作者：田琪1，祁春梅1，邢爱君1，刘婷2，安利杰3，张晖1，于双平4，王永芝1，霍红秋1

单位：

1.063000河北省唐山市，开滦总医院心血管内科　2.063000河北省唐山市，开滦总医院全科医学科3.063000河北省唐山市，开滦总医院护理部4.063000河北省唐山市，开滦总医院导管室

Units：

1.Cardiovascular Medicine, Kailuan General Hospital, Tangshan 063000, China2.General Medicine, Kailuan General Hospital, Tangshan 063000, China3.Nursing Department, Kailuan General Hospital, Tangshan 063000, China4.Catheter Room, Kailuan General Hospital, Tangshan 063000, China

关键词：

冠心病；老年人；抗阻训练；重组人脑利钠肽；经皮冠状动脉介入治疗；运动耐力；心肺功能；生活质量

Keywords：

Coronary heart disease; Aged; Resistance training; Recombinant human brain natriuretic peptide;Percutaneous coronary intervention; Exercise endurance; Cardiopulmonary function; Quality of life

CLC：

R 541.4

DOI：

10.12114/j.issn.1008-5971.2022.00.222

Funds：

2022年度河北省医学科学研究课题计划（20221573）

摘要：

目的　探讨抗阻训练联合重组人脑利钠肽对老年冠心病患者经皮冠状动脉介入治疗（PCI）后运动耐力、心肺功能及生活质量的影响。方法　选取2020年12月至2021年12月在开滦总医院治疗的108例老年冠心病患者作为研究对象，采用随机数字表法将其分为对照组和研究组，每组54例。两组患者PCI后均进行常规治疗，对照组给予注射用重组人脑利钠肽，研究组在对照组基础上给予抗阻训练。比较两组治疗前后运动耐力指标〔运动持续时间（ED）、峰值摄氧量（VO2peak）、无氧阈（AT）、6 min步行距离（6MWD）〕、心肺功能指标〔右心室前壁厚度（RVAWT）、右心室舒张末期内径（RVEDD）、肺动脉收缩压（PASP）、用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、FEV1/FVC〕、血液流变学指标（血浆黏度、全血低切黏度、全血高切黏度、纤维蛋白原及血细胞比容），治疗前及治疗后3 d、2周、3个月日常生活能力（ADL）量表评分，治疗前后中国心血管病人生活质量评定问卷（CQQC）评分及治疗期间不良心血管事件发生率。结果　治疗后，两组ED、6MWD分别长于本组治疗前，VO2peak、AT分别大于本组治疗前，且研究组ED、6MWD长于对照组，VO2peak、AT大于对照组（P ＜0.05）。治疗后，两组RVAWT、RVEDD分别小于本组治疗前，PASP分别低于本组治疗前，FVC、FEV1分别大于本组治疗前，FEV1/FVC分别高于本组治疗前（P ＜0.05）；治疗后，研究组RVAWT、RVEDD小于对照组，PASP低于对照组，FVC、FEV1大于对照组，FEV1/FVC高于对照组（P ＜0.05）。治疗后，两组血浆黏度、全血低切黏度、全血高切黏度、纤维蛋白原、血细胞比容分别低于本组治疗前，且研究组低于对照组（P ＜0.05）。治疗后3 d、2周、3个月，研究组ADL量表评分高于对照组（P ＜0.05）。治疗后，两组CQQC评分分别高于本组治疗前，且研究组高于对照组（P ＜0.05）。研究组患者治疗期间不良心血管事件发生率低于对照组（χ2=4.700，P =0.030）。结论　抗阻训练联合注射用重组人脑利钠肽可有效提高老年冠心病患者PCI后运动耐力、ADL及生活质量，改善患者心肺功能及血液流变学指标，且可以降低患者不良心血管事件发生风险。

Abstract：

Objective　To investigate the impact of resistance training combined with recombinant human brainnatriuretic peptide on cardiac rehabilitation, cardiopulmonary function and quality of life in elderly patients after percutaneouscoronary intervention (PCI) . Methods　A total of 108 elderly patients with coronary heart disease treated in Kailuan GeneralHospital from December 2020 to December 2021 were selected as the research objects. They were divided into control group andstudy group by random number table method, with 54 cases in each group. The patients in both groups received routine treatmentafter PCI. The control group was given recombinant human brain natriuretic peptide for injection, and the study group was givenresistance training on the basis of the control group. The exercise endurance indexes [exercise duration (ED) , peak oxygen uptake(VO2peak) , anaerobic threshold (AT) , 6 min walking distance (6MWD) ] , cardiopulmonary function indexes [right ventricularanterior wall thickness (RVAWT) , right ventricular end diastolic diameter (RVEDD) , pulmonary artery systolic pressure (PASP) ,forced vital capacity (FVC) , forced expiratory volume in the first second (FEV1) , FEV1/FVC] , hemorheological indexes (plasmaviscosity, whole blood low shear viscosity, whole blood high shear viscosity, fibrinogen and hematocrit) before and after treatment,the Activity of Daily Living (ADL) Scale score before treatment and at 3 days, 2 weeks and 3 months after treatment, ChineseQuestionnaire of Quality of Life in Chinese Patient with Cardiovascular Diseases (CQQC) before and after treatment, and theincidence of adverse cardiovascular events during treatment were compared between the two groups. Results　After treatment, EDand 6MWD of the two groups were longer than those before treatment, respectively, VO2peak and AT were greater than those beforetreatment, respectively, and ED and 6MWD of the study group were longer than those of the control group, VO2peak and AT weregreater than those of the control group (P < 0.05) . After treatment, RVAWT and RVEDD in the two groups were lower than thosebefore treatment, respectively, PASP was lower than that before treatment, respectively, FVC and FEV1 were bigger than those beforetreatment, respectively, and FEV1/FVC were higher than those before treatment, respectively (P < 0.05) . After treatment, RVAWTand RVEDD in the study group were less than those in the control group, PASP was lower than that in the control group, FVC andFEV1 were bigger than those in the control group, and FEV1/FVC was higher than that in the control group P( < 0.05) . After treatment,the plasma viscosity, whole blood low shear viscosity, whole blood high shear viscosity, fibrinogen and hematocrit of the two groupswere lower than those before treatment, respectively, and the plasma viscosity, whole blood low shear viscosity, whole blood high shearviscosity, fibrinogen and hematocrit in the study group were lower than those in the control group (P < 0.05) . The ADL Scale score inthe study group was higher than that in the control group at 3 days, 2 weeks and 3 months after treatment (P < 0.05) . After treatment,the CQQC score of the two groups were higher than those before treatment, respectively, and CQQC score of the study group washigher than that of the control group (P < 0.05) . The incidence of adverse cardiovascular events in the study group was lower than thatin the control group (χ2=4.700, P =0.030) . Conclusion　Resistance training combined with recombinant human brain natriureticpeptide for injection can effectively improve exercise endurance, ADL, quality of life, cardiopulmonary function and hemorheologicalindexes in elderly patients with coronary heart disease after PCI, and reduce the risk of adverse cardiovascular events.

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