摘要
目的探究Ⅰ期心脏运动康复对冠心病监护病房(coronary care unit,CCU)内经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者心功能及心血管不良事件(major adverse cardiovascular events,MACE)发生率的影响。方法选取2021年5月—2022年10月厦门大学附属第一医院CCU收治的需行PCI术治疗的138例急性STEMI患者为研究对象,采用随机数字表法将其分为观察组(PCI术后常规护理与Ⅰ期心脏运动康复干预,69例)及对照组(PCI术后常规护理,69例)。比较两组术前及出院时的心功能、心脏自主神经功能、抗氧化能力指标;记录两组术后1个月MACE发生率。结果出院时两组左室射血分数(left ventricular ejection fraction,LVEF)较术前明显提高,心肌肌钙蛋白(cardiac troponini,cTnI)、N末端脑钠肽前体(N-terminal-pro brain natriuretic peptide,NT-proBNP)水平较术前明显降低;观察组LVEF、NT-proBNP水平明显优于对照组,比较差异有统计学意义(P<0.05),两组cTnI水平比较差异无统计学意义(P>0.05)。两组出院时的相邻RR间期差值均方根(root mean square of successive differences,RMSSD)、相邻NN差>50 ms个数占总心跳的百分数(the percentage of adjacent NN difference>50 ms in total heartbeat,pNN50)、窦性RR间期标准差(standard deviation of NN intervals,SDNN)水平较术前明显升高,且观察组均高于对照组,比较差异有统计学意义(P<0.05)。两组出院时的血清超氧化物歧化酶(superoxide dismutase,SOD)、总抗氧化能力(total antioxidant capacity,T-AOC)水平较术前明显升高,丙二醛(malonic dialdehyde,MAD)水平明显降低,且观察组SOD、T-AOC水平明显高于对照组,MAD水平明显低于对照组,比较差异均有统计学意义(P<0.05)。观察组术后1个月MACE发生率为7.25%,对照组为11.59%,比较差异无统计学意义(P>0.05)。结论CCU内急性STEMI患者行PCI术后进行Ⅰ期心脏运动康复干预可改善其心功能及心脏自主神经功能,提高机体抗氧化能力,不增加MACE发生风险。
Objective To explore the impact of stageⅠcardiac exercise rehabilitation on cardiac function and incidence rates of major adverse cardiovascular events(MACE)in patients with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI)in coronary care unit(CCU).Methods A total of 138 patients with acute STEMI who needed PCI in CCU of the First Affiliated Hospital of Xiamen University from May 2021 to October 2022 were selected as the research subjects.According to the random number table method,the patients were divided into observation group(routine nursing after PCI and stageⅠcardiac exercise rehabilitation intervention,69 cases)and control group(routine nursing after PCI,69 cases).The indicators of cardiac function,cardiac autonomic nervous function and antioxidant capacity were compared between the two groups before surgery and at discharge.The incidence rates of MACE at 1 month after surgery were recorded in both groups.Results At discharge,the left ventricular ejection fraction(LVEF)in the two groups was significantly increased compared with that before surgery while the levels of cardiac troponin(cTnI)and N-terminal-pro brain natriuretic peptide(NT-proBNP)were significantly decreased compared with those before surgery,and the LVEF and NT-proBNP level in the observation group were significantly better than those in the control group(P<0.05),but the difference in cTnI level was not statistically significant between the two groups(P>0.05).The root mean square of successive differences(RMSSD),the percentage of adjacent NN interval difference>50 ms in total heartbeat(pNN50)and standard deviation of NN intervals(SDNN)in the two groups at discharge were significantly enhanced compared with those before surgery,and the indicators in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05).The levels of serum superoxide dismutase(SOD)and total antioxidant capacity(T-AOC)in the two groups at discharge were significantly increased than those before surgery while the level of serum malonic dialdehyde(MAD)was significantly decreased,and the levels of SOD and T-AOC in the observation group were significantly higher than those in control group while the level of MAD was significantly lower than that in the control group(P<0.05).The incidence rate of MACE at 1 month after surgery was 7.25%in the observation group and 11.59%in the control group,with no statistically significant difference(P>0.05).Conclusion StageⅠcardiac exercise rehabilitation intervention for patients with acute STEMI after PCI in CCU can improve the cardiac function and cardiac autonomic nervous function and increase the antioxidant capacity of the body,and it does not increase the risk of MACE.
作者
许玉娟
罗芳
张紫冠
XU Yujuan;LUO Fang;ZHANG Ziguan(Department of Cardiovascular Medicine,the First Affiliated Hospital of Xiamen University,Xiamen Fujian 361001,China)
出处
《中国卫生标准管理》
2023年第12期173-178,共6页
China Health Standard Management
基金
2022年厦门市自然科学基金项目(3502Z20227262)。
关键词
Ⅰ期心脏运动康复
经皮冠状动脉介入
急性ST段抬高型心肌梗死
心功能
心脏自主神经功能
抗氧化能力
心血管不良事件
stageⅠcardiac exercise rehabilitation
percutaneous coronary intervention
acute ST-segment elevation myocardial infarction
cardiac function
cardiac autonomic nervous function
antioxidant capacity
major adverse cardiovascular events
作者简介
通信作者:罗芳。
