Compostella Leonida, Russo Nicola, Setzu Tiziana, Bottio Tomaso, Compostella Caterina, Tarzia Vincenzo, Livi Ugolino, Gerosa Gino, Iliceto Sabino, Bellotto Fabio
Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo, (BL), Italy (Drs Compostella, Russo, Setzu, and Bellotto), Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy (Drs Compostella, Russo, Bottio, Tarzia, Gerosa, Iliceto, and Bellotto), Department of Medicine, School of Emergency Medicine, University of Padua, Padova, Italy (Dr Compostella); and Department of Cardiopulmonary Sciences, S. Maria della Misericordia University Hospital, Udine, Italy (Dr Livi).
J Cardiopulm Rehabil Prev. 2015 Sep-Oct;35(5):301-11. doi: 10.1097/HCR.0000000000000113.
An increasing number of patients with end-stage heart failure are being treated with continuous-flow left ventricular assist devices (cf-LVADs). These patients provide new challenges to the staff in exercise-based cardiac rehabilitation (CR) programs. Even though experience remains limited, it seems that patients supported by cf-LVADs may safely engage in typical rehabilitative activities, provided that some attention is paid to specific aspects, such as the presence of a short external drive line. In spite of initial physical deconditioning, CR allows progressive improvement of symptoms such as fatigue and dyspnea. Intensity of rehabilitative activities should ideally be based on measured aerobic capacity and increased appropriately over time. Regular, long-term exercise training results in improved physical fitness and survival rates. Appropriate adjustment of cf-LVAD settings, together with maintenance of adequate blood volume, provides maximal output, while avoiding suction effects. Ventricular arrhythmias, although not necessarily constituting an immediate life-threatening situation, deserve treatment as they could lead to an increased rate of hospitalization and poorer quality of life. Atrial fibrillation may worsen symptoms of right ventricular failure and reduce exercise tolerance. Blood pressure measurements are possible in cf-LVAD patients only using a Doppler technique, and a mean blood pressure ≤80 mmHg is considered "ideal." Some patients may present with orthostatic intolerance, related to autonomic dysfunction. While exercise training constitutes the basic rehabilitative tool, a comprehensive intervention that includes psychological and social support could better meet the complex needs of patients in which cf-LVAD may offer prolonged survival.
越来越多的终末期心力衰竭患者正在接受连续流左心室辅助装置（cf-LVADs）治疗。这些患者给基于运动的心脏康复（CR）项目的工作人员带来了新的挑战。尽管经验仍然有限，但似乎接受cf-LVADs支持的患者可以安全地参与典型的康复活动，前提是要注意一些特定方面，比如存在较短的外部驱动线。尽管最初存在身体机能下降的情况，但CR可以使疲劳和呼吸困难等症状逐步改善。康复活动的强度理想情况下应基于所测量的有氧能力，并随着时间适当增加。定期、长期的运动训练可提高身体素质和生存率。适当调整cf-LVAD设置，并维持足够的血容量，可提供最大输出，同时避免抽吸效应。室性心律失常虽然不一定构成即刻危及生命的情况，但因其可能导致住院率增加和生活质量下降，所以值得治疗。房颤可能会加重右心室衰竭的症状并降低运动耐量。cf-LVAD患者仅使用多普勒技术才能进行血压测量，平均血压≤80 mmHg被认为是“理想的”。一些患者可能会出现与自主神经功能障碍相关的体位性不耐受。虽然运动训练是基本的康复工具，但包括心理和社会支持在内的综合干预可能更能满足cf-LVAD可延长生存期的患者的复杂需求。
