作者：张建薇，徐娜，郑闻

单位：

210008江苏省南京市，南京鼓楼医院老年科

Units：

Geriatric Department, Nanjing Drum Tower Hospital, Nanjing 210008, China

关键词：

心力衰竭；心脏康复；胸阻抗法；血流动力学

Keywords：

Heart failure; Cardiac rehabilitation; Thoracic electrical bioimpedance; Hemodynamics

CLC：

R 541.62

DOI：

10.12114/j.issn.1008-5971.2024.00.094

Funds：

2020年江苏省干部保健科研课题项目（BJ20004）

摘要：

目的　探讨胸阻抗法无创血流动力学监测技术在慢性心力衰竭（CHF）患者心脏康复中的应用价值。 方法　选取2021年8月—2022年12月南京鼓楼医院收治的100例CHF患者为研究对象，将其随机分为对照组（n=50）和 试验组（n=50）。两组患者均接受常规抗心力衰竭治疗，在此基础上试验组患者进行心脏康复训练，两组患者均持 续干预6周。记录两组患者干预前后6 min步行距离（6MWD），采用胸阻抗法无创血流动力学监测技术检测两组患者 干预前后血流动力学指标〔心排血量（CO）、心脏指数（CI）、每搏输出量（SV）、外周血管阻力指数（SVRI）、 胸液传导性（TFC）〕。CHF患者干预前血流动力学指标与NYHA分级的相关性分析采用Spearman秩相关分析。结果 Spearman秩相关分析结果显示，CHF患者干预前CO、CI、SV与NYHA分级呈负相关（r s值分别为－0.404、－0.399、 －0.256，P值分别为＜0.001、＜0.001、0.010），TFC与NYHA分级呈正相关（r s=0.206，P=0.040）。干预后，对照组 和试验组患者6MWD分别长于本组干预前，且试验组患者6MWD长于对照组（P＜0.05）。干预后，对照组患者CO快于 干预前，SV大于干预前，SVRI和TFC低于干预前（P＜0.05）；干预后，试验组患者CO快于干预前，CI高于干预前， SV大于干预前，SVRI和TFC低于干预前（P＜0.05）。干预后，试验组患者CO快于对照组，CI高于对照组，TFC低于对 照组（P＜0.05）。结论　通过胸阻抗法无创血流动力学监测技术检测的血流动力学指标与CHF患者心功能有关，胸阻 抗法无创血流动力学监测技术可用于评估CHF患者心脏康复效果。

Abstract：

Objective To explore the application value of non-invasive hemodynamic monitoring technology of thoracic electrical bioimpedance in cardiac rehabilitation of patients with chronic heart failure (CHF) . Methods A total of 100 CHF patients admitted to Nanjing Drum Tower Hospital from August 2021 to December 2022 were selected and randomly divided into control group (n=50) and experimental group (n=50) . Patients in both groups received routine anti-heart failure treatment. On this basis, patients in the experimental group received cardiac rehabilitation training. Patients in both groups were intervened continuously for 6 weeks. The 6-minute walking distance (6MWT) of the two groups of patients before and after intervention was recorded. The hemodynamic indexes [cardiac output (CO) , cardiac index (CI) , stroke volume (SV) , systemic vascular resistance index (SVRI) , thoracic fluid conductivity (TFC) ] of the two groups before and after intervention were monitored by non invasive hemodynamic monitoring technology of thoracic electrical bioimpedance. Spearman rank correlation analysis was used to analyze the correlation between hemodynamic indexes and NYHA classification in CHF patients before intervention. Results Spearman rank correlation analysis showed that CO, CI and SV were negatively correlated with NYHA classification in CHF patients before intervention (r s values were －0.404, －0.399 and －0.256, respectively, P values were < 0.001, < 0.001 and 0.010, respectively) , and TFC was positively correlated with NYHA classification (r s=0.206, P=0.040) . After intervention, the 6MWD in the control group and the experimental group was longer than that before intervention, respectively, and the 6 MWD in the experimental group was longer than that in the control group (P < 0.05) . After intervention, CO in the control group was faster than that before intervention, SV was larger than that before intervention, SVRI and TFC were lower than those before intervention P < 0.05) ; after intervention, CO in the experimental group was faster than that before intervention, CI was higher than that before intervention, SV was larger than that before intervention, and SVRI and TFC were lower than those before intervention (P < 0.05) . After intervention, CO in the experimental group was faster than that in the control group, CI was higher than that in the control group, and TFC was lower than that in the control group (P < 0.05) . Conclusion The hemodynamic indexes detected by the non-invasive hemodynamic monitoring technology of thoracic impedance method are related to the cardiac function of CHF patients. The non-invasive hemodynamic monitoring technology of thoracic impedance method can be used to evaluate the cardiac rehabilitation effect of CHF patients.

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