康复运动对冠脉支架植入术后患者血脂及生活质量的影响
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摘要
目的:冠心病患者采用经皮冠状动脉成形术(PTCA)加支架植入术治疗具有良好的疗效,且目前已经作为对血管重建的首选治疗方法。但有研究指出冠脉支架植入术后仍有20%-30%的再狭窄,且PTCA支架后再狭窄是现在难以逾越的问题。多项研究表明高血脂是支架植入术后再狭窄的独立危险因素。血胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)均与冠脉狭窄程度呈正相关,而高密度脂蛋白(HDL)与冠脉狭窄程度呈负相关。因此,在支架植入术后控制血脂水平,消除高危因素,预防冠脉支架再狭窄对于术后患者的预后有重要影响。心脏康复运动能降低血小板活性,减少冠脉血栓的形成,纠正脂质代谢紊乱,有利于维持PTCA术后冠脉的再通和延缓再狭窄的发生,明显降低心绞痛和心脏事件的发生。本课题着重研究支架植入术后患者的心脏康复运动对降低患者血脂及改善生活质量的影响,为冠脉支架术后科学的康复运动提供理论依据。
方法:本课题采用系统分层抽样的方法,对在河北大学附属医院心内科成功植入冠状动脉支架的高血脂患者126例,随机分为对照组和康复组,对照组进行术后常规治疗并按日常习惯运动,康复组除常规治疗外同时进行心脏康复运动训练。术后6-10个月追踪随访患者血脂数值;发放西雅图心绞痛量表(SAQ)、焦虑自评量表(SAS)及症状自评量表(SCL-90)。比较两组患者心理状况、生活质量及血脂水平。全部数据用SAS8.0软件作统计分析处理。
结果:
1本次调查共发出问卷126份,回收问卷124份,回收率98.4%,其中有效问卷120份,有效率95.2%。
2两组患者术后生活质量较前均有明显改善,两组比较康复组西雅图心绞痛生活量表在心绞痛稳定状态、心绞痛发作情况、疾病认识程度、活动受限程度四个维度方面高于对照组(P<0.05),治疗满意程度方面无统计学差异(P>0.05)。
3两组患者术后均常规服用降血脂药物,康复运动前血脂水平无明显差异,康复组进行科学的康复运动6-10月后收集其在本院复查的血脂水平,康复组与对照组比较总胆固醇(TG酶法)有明显下将(P<0.05),高密度脂蛋白(HDL)明显升高(P<0.05)。康复组血脂水平有明显改善。
4两组患者比较,康复组对疾病认识程度显著提高,心理状况得分明显低于对照组,焦虑程度减轻,自觉症状较少,心理状态良好。
5两组患者比较,心绞痛发作次数减少,左室射血分数提高,心脏事件的发生率有下降,从而在生理功能方面有明显改善。
结论:
康复运动训练可以改善患者血脂、精神心理状态,减少患者心绞痛发作次数和心脏事件发生率,提高患者的生活质量,具有重要的临床意义和社会意义。
Objective: Percutaneous transluminal coronary angioplasty (PTCA) and stent implantation for treatment of coronary heart disease (CHD)in China patients have good effect, at present as one of the revascularization treatment of choices. Studies have pointed out that the coronary stent implantation is still 20% -30% of re-stenosis and PTCA-stent restenosis is now an inevitable problem .A number of studies have shown that high cholesterol are independent risk factors. Blood cholesterol (TC), triglyceride (TG) and low-density lipoprotein (LDL) related to the degree of coronary stenosis are positively correlated, while high-density lipoprotein (HDL) is negatively correlated with the degree of coronary stenosis. Therefore, control of lipid levels after stent implantation, eliminating risk factors, prevention of coronary-stent restenosis for the prognosis of postoperative patients have a major impact.
