摘要
目的分析急性冠状动脉综合征患者经皮冠状动脉介入治疗(PCI)术后康复早期的心肺功能特征,为患者出院后早期康复运动提供依据。方法选取北部战区总医院自2015年4月至2017年5月收治的急性冠状动脉综合征接受PCI和心肺运动试验的1 781例患者为研究对象。根据诊断不同,将患者分为ST段抬高型心肌梗死组(n=663)、非ST段抬高型心肌梗死组(n=127)、不稳定型心绞痛组(n=991)。收集并分析3组患者的基线资料、心肺功能指标及PCI术后康复早期心肺运动试验相关数据特点。结果 3组患者左室内径、左室射血分数、肌酸激酶、肌酸激酶同工酶、第1秒用力呼气量、第1秒用力呼气量/用力肺活量比较,差异有统计学意义(P<0.05)。不稳定型心绞痛组峰值心率、峰值摄氧量、峰值公斤摄氧量、峰值公斤摄氧量达预计值、峰值负荷、呼吸频率最高,非ST段抬高型心肌梗死组次之,ST段抬高型心肌梗死组最低,差异有统计学意义(P<0.05)。68.90%的患者提前终止试验,以腿酸、乏力及膝痛为最常见原因,其次为胸闷气短、严重高血压等,试验过程中未发生死亡或紧急血运重建等严重不良事件。结论急性冠状动脉综合征患者PCI术后早期的心肺耐力和运动能力下降,预后较差,表现为峰值摄氧量、峰值负荷等特异性指标的下降。急性冠状动脉综合征患者,尤其是急性心肌梗死患者在完全血运重建后早期进行心肺运动试验具有良好的安全性。
Objective To explore the characteristics of cardiopulmonary function in patients with complete revascularization of acute coronary syndrome in the early stage of rehabilitation after percutaneous transluminal coronary intervention(PCI).Methods A total of 1 781 patients who underwent cardiopulmonary exercise test(CPET)from April 2015 to May 2017 were retrospectively selected and divided into STEMI group(n=663),NSTEMI group(n=127)and UA group(n=991).The baseline data, cardiopulmonary function indexes and the characteristics of CPET in early rehabilitation after PCI were collected and analyzed in these three groups.Results There were statistically significant differences in left ventricular diameter, left ventricular ejection fraction, creatine kinase, creatine kinase co-enzyme, forced expiratory volume in 1 second, forced expiratory volume in 1 second/forced vital capacity among 3 groups(P<0.05).The peak heart rate, peak oxygen uptake, peak oxygen uptake per kg, peak oxygen uptake per kg, peak oxygen uptake per kg reached the expected value, peak load and respiratory rate were the highest in UA group, followed by NSTEMI group, and the lowest in STEMI group, the difference was statistically significant.68.90% of the patients were terminated the trial prematurely, the leg pain, fatigue and knee pain were the most common causes, other causes were chest tightness and shortness of breath, severe hypertension.There were no serious adverse events such as death or emergency revascularization in the three groups.Conclusion patients with acute coronary syndrome, cardiopulmonary endurance and exercise ability decreased in the early stage after PCI,and the prognosis was poor, which was manifested by the decline of specific indexes such as peak oxygen uptake and peak load.CPET has good safety in patients with acute coronary syndromeafter complete revascularization, especially in patients with acute myocardial infarction.
作者
王艳霞
梁延春
张剑
贺静斐
张伊
张权宇
WANG Yan-xia;LIANG Yan-chun;ZHANG Jian;HE Jing-fei;ZHANG Yi;ZHANG Quan-yu(Department of Cardiovascular,General Hospital of Northern Theater Command,Shenyang 110016,China)
出处
《临床军医杂志》
CAS
2021年第5期528-531,535,共5页
Clinical Journal of Medical Officers
基金
国家重点研究计划(2016YFC1301303)。
关键词
急性冠状动脉综合征
经皮冠状动脉介入治疗
心肺运动试验
Acute coronary syndrome
Percutaneous transluminal coronary intervention
Cardiopulmonary exercise test
