南方医科大学学报 ›› 2016, Vol. 36 ›› Issue (04): 461-.

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平板运动对60岁以下冠心病患者无创中心血流动力学参数的影响

王晋丽,陈韵岱,石亚君,薛浩,郜玲   

  • 出版日期:2016-04-20 发布日期:2016-04-20

Effects of treadmill exercise on central hemodynamics in patients below 60 years of age with coronary artery disease

  • Online:2016-04-20 Published:2016-04-20

摘要: 目的研究60岁以下冠心病患者平板运动试验前后无创中心血流动力学指标的变化,为冠心病患者的心脏康复提供新的 研究指标。方法连续入组2013年7月~2014年4月解放军总医院行平板运动试验且年龄小于等于60岁的受试者。采用Bruce 症状限制性方案,根据冠脉造影结果分为冠心病组(n=68)和非冠心病组(n=97)。应用无创方法检测运动前后受试者的中心血 流动力学参数:中心动脉压(cSBP),反射波增强指数(AI)和反射波增强压(AP)。结果平板运动结束即刻,在冠心病组,AI运动 后无明显变化(P=0.516),而非冠心病组有显著降低(P<0.001);两组cSBP均出现升高(P<0.001)。两组组间比较,冠心病组运 动前AI和运动后cSBP高于非冠心病组(P=0.009, P=0.009)。进一步回归分析发现,冠心病人群中,运动后最大心率是影响△ cSBP(运动后cSBP-运动前cSBP,cSBP增幅)的主要因素(B=-0.073,P=0.012)。冠心病组按照平板运动试验结果(阴性和阳 性)分层分析,发现阳性组运动后cSBP的增幅较小(P=0.048),进一步回归分析后无统计学意义(P>0.05)。结论平板运动后AI 出现差异性变化,冠心病患者AI未见明显降低,提示AI可能与运动后冠脉血流灌注密切相关;可能是康复治疗提高运动后心肌 缺血阈值治疗的又一靶点。

Abstract: Objective To investigate the effects of treadmill exercise on central hemodynamics in patients with coronary artery disease. Methods Sixty-eight consecutive patients below 60 years of age with the diagnosis of coronary artery disease (CAD) between July, 2013 and April, 2014 underwent treadmill exercise test following the standard Bruce protocol. Ninety-seven individuals without CAD served as the control group. Central hemodynamics of the subjects, including the central aortic blood pressure (cSBP), augmentation index (AI) and augmentation pressure (AP), were examined before and after the exercise. Results cSBP increased significantly after acute exercise in both groups (P<0.001). Immediately after treadmill exercise, AI showed no significant changes in CAD patients (P=0.561) but decreased significantly in the control subjects (P<0.001). AI before exercise and cSBP after exercise were significantly higher in CAD group than in the control group (P=0.009 and 0.009, respectively). Stepwise regression analysis showed that the maximal heart rate after exercise was the main factor that affected cSBP increment in CAD group (P=0.012), and the occurrence of ischemia after exercise was associated with a lower cSBP increment (P=0.048). Conclusion AI does not decrease significantly after acute exercise in patients with CAD, suggesting that AI is closely associated with coronary artery blood perfusion after exercise and may serve as a potential target for improving ischemic threshold during rehabilitation of the patients.