Rehabilitation exercise can reduce the platelet activity and the formation of coronary thrombosis and can conduct to maintaining the PTCA after coronary recanalization and delay the occurrence of restenosis, to correct lipid metabolism disorder, so that exercise stress-induced myocardial ischemia reduction, significantly reduced the incidence of angina and cardiac events, so that patients can soon return to normal social activities and work. The topic focused study of patients with stent implantation in patients with cardiac rehabilitation exercise on blood lipids and quality of life
Methods: The subject of a systematic stratified sampling method in the Affiliated Hospital of Hebei University of Cardiology, successful coronary stent implantation in patients with hyperlipidemia were randomly divided into experimental group and control group, the control group receive routine postoperative treatment, the experimental group receive rehabilitation exercise training except routine treatment at the same time. After 6-10 months follow-up of patients with blood lipid values and the issuance of the Seattle Angina Scale (SAQ), Self-Rating Anxiety Scale (SAS) and the Symptom Checklist (SCL-90), compared two groups of patients with psychological status, life quality and lipid levels. All data are used for statistical analysis and processing software SAS8.0.
Results:
1 The survey of 126 questionnaires were issued, 124 questionnaires were recovered, the recovery rate 98.4%, of which 120 valid questionnaires, efficiency 95.2%.
2 Postoperative and preoperative groups compared to the quality of life were markedly improved, the two groups have difference in degree of activity limitation, Angina stability, angina attack, aspects of the awareness of high level in disease of four dimensions (P <0.05). Treatment satisfaction has no statistical difference between two groups (P> 0.05).
3 Routine postoperative groups were taking lipid-lowering drugs, whereas rehabilitation group, pre-exercise no significant difference in blood lipid levels, exercise science scientifically. After collection of the lipid levels in our hospital, two groups in total cholesterol ( TG enzyme) have significant difference(P <0.05), high-density lipoprotein (HDL) is significantly higher (P <0.05). Rehabilitation group had significant improvement in blood lipid levels.
4 In psychological scores rehabilitation group is significantly lower than the control group, the degree of anxiety reduced and has fewer symptoms. Psychological condition is good.
5 Rehabilitation group and control group, significantly reduced the number of angina attacks, left ventricular ejection fraction significantly increased and the incidence of cardiac events decreased significantly. Physiological function and physiological functions have improved significantly.
Conclusion: Rehabilitation exercise training can improve blood lipids, psychological state and reduce the number of patients with angina pectoris and the incidence of cardiac events and improve the quality life of patients .
方法:本课题采用系统分层抽样的方法,对在河北大学附属医院心内科成功植入冠状动脉支架的高血脂患者126例,随机分为对照组和康复组,对照组进行术后常规治疗并按日常习惯运动,康复组除常规治疗外同时进行心脏康复运动训练。术后6-10个月追踪随访患者血脂数值;发放西雅图心绞痛量表(SAQ)、焦虑自评量表(SAS)及症状自评量表(SCL-90)。比较两组患者心理状况、生活质量及血脂水平。全部数据用SAS8.0软件作统计分析处理。
结果:
1本次调查共发出问卷126份,回收问卷124份,回收率98.4%,其中有效问卷120份,有效率95.2%。
2两组患者术后生活质量较前均有明显改善,两组比较康复组西雅图心绞痛生活量表在心绞痛稳定状态、心绞痛发作情况、疾病认识程度、活动受限程度四个维度方面高于对照组(P<0.05),治疗满意程度方面无统计学差异(P>0.05)。
3两组患者术后均常规服用降血脂药物,康复运动前血脂水平无明显差异,康复组进行科学的康复运动6-10月后收集其在本院复查的血脂水平,康复组与对照组比较总胆固醇(TG酶法)有明显下将(P<0.05),高密度脂蛋白(HDL)明显升高(P<0.05)。康复组血脂水平有明显改善。
4两组患者比较,康复组对疾病认识程度显著提高,心理状况得分明显低于对照组,焦虑程度减轻,自觉症状较少,心理状态良好。
5两组患者比较,心绞痛发作次数减少,左室射血分数提高,心脏事件的发生率有下降,从而在生理功能方面有明显改善。
结论:
康复运动训练可以改善患者血脂、精神心理状态,减少患者心绞痛发作次数和心脏事件发生率,提高患者的生活质量,具有重要的临床意义和社会意义。
Objective: Percutaneous transluminal coronary angioplasty (PTCA) and stent implantation for treatment of coronary heart disease (CHD)in China patients have good effect, at present as one of the revascularization treatment of choices. Studies have pointed out that the coronary stent implantation is still 20% -30% of re-stenosis and PTCA-stent restenosis is now an inevitable problem .A number of studies have shown that high cholesterol are independent risk factors. Blood cholesterol (TC), triglyceride (TG) and low-density lipoprotein (LDL) related to the degree of coronary stenosis are positively correlated, while high-density lipoprotein (HDL) is negatively correlated with the degree of coronary stenosis. Therefore, control of lipid levels after stent implantation, eliminating risk factors, prevention of coronary-stent restenosis for the prognosis of postoperative patients have a major impact.
