运动训练对冠状动脉搭桥术后患者肌肉代谢反射激活时心血管反应的影响。
The effects of exercise training on cardiovascular responses to muscle metaboreflex activation in patients after coronary artery bypass grafting.
作者信息
Borges Juliana Pereira, da Silva Gama Gabriel, Cunha de Oliveira Coelho Vanessa, Farias Caio Luan, Dos Santos Rangel Marcus V
机构信息
Laboratory of Physical Activity and Health Promotion (LABSAU), Institute of Physical Education and Sports, University of Rio de Janeiro State, Rua São Francisco Xavier, 524, sala 8133 F, Maracanã, Rio de Janeiro, RJ, CEP 20550 - 013, Brazil.
Graduate Program in Exercise and Sport Sciences, University of Rio de Janeiro State, Rio de Janeiro, RJ, Brazil.
出版信息
Eur J Appl Physiol. 2025 Apr 12. doi: 10.1007/s00421-025-05781-7.
PURPOSE
To investigate cardiovascular responses to muscle metaboreflex activation in patients with coronary artery disease (CAD) after coronary artery bypass grafting (CABG) and assess the effects of exercise training on these responses.
METHODS
Cardiovascular responses of 11 post-CABG patients (60 ± 8 years) and 9 controls (CTL, 54 ± 6 years) were compared at rest, during a cold pressor test (CPT), and muscle metaboreflex activation using a post-exercise circulatory arrest (PECA) protocol. After baseline comparisons, the post-CABG group underwent 12 weeks of exercise training and was reevaluated.
RESULTS
During CPT, the post-CABG group exhibited greater increases in mean arterial pressure [MAP] (38.0 ± 9.0 vs. 18.7 ± 16.8 mmHg; P < 0.01) and systemic vascular resistance [SVR] (1053.0 ± 600.5 vs. 499.8 ± 481.0 mmHg.s/mL; P = 0.04) than CTL group. Muscle metaboreflex activation induced greater increases from rest in post-CABG than CTL for systolic blood pressure [SBP] (27.5 ± 17.3 vs. 14.2 ± 4.5 mmHg; P = 0.04), diastolic blood pressure [DBP] (10.1 ± 6.5 vs. 4.2 ± 1.8 mmHg; P = 0.02), MAP (27.5 ± 17.3 vs. 14.2 ± 4.5 mmHg; P = 0.04), SVR (149.7 ± 86.9 vs. 61.0 ± 47.4 mmHg.s/mL; P = 0.02), and blood lactate (0.48 ± 0.42 vs. - 0.18 ± 0.40 mmol/L; P < 0.01). After training, the post-CABG group reduced DBP response to CPT by 30% (P = 0.05). In addition, changes from rest induced by muscle metaboreflex in DBP, MAP, and blood lactate decreased by 28% (P = 0.05), 28% (P = 0.04), and 85% (P = 0.01), respectively.
CONCLUSION
Patients who underwent CABG exhibit exacerbated pressor responses to muscle metaboreflex activation, driven by increased SVR and blood lactate levels. This response potentially involves dysregulation in the brain stem or the efferent pathway of the muscle metaboreflex. Exercise training effectively attenuated these responses, highlighting its beneficial impact in CAD management.
TRIAL REGISTRATION
The study was registered on 01/12/2023 at EnsaiosClinicos.gov.br (RBR- 497 mxmm).
目的
研究冠状动脉搭桥术（CABG）后冠心病（CAD）患者对肌肉代谢反射激活的心血管反应，并评估运动训练对这些反应的影响。
方法
比较11例CABG术后患者（60±8岁）和9例对照组（CTL，54±6岁）在静息状态、冷加压试验（CPT）期间以及使用运动后循环停止（PECA）方案激活肌肉代谢反射时的心血管反应。在基线比较后，CABG术后组接受12周的运动训练并重新评估。
结果
在CPT期间，CABG术后组的平均动脉压[MAP]（38.0±9.0 vs. 18.7±16.8 mmHg；P<0.01）和全身血管阻力[SVR]（1053.0±600.5 vs. 499.8±481.0 mmHg·s/mL；P=0.04）的升高幅度大于CTL组。与CTL组相比，肌肉代谢反射激活使CABG术后组的收缩压[SBP]（27.5±17.3 vs. 14.2±4.5 mmHg；P=0.04）、舒张压[DBP]（10.1±6.5 vs. 4.2±1.8 mmHg；P=0.02）、MAP（27.5±17.3 vs. 14.2±4.5 mmHg；P=0.04）、SVR（149.7±86.9 vs. 61.0±47.4 mmHg·s/mL；P=0.02）和血乳酸（0.48±0.42 vs. -0.18±0.40 mmol/L；P<0.01）从静息状态起的升高幅度更大。训练后，CABG术后组对CPT的DBP反应降低了30%（P=0.05）。此外，肌肉代谢反射引起的静息状态下DBP、MAP和血乳酸的变化分别降低了28%（P=0.05）、28%（P=0.04）和85%（P=0.01）。
结论
接受CABG的患者对肌肉代谢反射激活表现出加剧的升压反应，这是由SVR和血乳酸水平升高驱动的。这种反应可能涉及脑干或肌肉代谢反射传出通路的调节异常。运动训练有效地减弱了这些反应，突出了其在CAD管理中的有益影响。
试验注册
该研究于2023年12月1日在EnsaiosClinicos.gov.br注册（注册号：RBR-497 mxmm）。
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