文章摘要
齐丽,陈烨,陈雷,姜秋岩,李春江.心脏康复锻炼对维持性血透合并心功能不全患者的疗效观察[J].中国康复,2018,33(4):297-300
心脏康复锻炼对维持性血透合并心功能不全患者的疗效观察
Curative efficacy of cardiac rehabilitative exercise for cardiac insufficiency in patients receiving maintenance hemodialysis: An observation on various therapeutic indexes
  
DOI:
中文关键词: 维持性血透/心衰  心脏康复锻炼  超声心动图/心功能  运动耐量  透析充分性指标  肾脏病特异性生活质量问卷
英文关键词: Maintenance hemodialysis/Heart failure  Cardiac rehabilitative exercise  Ultrasonic cardiogram/Cardiac function  Exercise tolerance  Dialysis adequacy index  Kidney disease questionnaire
基金项目:
作者单位
齐丽 阜新市中心医院肾内科辽宁 阜新 123000 
陈烨 阜新市中心医院肾内科辽宁 阜新 123000 
陈雷 阜新市中心医院肾内科辽宁 阜新 123000 
姜秋岩 阜新市中心医院肾内科辽宁 阜新 123000 
李春江 解放军第二零二医院心内科沈阳 110003 
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中文摘要:
  目的:观察心脏康复锻炼改善维持性血透(MHD)合并心功能不全患者各类疗效指标。方法:选择在血液透析中心接受MHD治疗(>3个月)的慢性肾衰合并心功能不全患者63例,随机分为康复组(32例)及对照组(31例)。对照组仅接受MHD常规治疗,康复组另外在MHD间歇期接受了心脏康复锻炼,内容包括:根据6min步行试验结果,设计合理运动处方;从低运动量开始逐渐加大;经常随访、监测患者血压、心率和体重变化。2组对象分别在治疗前后接受了心脏超声心动图、透析充分性及运动耐量指标、肾脏病特异性生活质量问卷(KDQ)评估。结果:治疗6个月后,康复组的左室舒张末内径(LVEDd)、左室收缩末内径(LVEDs)、左室质量指数(LVMI)、心脏指数(CI)、左心室内径缩短率(FS)、左室射血分数(EF%)均明显优于治疗前和对照组(P<0.01,0.05)。治疗后,康复组的6min步行试验距离均明显高于治疗前和对照组(P<0.01,0.05)。治疗后,康复组的KDQ多数分项分及总分均明显高于治疗前和对照组(P<0.01,0.05)。结论:心脏康复锻炼可以明确改善接受MHD治疗心衰患者各类疗效指标。
英文摘要:
  Objective: To observe the improvement of various therapeutic indexes by cardiac rehabilitative exercise for maintenance hemodialysis (MHD) patients with cardiac insufficiency. Methods: A total of 63 patients with chronic renal failure combined with cardiac insufficiency, who accepted MHD treatment (> 3 months) were successively selected, and they were divided into the rehabilitative exercise group (n=32) and the control group (n=31) according to the time of enrollment and the method of random number table. The patients in the rehabilitative exercise group were given the treatment of cardiac rehabilitation exercise during the intermission of MHD, including designing the reasonable exercise prescription according to the results of the 6-min walking test; gradually increasing the exercise amount from a low amount; and always following up and monitoring the changes in the blood pressure, heart rate and body mass of the patients. The patients in the control group were subjected to the routine treatment of MHD. The subjects in both groups were assessed by ultrasonic cardiogram, the dialysis adequacy indexes and exercise tolerance, and kidney disease questionnaire (KDQ) at enrollment and after 6 months. Results: The left ventricular end-systolic dimension (LVEDs), left ventricular end-diastolic dimension (LVEDd), left ventricular mass index (LVMI), cardiac index (CI), and ejection fraction (EF) after treatment for 6 months in the rehabilitative exercise group were all obviously superior to those at enrollment and those in the control group at the same period (P<0.01, <0.05). There was no significant difference in the distribution of indexes of exercise tolerance and dialysis adequacy at enrollment between two groups, and the distances of the 6 min walking test after 6 months in the rehabilitative exercise group were all obviously longer than those at enrollment and those in the control group at the same period (P<0.01, <0.05). The sub time scores and the total score of the KDQ at enrollment showed no significant difference between two groups (P>0.05), and most sub-time scores and the total score of the KDQ after 6 months in the rehabilitative exercise group were all obviously higher than those at enrollment and those in the control group at the same period (P<0.01, <0.05). Conclusion: Cardiac rehabilitative exercise can obviously ameliorate various therapeutic indexes of MHD patients with cardiac insufficiency.
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