CPET指导下心脏康复治疗对老年冠心病HFpEF患者心肺功能运动耐量及生活质量的影响

doi:10.3969/j.issn.1006-6233.2024.08.016

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摘要 目的: 探讨心肺运动测试(Cardiopulmonary exercise test,CPET)指导下心脏康复治疗对老年冠心病射血分数保留型心力衰竭(HFpEF)患者心肺功能、运动耐量及生活质量的影响。方法: 回顾性分析昆明市第二人民医院2020年6月至2022年5月收治的103例老年冠心病HFpEF患者的临床资料,按治疗方式不同分为对照组(51例)、观察组(52例),对照组予以常规对症治疗,观察组在此基础上予以CPET指导下心脏康复治疗,持续治疗12周。比较两组治疗前后心肺功能[无氧阈(AT)、峰值氧耗量(VO₂ peak)、运动持续时间(ED)、通气二氧化碳斜率(VE/VCO₂ slop)]、心肌酶谱[肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)、乳酸脱氢酶(LDH)]、N-末端前体脑利钠肽(NT-proBNP)、运动耐量[6 min步行距离(6 MWT)]、明尼苏达心力衰竭生活质量表(LHFQ)评分、预后情况(1年再住院率、1年内死亡率)。结果: 治疗后观察组AT、VO₂ peak、ED分别为(14.65±2.03)(mL·kg^-1·min^-1)、(25.32±2.57)(mL·kg^-1·min^-1)、(436.89±46.85)s高于对照组的(11.24±1.95)(mL·kg^-1·min^-1)、(21.65±2.49)(mL·kg^-1·min^-1)、(378.46±46.18)s,VE/VCO₂ slop为(30.27±2.75)mmoL/L低于对照组的(35.05±2.80)mmoL/L,差异具有统计学意义(P<0.05);治疗后观察组CK-MB、CK、LDH、NT-proBNP分别为(136.84±24.35)IU/L、(28.48±4.29)IU/L、(26.48±5.85)IU/L、(1535.25±32.09)pg/mL低于对照组的(325.45±35.48)IU/L、(56.26±5.84)IU/L、(49.32±6.88)IU/L、(1716.73±39.42)pg/mL,差异具有统计学意义(P<0.05);治疗后观察组6 MWT为(405.46±52.28)m大于对照组的(345.19±48.64)m,差异具有统计学意义(P<0.05);治疗后观察组LHFQ量表情绪领域、身体领域、其他领域及总分分别为(8.26±1.95)分、(22.49±3.68)分、(21.58±3.39)分、(56.29±5.39)分低于对照组的(11.38±2.26)分、(25.55±3.80)分、(24.68±3.97)分、(63.45±6.98)分,差异具有统计学意义(P<0.05);观察组1年再住院率15.38%、1年内死亡率5.77%与对照组31.37%、15.69%比较,差异无统计学意义(P>0.05)。结论: CPET指导下心脏康复治疗可抑制老年冠心病HFpEF患者心肌酶谱水平,改善其心肺功能,有利于提高患者运动耐量及生活质量。

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关键词 ：冠心病, 心力衰竭, 心脏康复, 心肺运动测试, 心肺功能, 运动耐量

Abstract：Objective: To explore the effects of cardiopulmonary exercise testing (CPET)-guided cardiac rehabilitation on cardiorespiratory function, exercise tolerance, and quality of life in elderly patients with coronary heart disease (CHD) and heart failure with preserved ejection fraction (HFpEF).Methods: A retrospective analysis was conducted on the clinical data of 103 elderly patients with coronary heart disease and HFpEF admitted to Kunming Second People's Hospital from June 2020 to May 2022. Patients were divided into two groups: the control group (51 cases) and the observation group (52 cases). The control group received conventional symptomatic treatment, while the observation group received CPET-guided cardiac rehabilitation in addition to the conventional treatment for 12 weeks. Changes in cardiorespiratory function [anaerobic threshold (AT), peak oxygen consumption (VO₂ peak), exercise duration (ED), and ventilatory equivalent for carbon dioxide slope (VE/VCO₂ slope)], myocardial enzyme levels [creatine kinase-MB (CK-MB), creatine kinase (CK), and lactate dehydrogenase (LDH)], N-terminal pro-brain natriuretic peptide (NT-proBNP), exercise tolerance [6-minute walk test (6 MWT)], Minnesota Living with Heart Failure Questionnaire (LHFQ) scores, and prognosis (1-year readmission rate and 1-year mortality rate) were compared before and after treatment.Results: After treatment, the observation group showed significantly higher AT 14.65±2.03mL·kg^-1·min^-1, VO₂ peak mL·kg^-1·min^-1, and ED [(436.89±46.85) s] compared to the control group (11.24±1.95)mL·kg^-1·min^-1,(21.65±2.49)mL·kg^-1·min^-1, and (378.46±46.18)s, respectively. The VE/VCO₂ slope in the observation group (30.27±2.75)mmoL/L was lower than in the control group (35.05±2.80)mmoL/L, with statistically significant differences (P<0.05). The observation group also had lower levels of CK-MB (136.84±24.35) IU/L, CK (28.48±4.29)IU/L, LDH (26.48±5.85)IU/L, and NT-proBNP (1535.25±32.09)pg/mL compared to the control group (325.45±35.48)IU/L, (56.26±5.84) IU/L, (49.32±6.88)IU/L, and (1716.73±39.42)pg/mL respectively, with statistically significant differences (P<0.05). The 6 MWT in the observation group [(405.46±52.28) m] was greater than in the control group [(345.19±48.64) m], with a statistically significant difference (P<0.05). LHFQ scores for emotional, physical, and other domains, as well as the total score, were significantly lower in the observation group [(8.26±1.95) points, (22.49±3.68) points, (21.58±3.39) points, and (56.29±5.39) points] compared to the control group [(11.38±2.26) points, (25.55±3.80) points, (24.68±3.97) points, and (63.45±6.98) points], with statistically significant differences (P<0.05). The 1-year readmission rate and 1-year mortality rate in the observation group were 15.38% and 5.77%, respectively, compared to 31.37% and 15.69% in the control group, with no statistically significant difference (P>0.05).Conclusion: CPET-guided cardiac rehabilitation can suppress myocardial enzyme levels, improve cardiorespiratory function, and enhance exercise tolerance and quality of life in elderly patients with coronary heart disease and HFpEF.

Key words： Coronary heart disease Heart failure Cardiac rehabilitation Cardiopulmonary exercise test Cardiopulmonary function Exercise tolerance

基金资助:昆明市卫生科技人才培养项目医学科技学科后备人才(千工程)培养计划,[编号:2023-SW(后备)-74]

通讯作者: 张铨

引用本文:

张云珊, 钱佳丽, 陈秀丽, 王旋, 张永调, 刘福琳, 李结赛, 张铨. CPET指导下心脏康复治疗对老年冠心病HFpEF患者心肺功能运动耐量及生活质量的影响[J]. 河北医学, 2024, 30(8): 1319-1326.
ZHANG Yunshan, QIAN Jiali, CHEN Xiuli. Impact of Cardiopulmonary Exercise Testing-Guided Cardiac Rehabilitation on Cardiorespiratory Function Exercise Tolerance and Quality of Life in Elderly Patients with CHD and HFpEF. HeBei Med, 2024, 30(8): 1319-1326.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2024.08.016 或 http://www.hbyxzzs.cn/CN/Y2024/V30/I8/1319

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