神经肌肉电刺激改善连续静脉正性肌力支持使用的晚期心力衰竭患者的运动耐量 - 随机对照试验。

Neuromuscular electrical stimulation improves exercise tolerance in patients with advanced heart failure on continuous intravenous inotropic support use-randomized controlled trial.

机构信息

1 Cardiology and Cardiovascular Surgery Discipline, Sao Paulo Hospital, Federal University of Sao Paulo, São Paulo, Brazil.

2 Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos, São Carlos, Brazil.

出版信息

Clin Rehabil. 2018 Jan;32(1):66-74. doi: 10.1177/0269215517715762. Epub 2017 Jun 21.

DOI:10.1177/0269215517715762

PMID:28633534

Abstract

OBJECTIVE

To evaluate the impact of a short-term neuromuscular electrical stimulation program on exercise tolerance in hospitalized patients with advanced heart failure who have suffered an acute decompensation and are under continuous intravenous inotropic support.

DESIGN

A randomized controlled study.

SUBJECTS

Initially, 195 patients hospitalized for decompensated heart failure were recruited, but 70 were randomized.

INTERVENTION

Patients were randomized into two groups: control group subject to the usual care ( n = 35); neuromuscular electrical stimulation group ( n = 35) received daily training sessions to both lower extremities for around two weeks.

MAIN MEASURES

The baseline 6-minute walk test to determine functional capacity was performed 24 hours after hospital admission, and intravenous inotropic support dose was daily checked in all patients. The outcomes were measured in two weeks or at the discharge if the patients were sent back home earlier than two weeks.

RESULTS

After losses of follow-up, a total of 49 patients were included and considered for final analysis (control group, n = 25 and neuromuscular electrical stimulation group, n = 24). The neuromuscular electrical stimulation group presented with a higher 6-minute walk test distance compared to the control group after the study protocol (293 ± 34.78 m vs. 265.8 ± 48.53 m, P < 0.001, respectively). Neuromuscular electrical stimulation group also demonstrated a significantly higher dose reduction of dobutamine compared to control group after the study protocol (2.72 ± 1.72 µg/kg/min vs. 3.86 ± 1.61 µg/kg/min, P = 0.001, respectively).

CONCLUSION

A short-term inpatient neuromuscular electrical stimulation rehabilitation protocol improved exercise tolerance and reduced intravenous inotropic support necessity in patients with advanced heart failure suffering a decompensation episode.

摘要

目的

评估短期神经肌肉电刺激方案对因急性失代偿而接受连续静脉正性肌力支持的晚期心力衰竭住院患者的运动耐量的影响。

设计

随机对照研究。

受试者

最初招募了 195 名因心力衰竭失代偿而住院的患者，但只有 70 名被随机分组。

干预

患者被随机分为两组：对照组（n=35）接受常规护理；神经肌肉电刺激组（n=35）接受为期两周左右的双侧下肢每日训练。

主要观察指标

入院后 24 小时进行基线 6 分钟步行试验以确定功能能力，所有患者每日检查静脉正性肌力支持剂量。如果患者在两周内提前出院，则在两周时或出院时进行评估。

结果

随访丢失后，共有 49 名患者纳入最终分析（对照组，n=25；神经肌肉电刺激组，n=24）。与对照组相比，研究方案后神经肌肉电刺激组的 6 分钟步行试验距离更长（293±34.78 m 比 265.8±48.53 m，P<0.001）。研究方案后，与对照组相比，神经肌肉电刺激组的多巴酚丁胺剂量也显著降低（2.72±1.72 µg/kg/min 比 3.86±1.61 µg/kg/min，P=0.001）。