Effect Evaluation of Exercise Rehabilitation on Patients with Chronic Heart Failure
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摘要:
目的 探讨慢性心力衰竭患者在基础疾病治疗和规范化药物治疗的基础上联合运动康复对患者的临床治疗效果。 方法 入选2020年01月至2021年08月就诊于某医院的CHF患者110例作为研究对象。随机分为对照组（56例）和康复组（54例）。对照组给予标准治疗，康复组在此基础上联合运动康复治疗。2组患者均在入选时和治疗3个月后采集以下指标：AT时VO2 /VO2max、Peak VO2/kg、Peak VO2 /VO2max、VE/VCO2；LVEF、LVEDD、LVESD；NT-ProBNP；生活质量、焦虑、抑郁评分；再住院率。 结果 干预后，康复组患者AT时VO2 /VO2 max、Peak VO2/kg、Peak VO2 /VO2 max、LVEF 均较对照组增高（P < 0.05）；康复组VE/VCO2、NT-ProBNP、再住院率、生活质量、焦虑、抑郁评分均较对照组降低（P < 0.05）；2组LVEDD、LVESD无明显变化。 结论 心脏运动康复不仅能改善CHF患者的心肺功能指标、心脏泵血功能、血生化指标、焦虑抑郁情绪，提高生存质量、幸福指数、还能降低再住院率。 Abstract:Objective To explore the clinical therapeutic effect of chronic heart failure patients on the basis of basic disease treatment and standardized drug treatment combined with exercise rehabilitation. Methods A total of 110 CHF patients admitted to a hospital from January 2020 to August 2021 were selected as the research objects. The patients were randomly divided into control group （56 cases） and rehabilitation group （54 cases）. The control group was given standardized treatment, and the rehabilitation group was given combined exercise rehabilitation treatment on this basis. In both groups, the following indicators were collected at the time of enrollment and three months after treatment: AT VO2/ VO2max, Peak VO2/kg, Peak VO2/ VO2max, VE/VCO2; LVEF, LVEDD, LVESD; NT - ProBNP numerical; Quality of life, anxiety and depression scores; Readmission rates. Results After intervention, the value of VO2/ VO2 Max, Peak VO2/kg, Peak VO2/ VO2 Max and LVEF in the rehabilitation group were all higher than those in the control group （P < 0.05）. The VE/VCO2 value, NT-probNP value, re-hospitalization rate, quality of life, anxiety and depression score in the rehabilitation group were lower than those in the control group （P < 0.05）. There were no statistically significant differences in LVEDD, LVESD between the two groups. Conclusion Cardiac exercise rehabilitation can not only improve the cardiopulmonary function index, cardiac pumping function, blood biochemical index, anxiety, depression mood, improve the quality of life, happiness index, but also reduce the rate of re-hospitalization of CHF patients. -
表 1 无氧阈（AT）的分级（%）
Table 1. Classification of anaerobic threshold （%）
级别 分级标准（AT时VO2/VO2max） 正常 > 40 轻度低下 < 40 中度低下 < 30 重度低下 < 20 
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表 2 Weber心功能分级
Table 2. Weber classification of cardiac function
级别 分级标准（AT时VO2/kg） 基本正常 ≥14 运动轻度受限 ≥11且< 14 运动中度受限 ≥8且< 11 运动严重受限 < 8
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表 3 运动耐量的分级（%）
Table 3. Classification of exercise tolerance（%）
级别 分级标准（最大负荷时VO2/VO2max） 正常 > 80 缺乏锻炼 < 80 轻度低下 < 70 中度低下 < 50
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表 4 VE/VCO2 的数值和意义
Table 4. Value and significance of VE/VCO2
VE/VCO2斜率 意义 < 30° 正常 > 30° 心功能低下 > 34° 高危预测因子
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表 5 2组基线对比[（
$ \bar x \pm s $ ）/n（%）]Table 5. Baseline comparison between the two groups [（
$ \bar x \pm s $ ）/n（%）]项目 康复组（n = 54） 对照组（n = 56） t/χ2 P 性别[（男/女）/n] 30/24 27/29 0.593 0.441 年龄（岁） 58.19 ± 9.08 58.94 ± 8.22 −0.458 0.213 BMI（kg/m2） 26.21 ± 3.38 25.73 ± 3.72 0.715 0.965 吸烟（n） 22（40.7） 20（35.7） 0.294 0.587 高血压（n） 25（46.3） 30（53.6） 0.582 0.446 糖尿病（n） 30（55.6） 32（57.1） 0.028 0.867 高脂血症（n） 33（61.1） 29（51.8） 0.972 0.324 冠心病（n） 43（79.6） 46（82.1） 0.112 0.737
