks exercise-based rehabilitation can improve exercise capacity and modulating function of cardiac autonomic nervous in coronary heart disease patients both with and without chronotropic competence. The positive role of chronotropic function is more obvious in patients without chronotropic incompetence.