Uchi Masayuki, Saji Tsutomu, Harada Takashi
Department of Physical Medicine and Rehabilitation, School of Medicine, Faculty of Medicine, Toho University, Tokyo.
J Cardiol. 2005 Nov;46(5):183-93.
To evaluate cardiopulmonary rehabilitation in patients with idiopathic pulmonary arterial hypertension who had severe heart failure.
The subjects comprised 11 men and 13 women aged 5 to 37 years old with idiopathic pulmonary arterial hypertension, who received cardiopulmonary rehabilitation following the start of continuous intravenous prostacyclin administration between January 1999 and September 2003. Fifteen patients were categorized in New York Heart Association (NYHA) functional class-III and 9 were class-IV on admission. Patients received cardiopulmonary rehabilitation consisting of breathing exercise, training of upper extremity muscles, gait training, bicycle ergometer training, and treadmill walking for 30 to 60 min per day, 5 days a week. Cardiothoracic ratio, NYHA class, heart rate, pulse oximeter saturation, plasma levels of human atrial natriuretic peptide and brain natriuretic peptide, tricuspid regurgitation, and right ventricular myocardial index (RV Tei index) were evaluated by echocardiography, lower extremity muscle strength, ambulation ability, Barthel index, and 6-minute walking distance at the beginning and end of cardiopulmonary rehabilitation.
The average period of cardiopulmonary rehabilitation was 6.7 weeks. There was no deterioration in cardiothoracic ratio, human atrial natriuretic peptide, brain natriuretic peptide levels, tricuspid regurgitation, RV Tei index and pulse oximeter saturation. The results also showed decreased heart rate at rest (p = 0.007), and improved NYHA class (p = 0.010), lower extremity strength (p < 0.001), ambulation ability (p < 0.001), Barthel index (p < 0.001), and 6-minute walking distance (p = 0.001).
Cardiopulmonary rehabilitation is safe and effective for idiopathic pulmonary arterial hypertension patients in NYHA class-III and IV during intravenous prostacyclin infusion without deterioration of cardiac functions, despite the conventional contraindication.
评估重度心力衰竭的特发性肺动脉高压患者的心肺康复效果。
研究对象为11名男性和13名女性，年龄在5至37岁之间，患有特发性肺动脉高压，于1999年1月至2003年9月开始持续静脉注射前列环素后接受心肺康复治疗。15例患者入院时纽约心脏协会（NYHA）心功能分级为III级，9例为IV级。患者接受的心肺康复包括呼吸锻炼、上肢肌肉训练、步态训练、自行车测力计训练和跑步机行走，每天30至60分钟，每周5天。在心肺康复开始和结束时，通过超声心动图评估心胸比率、NYHA分级、心率、脉搏血氧饱和度、人心房利钠肽和脑利钠肽的血浆水平、三尖瓣反流和右心室心肌指数（RV Tei指数），并评估下肢肌肉力量、行走能力、Barthel指数和6分钟步行距离。
心肺康复的平均时间为6.7周。心胸比率、人心房利钠肽、脑利钠肽水平、三尖瓣反流、RV Tei指数和脉搏血氧饱和度均无恶化。结果还显示静息心率降低（p = 0.007），NYHA分级改善（p = 0.010），下肢力量增强（p < 0.001），行走能力提高（p < 0.001），Barthel指数改善（p < 0.001），6分钟步行距离增加（p = 0.001）。
尽管有传统的禁忌症，但心肺康复对NYHA III级和IV级的特发性肺动脉高压患者在静脉注射前列环素期间是安全有效的，且不会导致心功能恶化。
