心脏康复治疗对心房颤动合并高血压患者的影响

doi:10.3969/j.issn.1000-8535.2023.03.008

摘要/Abstract

摘要： 目的探索心脏康复干预对房颤合并高血压患者的血脂血压变化、运动耐量、心脏功能、肺功能等指标的影响。方法选取房颤合并高血压患者96例,随机分为常规治疗组和心脏康复(CR)组,每组各48例患者。常规治疗组给予规范的药物治疗,CR组在规范药物治疗的基础上予运动干预6个月,对比治疗前后2组甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)水平,左心房直径(LA)、左心室射血分数(LVEF)、左心室舒张末内径(LVEDd),无氧阈值(AT)、峰值公斤摄氧量(PeakVO₂/kg)、峰值通气量(VEpeak)、每搏输出量(SV)、峰值氧脉搏(PeakO₂pluse),收缩压(SBP)与舒张压(DBP)变化情况,6分钟步行距离(6MWD),以及Borg劳累评估量表评分、焦虑自评量表(SAS)和抑郁自评量表(SDS)评分。结果 2组患者治疗6个月时,TC、TG、LDL-C水平以及SBP、DBP均下降(P<0.05),但2组之间比较,3项血脂指标无统计学差异(P>0.05),而CR组血压显著下降(P<0.05) 。2组患者治疗6个月时,LA、LVEDd减小(P<0.05),而LVEF无变化(P>0.05),CR组LA较常规治疗组缩小(P<0.05)。治疗6个月时,CR组AT、PeakVO₂/kg、VEpeak、SV和PeakO₂plus水平均升高(P<0.05),而常规治疗组的上述相关指标无明显变化(P>0.05)。治疗6个月时,2组患者6分钟步行距离均增加,CR组较常规组增加(P<0.05)。治疗6个月时,CR组Borg劳累评估量表评分、SAS评分及SDS评分均下降,而常规治疗组上述3项评分较治疗前无变化(P>0.05),与常规治疗组比较,CR组上述3项评分降低(P<0.05)。结论以中等强度运动干预为主导的心脏康复治疗能够降低房颤合并高血压患者的血脂水平、控制血压状态、改善左心房及左心室结构重构,还可以增加该群体的运动耐力及心肺功能、减少消极情绪并提高生活质量。

关键词: 心房颤动, 高血压, 运动, 康复

Abstract: Objective To evaluate the impact of cardiac rehabilitation on blood lipid level,blood pressure control,exercise endurance,cardiac function, quality of life and lung function in patients with hypertension and atrial fibrillation (AF). Methods This prospective cohort study enrolled 96 patients with AF and hypertension, who were randomly and evenly assigned to the conventional group and the cardiac rehabilitation (CR) group, both treated for at least 6 months. Research indicators included the levels of triglycerides (TG), total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C); left atrial diameter (LA), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDd), anaerobic threshold (AT), peak oxygen uptake volume per kilogram (PeakVO₂/kg), peak ventilation volume (VEpeak), stroke volume (SV), peak oxygen pulse (PeakO₂pluse), changes in blood pressure, 6 minutes walking distance, Borg Fatigue Scale score, Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores. Results At the 6th month of the treatment, the levels of TG, TC, LDL-C, systolic blood pressure (SBP), diastolic blood pressure (DBP) were significantly reduced (P<0.05) in both groups. However, there was no statistical difference among the three blood lipid indicators between the conventional group and the CR group after treatment (P>0.05). Blood pressure dropped significantly(P<0.05) in both groups, especially in the CR group. Meanwhile, after treatment, LA and LVEDd decreased significantly (P<0.05) in both groups, except LVEF. LA decreased significantly (P<0.05) in CR group, compared with conventional group. In addition, AT, PeakVO₂/kg, VEpeak, SV and PeakO₂pluse levels were significantly elevated (P<0.05) in CR group compared with the conventional group after the treatment. There was no significant difference (P>0.05) in the indicators above in the conventional group. Six minutes walking distance were significantly increased (P<0.05) in both groups at 6th month of treatment, compared with the conventional group, the CR group increased more (P<0.05). Borg Fatigue Scale score, SAS score and SDS score were significantly reduced (P<0.05) in CR group at 6th month of treatment, however, there was no statistical difference (P>0.05) in the conventional group compared with that before treatment. The scores above were significantly reduced (P<0.05) in CR group compared with the conventional group after the treatment. Conclusions Cardiac rehabilitation therapy dominated by moderate-intensity exercise intervention can reduce the blood lipid level of atrial fibrillation and hypertension patients, control the blood pressure, improve the left atrial and left ventricular structure reconstruction, increase the exercise endurance, improve cardiopulmonary function, reduce negative emotions and improve the quality of life.