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表 6 2组干预前后心肺功能指标对比（
$\bar x \pm s$ ）Table 6. Comparison of cardiopulmonary function indexes between the two groups before and after intervention （
$\bar x \pm s$ ）指标 康复组 对照组 t P AT时VO2/VO2max（%） 干预前 45.12 ± 11.09 45.07 ± 10.24 0.029 0.977 干预后 53.38 ± 11.19 46.10 ± 9.96 3.606 P < 0.001# t −11.68 −2.29 P < 0.001* 0.026* Peak VO2/kg[mL/（min·kg）] 干预前 15.88 ± 3.91 15.17 ± 3.15 1.052 0.295 干预后 20.59 ± 3.98 15.76 ± 3.03 7.167 < 0.001# t −16.77 −3.22 P < 0.001* 0.002* Peak时VO2/VO2max（%） 干预前 61.18 ± 14.41 60.25 ± 12.25 0.367 0.714 干预后 74.64 ± 12.95 61.66 ± 11.73 5.515 < 0.001# t −21.31 −2.75 P < 0.001* 0.008* VE/VCO2 slop 干预前 26.79 ± 3.56 27.10 ± 3.74 −0.446 0.657 干预后 18.07 ± 3.20 20.00 ± 4.02 −2.772 0.007# t 22.27 16.41 P < 0.001* < 0.001* 与干预前比较，*P < 0.05；与对照组比较，#P < 0.05。
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表 7 2组干预前后心脏彩超的对比（
$\bar x \pm s$ ）Table 7. Comparison of color doppler echocardiography between two groups before and after intervention （
$\bar x \pm s$ ）指标 康复组 对照组 t P LVEF（%） 干预前 39.27 ± 4.25 39.62 ± 4.35 −0.423 0.673 干预后 48.20 ± 3.96 46.39 ± 4.49 2.237 0.027# t −22.824 −15.109 P < 0.001* < 0.001* LVEDD（mm） 干预前 47.70 ± 4.12 46.39 ± 4.17 1.656 0.101 干预后 46.85 ± 4.78 46.10 ± 5.38 0.884 0.379 t 1.747 0.540 P 0.087 0.592 LVESD（mm） 干预前 32.68 ± 3.19 32.78 ± 3.26 −0.163 0.871 干预后 32.22 ± 3.43 32.44 ± 3.74 −0.327 0.744 t 1.285 0.950 P 0.204 0.346 与干预前比较，*P < 0.05；与对照组比较，#P < 0.05。
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表 8 2组干预前后NT-proBNP水平对比[（
$\bar x \pm s $ ），pg/mL]Table 8. Comparison of NT-probNP levels between the two groups before and after intervention [（
$\bar x \pm s $ ），pg/mL]指标 康复组 对照组 t P NT-probNP 干预前 569.64 ± 36.68 568.64 ± 38.74 0.140 0.889 干预后 315.57 ± 32.06 329.66 ± 35.52 −2.181 0.031# t 61.825 110.253 P < 0.001* < 0.001* 与干预前比较，*P < 0.05；与对照组比较，#P < 0.05。
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表 9 2组干预前后生活质量评分比较[（
$\bar x \pm s$ ），分]Table 9. Quality of life scores were compared between the two groups before and after intervention [（
$\bar x \pm s$ ），scores]指标 康复组 对照组 t P 生活质量评分 干预前 48.20 ± 6.12 47.80 ± 5.69 0.355 0.724 干预后 34.75 ± 5.14 37.37 ± 6.91 −2.244 0.027# t 22.84 10.78 P < 0.001* < 0.001* 与干预前比较，*P < 0.05；与对照组比较，#P < 0.05。
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表 10 2组干预前后焦虑评分比较[（
$\bar x \pm s$ ） ，分]Table 10. Anxiety scores were compared between the two groups before and after intervention [（
$\bar x \pm s$ ），scores]指标 康复组 对照组 t P 焦虑评分 干预前 12.61 ± 2.52 12.01 ± 2.78 1.168 0.245 干预后 7.98 ± 2.10 8.91 ± 2.52 −2.092 0.039# t 20.88 14.82 P < 0.001* < 0.001* 与干预前比较，*P < 0.05；与对照组比较，#P < 0.05。
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表 11 2组干预前后抑郁评分比较（
$\bar x \pm s $ ，分）Table 11. Comparison of depression scores between the two groups before and after intervention （
$\bar x \pm s$ ， scores）指标 康复组 对照组 t P 抑郁评分 干预前 15.40 ± 2.43 15.19 ± 2.05 0.492 0.624 干预后 9.38 ± 1.94 10.28 ± 2.36 −2.168 0.032# t 21.56 21.37 P < 0.001* < 0.001* 与干预前比较，*P < 0.05；与对照组比较，#P < 0.05。
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表 12 干预后2组再住院率的比较（n）
Table 12. Comparison of rehospitalization rate between two groups after intervention （n）
组别 n 再住院例数 康复组 54 1 对照组 56 8 t 4.123 P 0.042* *P < 0.05。
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