[运动康复对急性心肌梗死患者左心室重构及收缩功能的影响]

[The impact of exercise rehabilitation on left ventricular remodeling and systolic function in acute myocardial infarction patients].

作者信息

Jiang Ao-feng, Zhang Fu-chun, Gao Wei, Li Zhao-ping, Zhao Wei, Li Xiao-wen, Wang Xiao-hong, Zhang Bao-hui

机构信息

Department of Cardiology, Peking University Third Hospital, Beijing 100083, China.

出版信息

Zhonghua Nei Ke Za Zhi. 2006 Nov;45(11):904-6.

PMID:17313876

Abstract

OBJECTIVE

To investigate the influence of rehabilitation on left ventricular remodeling and systolic function in acute myocardial infarction patients.

METHODS

Patients meeting the inclusion criteria with uneventful clinical course after a first myocardial infarction were randomly assigned to a 3-month exercise training period (exercise group, n = 35) or a control group (n = 29). Before randomization, all patients underwent NT-proBNP test, 2-dimensional echocardiography, and submaximal exercise test.

RESULTS

(1) At baseline, there were no significant differences in NT-proBNP, left ventricular end-diastolic diameter (LVDd) and left ventricular ejection fraction (LVEF) between the exercise and control groups. After 3 months, a significant decrease in NT-proBNP was observed only in the exercise group [from (845.29 +/- 93.48) ng/L to (335.64 +/- 246.14) ng/L, P < 0.05], but not in the control group [from (1091.62 +/- 101.78) ng/L to (1099.83 +/- 168.75) ng/L, P > 0.05) and there was significant difference in NT-proBNP level between the two groups after 3 months (P < 0.01). The LVDd increased in the control group [from (50.9 +/- 5.8) to (52.6 +/- 5.4) mm, P < 0.05] but not in the exercise group [from (50.7 +/- 4.5) to (50.3 +/- 3.9) mm, P > 0.05] and there was significant difference in LVDd between the two groupsafter 3 months (P < 0.05). Conversely, LVEF improved in the exercise group [from (55.0 +/- 8.6)% to (60.0 +/- 8.0)%, P < 0.05] but not in the control group (P > 0.05) and there was significant difference in LVEF between the two groups after 3 months (P < 0.05). (2) NT-proBNP was inversely correlated with LVEF.

CONCLUSIONS

Rehabilitation exercise training under instructions based on family condition in the early and recovery stage of AMI can lower the NT-proBNP level, improve ejection fraction, and prevent the increase of left ventricular end-diastolic diameter. Therefore, it may reduce unfavorable remodeling response and improve cardiac systolic function hereafter.

摘要

目的

探讨康复治疗对急性心肌梗死患者左心室重构及收缩功能的影响。

方法

将首次心肌梗死后临床过程平稳且符合纳入标准的患者随机分为3个月运动训练组（运动组，n = 35）和对照组（n = 29）。随机分组前，所有患者均接受N末端脑钠肽前体（NT-proBNP）检测、二维超声心动图检查及次极量运动试验。

结果

（1）基线时，运动组与对照组在NT-proBNP、左心室舒张末期内径（LVDd）和左心室射血分数（LVEF）方面无显著差异。3个月后，仅运动组NT-proBNP显著降低[从（845.29±93.48）ng/L降至（335.64±246.14）ng/L，P < 0.05]，而对照组未降低[从（1091.62±101.78）ng/L升至（1099.83±168.75）ng/L，P > 0.05]，且3个月后两组NT-proBNP水平有显著差异（P < 0.01）。对照组LVDd增加[从（50.9±5.8）mm增至（52.6±5.4）mm，P < 0.05]，运动组未增加[从（50.7±4.5）mm降至（50.3±3.9）mm，P > 0.05]，3个月后两组LVDd有显著差异（P < 0.05）。相反，运动组LVEF改善[从（55.0±8.6）%升至（60.0±8.0）%，P < 0.05]，对照组未改善（P > 0.05），3个月后两组LVEF有显著差异（P < 0.05）。（2）NT-proBNP与LVEF呈负相关。