Rehabilitation exercise can reduce the platelet activity and the formation of coronary thrombosis and can conduct to maintaining the PTCA after coronary recanalization and delay the occurrence of restenosis, to correct lipid metabolism disorder, so that exercise stress-induced myocardial ischemia reduction, significantly reduced the incidence of angina and cardiac events, so that patients can soon return to normal social activities and work. The topic focused study of patients with stent implantation in patients with cardiac rehabilitation exercise on blood lipids and quality of life
Methods: The subject of a systematic stratified sampling method in the Affiliated Hospital of Hebei University of Cardiology, successful coronary stent implantation in patients with hyperlipidemia were randomly divided into experimental group and control group, the control group receive routine postoperative treatment, the experimental group receive rehabilitation exercise training except routine treatment at the same time. After 6-10 months follow-up of patients with blood lipid values and the issuance of the Seattle Angina Scale (SAQ), Self-Rating Anxiety Scale (SAS) and the Symptom Checklist (SCL-90), compared two groups of patients with psychological status, life quality and lipid levels. All data are used for statistical analysis and processing software SAS8.0.
Results:
1 The survey of 126 questionnaires were issued, 124 questionnaires were recovered, the recovery rate 98.4%, of which 120 valid questionnaires, efficiency 95.2%.
2 Postoperative and preoperative groups compared to the quality of life were markedly improved, the two groups have difference in degree of activity limitation, Angina stability, angina attack, aspects of the awareness of high level in disease of four dimensions (P <0.05). Treatment satisfaction has no statistical difference between two groups (P> 0.05).
3 Routine postoperative groups were taking lipid-lowering drugs, whereas rehabilitation group, pre-exercise no significant difference in blood lipid levels, exercise science scientifically. After collection of the lipid levels in our hospital, two groups in total cholesterol ( TG enzyme) have significant difference(P <0.05), high-density lipoprotein (HDL) is significantly higher (P <0.05). Rehabilitation group had significant improvement in blood lipid levels.
4 In psychological scores rehabilitation group is significantly lower than the control group, the degree of anxiety reduced and has fewer symptoms. Psychological condition is good.
5 Rehabilitation group and control group, significantly reduced the number of angina attacks, left ventricular ejection fraction significantly increased and the incidence of cardiac events decreased significantly. Physiological function and physiological functions have improved significantly.
Conclusion: Rehabilitation exercise training can improve blood lipids, psychological state and reduce the number of patients with angina pectoris and the incidence of cardiac events and improve the quality life of patients .
