Jetté M, Heller R, Landry F, Blümchen G
Klinik Roderbirken für Herz- und Kreislaufkrankheiten, Leichlingen, FRG.
Circulation. 1991 Oct;84(4):1561-7. doi: 10.1161/01.cir.84.4.1561.
This study was designed to determine the controlled effects of a short-term exercise rehabilitation program on patients with moderate-to-severe left ventricular dysfunction after a recent myocardial infarction.
Thirty-nine male patients 51 +/- 8 years old with a large anterior myocardial infarction less than 10 weeks old were recruited for the study. The patients were randomly assigned to either one of two training or control groups on the basis of their resting ejection fraction: training, less than 30%; control, less than 30%; training, 31-50%; or control, 31-50%. Patients were evaluated for filling pressures, radionuclide ventriculography, heart volume, echocardiography, and work capacity. Patients who underwent training participated in an intensive 4-week in-hospital exercise program, whereas the control patients were restricted to a minimal activity program. Results indicated that there were no significant improvements in resting, submaximal, and maximal hemodynamic measurements as a result of the program. Mean work capacity and peak oxygen consumption improved significantly in the less-than-30% training group but was accompanied by a significant increase in mean pulmonary wedge pressure. Resting ejection fraction improved markedly in both less-than-30% training and control patients, but ejection fraction measures were not associated with work capacity. Training did not cause further deterioration in ventricular function.
It was concluded that in the present study, exercise training had little or no effect on hemodynamic measurements and that the training effects achieved in patients with left ventricular dysfunction are most likely due to corrected impaired vasodilation, not necessarily to cardiac function. The importance of using a control group in this type of study and the wide interindividual variations in training responses are emphasized.
本研究旨在确定短期运动康复计划对近期心肌梗死后中重度左心室功能障碍患者的控制效果。
招募了39名年龄在51±8岁、前壁大面积心肌梗死且发病时间小于10周的男性患者进行研究。根据静息射血分数将患者随机分为两个训练组或对照组之一：训练组，射血分数小于30%；对照组，射血分数小于30%；训练组，射血分数31 - 50%；或对照组，射血分数31 - 50%。对患者进行充盈压、放射性核素心室造影、心脏容积、超声心动图和工作能力评估。接受训练的患者参加了为期4周的强化住院运动计划，而对照组患者则限制在最低限度的活动计划。结果表明，该计划并未使静息、次极量和极量血流动力学测量结果有显著改善。小于30%射血分数训练组的平均工作能力和峰值耗氧量显著提高，但平均肺楔压也显著升高。小于30%射血分数训练组和对照组患者的静息射血分数均显著改善，但射血分数测量结果与工作能力无关。训练并未导致心室功能进一步恶化。
得出结论，在本研究中，运动训练对血流动力学测量几乎没有影响，左心室功能障碍患者所取得的训练效果很可能是由于纠正了受损的血管舒张功能，而不一定是心脏功能。强调了在这类研究中使用对照组的重要性以及训练反应中个体间的广泛差异。