Key words: atrial fibrillation, hypertension, exercise, cardiac rehabilitation

李寰, 胡良巧, 罗伟康, 张琳, 赖玉林. 心脏康复治疗对心房颤动合并高血压患者的影响[J]. 广州医药, 2023, 54(3): 41-47.

LI Huan, HU Liangqiao, LUO Weikang, ZHANG Lin, LAI Yulin. Effect of cardiac rehabilitation on patients with atrial fibrillation and hypertension[J]. Guangzhou Medical Journal, 2023, 54(3): 41-47.

参考文献

[1] GOROG D A, GUE Y X, CHAO T F, et al. Assessment and mitigation of bleeding risk in atrial fibrillation and venous thromboembolism: A position paper from the ESC working group on thrombosis, in collaboration with the european heart rhythm association, the association for acute cardiovascular care and the asia-pacific heart rhythm society[J].Europace,2022: euac020.
[2] ROBAYE B,LAKISS N,DUMONT F, et al. Atrial fibrillation and cardiac rehabilitation:an overview[J].Acta Cardiol,2020,75(2):116-120.
[3] 陈东学,初金泽,孙磊,等.运动与心房颤动相互关系的研究进展[J].临床内科杂志,2020,37(12):892-894.
[4] OTT C, SCHMIEDER R E.Diagnosis and treatment of arterial hypertension 2021[J].Kidney Int,2022, 101(1):36-46.
[5] 中国康复医学会心血管病预防与康复专业委员会.心房颤动患者心脏康复中国专家共识[J].中华内科杂志,2021,60(2):106-116.
[6] 中国康复医学会心血管病专业委员会.中国心脏康复与二级预防指南2018精要[J].中华内科杂志,2018,57(11):802-810.
[7] MESSORI A, BARTOLI L, FERRACANE E, et al.Medical therapy, radiofrequency ablation or cryoballoon ablation as first-line treatment for paroxysmal atrial fibrillation: interpreting efficacy through restricted mean survival time and network meta-analysis[J].Rev Cardiovasc Med,2021,22(3):557-561.
[8] BUCKLEY B J R, HARRISON S L, FAZIO-EYNULLAYEVA E, et al. Exercise-based cardiac rehabilitation and all-cause mortality among patients with atrial fibrillation[J].J Am Heart Assoc, 2021, 10(12):e020804.
[9] 张苗苗,陈桂英,胡大一,等.运动在心房颤动康复中作用的研究进展[J].中国心血管病研究,2020,18(10):932-935.
[10] S＇WIATKIEWICZ I, DI SOMMA S, de FAZIO L, et al.Effectiveness of intensive cardiac rehabilitation in high-risk patients with cardiovascular disease in real-world practice[J].Nutrients, 2021,13(11):3883.
[11] BARONE GIBBS B, HIVERT M F, JEROME G J,et al. Physical activity as a critical component of first line treatment for elevated blood pressure or cholesterol: who, what, and how?A scientific statement from the American Heart Association[J].Hypertension,2021,78(2):e26-e37.
[12] QIU D, PENG L, GHISTA D N, et al. Left atrial remodeling mechanisms associated with atrial fibrillation[J].Cardiovasc Eng Technol, 2021,12(3):361-372.
[13] 刘顺民,王顺楷,徐顺霖,等.心脏康复运动训练持续时间对介入治疗后冠心病患者心肺功能、运动能力及内皮细胞功能的影响研究[J].实用心脑肺血管病杂志,2019,27(2):115-118.
[14] 彭夏锋,李库林,王如兴,等.二维斑点追踪对房颤所致的左房重构及房颤相关疾病发生的评估[J].江苏大学学报(医学版),2019,29(5):451-455.
[15] DECATO T W, HAVERKAMP H, HEGEWALD M J.Cardiopulmonary exercise testing (CPET)[J].Am J Respir Crit Care Med,2020,201(1):P1-P2.
[16] 李晗,冯茹,陈红琢,等.运动训练在心力衰竭患者心脏康复中的研究进展[J].中国康复,2020,35(4):208-211.