引文
1陈纪林,高润霖,蔡强平.经皮冠状动脉腔内成形术及置入支架的长期预后分析(J).中华心血管杂志,2001,29(1):65
2黄淑萍,冠心病患者经皮冠状动脉腔内成形术的康复指导(J).南方护理学报,2003,10(3):46
3 Fischman DL,Leon MB,Baim DS,et al.A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease :stent restenosis study investigation .N Engl Med,1994,331(8):496-501
4 Hoffmann R, Mintz GS, Dussaillant GR, etal. Patterns and mechanisms of in-stent restenosis :a sterial intravascular ultrasonndstudy, circulation,1996,94:1247-1254. (5) Kastrati S. Schomig A. Elezi S, al. Predictive factors of restenosis after coronary stent placement. J .Am Coll Cardiol,1997,30:1428-1436
5 Kastrati S. Schomig A. Elezi S, al. Predictive factors of resten -osis after coronary stent placement. J .Am Coll CARDIOL, 199 7, 30: 1428-1436
6陈纪言,张励庭,罗建方等,冠状动脉支架植入术后再狭窄的危险因素分析.实用医学杂志,2002,18(11):1161-1162
7高润霖,陈纪林,杨跃林等,冠状动脉内支架植入术后再狭窄的危险因素和预测.中华心血管杂志,2000,28(6):426-429
8郭军,程祖亨,杨新春等,冠状动脉内再狭窄的相关因素研究.新疆医科大学学报,2004, 27(3):234-236
9胡春燕,何奔,孙宝贵等,冠状动脉支架内再狭窄的危险因素分析.上海医学,2006,29(1):1-2
10方叶清,杨天伦,陈小彬等,血脂比值和单项血脂与冠脉狭窄程度的相关分析.湘南学院学报(医学版),2006,8(4):7-8
11袁宇,李胜利,赵国安.血脂水平与冠状动脉病变程度的相关性研究.中国实用内科杂志,2001,21(5):287-288
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1陈纪林,高润霖,蔡强平.经皮冠状动脉腔内成形术及置入支架的长期预后分析(J).中华心血管杂志,2001,29(1):65
2黄淑萍,冠心病患者经皮冠状动脉腔内成形术的康复指导(J).南方护理学报,2003,10(3):46
3 Fischman DL,Leon MB,Baim DS,et al.A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease :stent restenosis study investigation .N Engl Med, 1994, 31(8):496-501
4 Hoffmann R, Mintz GS, Dussaillant GR, etal. Patterns and echanisms of in-stent restenosis :a sterial intravascular ultrasonnd study, circulation, 1996,94:1247-1254Kastrati S. Schomig A. Elezi S, al. Predictive factors of restenosis after coronary stent placement. J .Am Coll CARDIOL,1997,30:1428-1436.
5陈纪言,张励庭,罗建方等,冠状动脉支架植入术后再狭窄的危险因素分析.实用医学杂志,2002,18(11):1161-1162
6高润霖,陈纪林,杨跃林等,冠状动脉内支架植入术后再狭窄的危险因素和预测.中华心血管杂志,2000,28(6):426-429
7郭军,程祖亨,杨新春等,冠状动脉内再狭窄的相关因素研究.新疆医科大学学报,2004, 27(3):234-236
8胡春燕,何奔,孙宝贵等,冠状动脉支架内再狭窄的危险因素分析.上海医学,2006,29(1):1-2
9方叶清,杨天伦,陈小彬等,血脂比值和单项血脂与冠脉狭窄程度的相关分析.湘南学院学报(医学版),2006,8(4):7-8
10袁宇,李胜利,赵国安.血脂水平与冠状动脉病变程度的相关性研究.中国实用内科杂志,2001,21(5):287-288
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14励建安.国际心脏康复研究新趋向(J).中国康复医学杂志,2002,17(1):14-15
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24蒋晓莲,薛咏红,汪国成等,心脏康复训练对冠心病患者生存质量的影响.中国循证医学杂志,2004,4(12):855-858
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27 Roffi M,Wenaweser P, Windecker S, et al. Early exercis after coronary stenting is safe :J Am Coll Cardiol.2003,42:1569-1573
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29 FosterC, Gal R, Murphy P, et al .Left Ventracular function during exercises testing and training(J). Med Sci Sports Exerc,1996,29:297-305
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23徐岫岚,梁江,柴哲宣等,康复运动对冠心病患者生存质量的影响.中国临床康复,2004,12(5):1651
24蒋晓莲,薛咏红,汪国成等,心脏康复训练对冠心病患者生存质量的影响.中国循证医学杂志,2004,4(12):855-858
25杨彩霞,李海斌,冠心病患者康复期运动训练效果及安全性的评价.中国临床康复,2004,9(36):8247-8253
26 Purcell JA. Heart attack :what ahead? American Association, Atlanta Georgia Affiliate, Inc, 1986.112-120
27 Roffi M,Wenaweser P, Windecker S, et al. Early exercis after coronary stenting is safe :J Am Coll Cardiol.2003,42:1569-1573
28 Thomas RJ, Miller NH, Lamendola C,et al. National Survey on Gender Difference .In Cardiac Rehabilitation Programs:Patient Characteristics and enrollment patterns(J). J Cardiopulm Rehabil .1996,16(6):402-412
29 FosterC, Gal R, Murphy P, et al .Left Ventracular function during exercises testing and training(J). Med Sci Sports Exerc,1996,29:297-305