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目的:探讨老年慢性心衰患者实施运动康复的安全性及效果。方法:83例老年慢性心衰患者被随机分为常规护理组(41例,常规护理)和运动康复组(42例,在常规护理基础上接受运动训练)。疗程均为8周,随访12个月。患者心功能以纽约心脏病协会(NYHA)分级表示,以超声心动图测定左室射血分数(LVEF)和左室舒张末期内径(LVEDd),同时测定6min步行距离(6MWD),血浆脑钠肽(BNP)水平,代谢当量(METs),明尼苏达心力衰竭生活质量量表(MLHFQ)评分表示健康相关生活质量,记录12个月内的再入院率和死亡率。结果:两组治疗8周时LVEF、LVEDd、NYHA分级均显著改善(P均<0.05),且与常规护理组相比,运动康复组LVEF[(54.7±6.2)%比(65.4±8.7)%]、LVEDd[(49.6±8.3)mm比(40.2±9.3)mm]、NYHA分级[(2.7±0.8)级比(1.9±0.9)级]改善更显著(P<0.05);6MWD[(122.7±9.2)m比(175.6±8.7)m]和METs[(5.8±1.8)比(8.4±2.4)]也明显增加(P<0.01),血浆BNP水平[(43.4±9.8)pg/ml比(31.7±8.9)pg/ml]明显降低(P<0.05);运动康复组康复训练中未发生严重不良事件。12个月时,运动康复组MLH-FQ评分明显高于常规护理组[(68.9±7.9)分比(45.6±8.2)分,P<0.05],因心衰再入院率明显低于常规护理组(9.5%比24.4%,P<0.05)。结论:对老年慢性心衰患者实施运动康复安全有效,可明显改善心功能,增强运动耐力,提高生活质量。
Objective: To investigate the safety and effect of exercise rehabilitation in elderly patients with chronic heart failure. METHODS: Eighty-three elderly patients with chronic heart failure were randomly divided into routine care (n = 41, routine care) and sports rehabilitation (n = 42), who received exercise training on a regular basis. The course of treatment was 8 weeks and followed up for 12 months. Cardiac function was graded by New York Heart Association (NYHA). Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDd) were measured by echocardiography. Six minutes walking distance (6MWD), plasma brain natriuretic peptide (BNP), Metabolic Equivalence (METs), and Minnesota Heart Failure Quality of Living Scale (MLHFQ) scores expressed health-related quality of life. Rehospitalization and mortality rates were recorded over a 12-month period. Results: The LVEF, LVEDd and NYHA scores of both groups were significantly improved at 8 weeks (P <0.05). Compared with the conventional nursing group, LVEF [(54.7 ± 6.2)% vs 65.4 ± 8.7% (P <0.05); LVEDd [(49.6 ± 8.3) mm vs (40.2 ± 9.3) mm] and NYHA class [(2.7 ± 0.8) (P <0.01). Plasma levels of BNP [(43.4 ± 9.8) pg / ml vs (31.7 ± 8.9) pg / ml] was significantly lower (P <0.05). There was no serious adverse events in rehabilitation training in sports rehabilitation group. At 12 months, the MLH-FQ score of exercise rehabilitation group was significantly higher than that of the routine nursing group [(68.9 ± 7.9) points (45.6 ± 8.2) points, P <0.05] (9.5% vs. 24.4%, P <0.05). Conclusion: It is safe and effective to exercise rehabilitation in elderly patients with chronic heart failure, which can significantly improve cardiac function, enhance exercise endurance and improve quality of life.