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外周动脉疾病的综合心脏康复计划。

Comprehensive cardiac rehabilitation program for peripheral arterial diseases.

机构信息

Department of Cardiovascular Medicine & Nephrology, Dokkyo Medical University.

出版信息

J Cardiol. 2022 Oct;80(4):303-305. doi: 10.1016/j.jjcc.2021.11.011. Epub 2021 Nov 29.

Abstract

Peripheral arterial disease (PAD) is a phenotype of atherosclerotic disease often associated with cerebrovascular or coronary artery disease. The incidence of cardiovascular events in patients with PAD is 5.4% per year, which is higher than that of cerebrovascular or coronary artery disease. The most useful screening method for PAD is the ankle brachial pressure index (ABI). The ABI should be measured in (1) all patients with lower limb symptoms such as claudication, (2) all patients aged 65 years and over, and (3) those aged 50 to 65 years who have risk factors such as smoking and diabetes mellitus. PAD is diagnosed if the ABI is <0.9. A comprehensive cardiac rehabilitation program includes complete smoking cessation, blood pressure control with antihypertensive medications and salt reduction for hypertension, glycemic control for diabetes mellitus, and appropriate medications such as antiplatelet agents and statins. A multidisciplinary team approach is effective in comprehensive cardiac rehabilitation for patients with PAD, even those with critical limb ischemia (CLI). Exercise therapy is a crucial and essential treatment for PAD, except in CLI. Exercise therapy is contraindicated in patients with acute arterial occlusion and CLI with infection. PAD is often associated with other atherosclerotic diseases; the patient should be monitored for ischemic heart disease during the initial exercise stress test using the Gardner treadmill protocol. Supervised exercise therapy is highly recommended (Class I, Level of Evidence A). Alternatively, a home-based exercise program is feasible (Class IIa, Level of Evidence A). The exercise type (treadmill, track walking, ergometer), frequency (3 to 5 days per week), intensity (speed and incline), and duration (30 minutes) are determined based on the exercise stress test results for each patient. Exercise should be continued at least 3 times a week for at least 12 weeks. Cilostazol is highly recommended (Class I, Level of Evidence A).

摘要

外周动脉疾病(PAD)是动脉粥样硬化疾病的一种表型,常与脑血管或冠状动脉疾病相关。PAD 患者心血管事件的发生率为每年 5.4%,高于脑血管或冠状动脉疾病。PAD 最有用的筛查方法是踝肱血压指数(ABI)。ABI 应在以下情况下测量:(1)所有下肢有跛行等症状的患者;(2)所有 65 岁及以上的患者;(3)年龄在 50 至 65 岁之间且有吸烟和糖尿病等危险因素的患者。ABI<0.9 可诊断为 PAD。全面心脏康复计划包括完全戒烟、使用降压药物控制血压和减少高血压盐摄入、控制糖尿病患者的血糖水平,以及适当使用抗血小板药物和他汀类药物等。多学科团队方法对外周动脉疾病患者的全面心脏康复有效,即使是患有严重肢体缺血(CLI)的患者也是如此。运动疗法是 PAD 的关键和基本治疗方法,除 CLI 外。急性动脉闭塞和伴有感染的 CLI 患者禁忌运动疗法。PAD 常与其他动脉粥样硬化疾病相关;患者应在初始运动应激试验中使用 Gardner 跑步机方案监测缺血性心脏病。强烈推荐(I 类,A级证据)监督运动疗法。或者,家庭运动方案也是可行的(IIa 类,A级证据)。运动类型(跑步机、赛道行走、测功计)、频率(每周 3 至 5 天)、强度(速度和坡度)和持续时间(30 分钟)是根据每位患者的运动应激试验结果确定的。运动应每周至少进行 3 次,持续至少 12 周。西洛他唑是高度推荐的(I 类,A级证据)。

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