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目的:探讨运动康复治疗对射血分数保存心力衰竭(心衰)患者运动耐力、舒张功能和生活质量的影响。方法:入选了100例NYHA心功能Ⅱ~Ⅲ级,左室射血分数(LVEF)保存心衰患者,在药物治疗基础上,根据患者意愿分为运动康复组和对照组。运动康复组采用踏车运动康复,训练强度为基线水平症状限制性心肺运动试验测得的峰值氧耗量(peak VO_2)50%~80%。每周运动3次,每次40min。在基线及12周随访结束时通过心肺运动试验测peak VO_2,二氧化碳通气当量斜率(VE/VCO2slop),无氧阈氧耗量(VO_2AT),最大运动功率和最大运动时间;超声心动图仪检测并计算舒张早期二尖瓣血流速度与舒张早期二尖瓣环运动速度比(E/e’),左房容积指数(LAVI),左室肌重量指数(LVMI),LVEF;测试6 min步行距离;测血浆N端B型脑钠肽前体(NTproBNP);通过明尼苏达心衰生活质量问卷表(MLWHFQ)评估生活质量。并对上述指标进行组内及组间比较。结果:运动康复组及对照组随访12周后peak VO_2、VO_2AT、最大运动功率、最大运动时间及6min步行距离均较前增加(P<0.05);VE/VCO2slop、E/e’、LAVI及MLWHFQ总分均较前下降(P<0.05),但运动康复组优于对照组(P<0.05)。LVMI、LVEF及NT-proBNP组内比较及组间比较差异无统计学意义(P>0.05)。结论:运动康复治疗改善了LVEF保存心衰患者的运动耐力、左室舒张功能及生活质量。
Objective: To investigate the effects of exercise rehabilitation on exercise tolerance, diastolic function and quality of life in patients with preserved heart failure (HF). Methods: A total of 100 patients with heart failure NYHA Ⅱ ~ Ⅲ and left ventricular ejection fraction (LVEF) were enrolled in the study. The patients were divided into exercise rehabilitation group and control group according to their wishes. Exercise rehabilitation team treadmill exercise rehabilitation, training intensity baseline peak symptom-based cardiopulmonary exercise test peak oxygen consumption (peak VO_2) 50% to 80%. Exercise 3 times a week, each 40min. Peak VO_2, VE / VCO2slop, VO_2AT, maximal exercise power and maximal exercise time were measured by cardiopulmonary exercise test at baseline and at the end of 12-week follow-up. Echocardiography The mitral valve velocity and early diastolic mitral annulus velocity (E / e ’), left atrium volume index (LAVI), left ventricular muscle mass index (LVMI) and LVEF were calculated. Plasma N-terminal pro-brain natriuretic peptide (NTproBNP) was measured. Quality of life was assessed by Minnesota Heart Failure Quality of Life Questionnaire (MLWHFQ). The above indicators were compared within and between groups. Results: The peak VO_2, VO_2AT, maximum exercise power, maximal exercise time and 6-minute walk distance in exercise rehabilitation group and control group were higher than those in the previous period after 12-week follow-up (P <0.05); VE / VCO2slop, E / e ’, LAVI and MLWHFQ The total scores were lower than before (P <0.05), but the exercise rehabilitation group was better than the control group (P <0.05). LVMI, LVEF and NT-proBNP group comparison and between groups showed no significant difference (P> 0.05). Conclusion: Exercise rehabilitation therapy can improve exercise tolerance, left ventricular diastolic function and quality of life in patients with LVEF preserved heart failure.