刘龙华+蒙冠云+周黎明

【摘要】 目的 观察心脏康复结合体外反搏治疗扩张型心肌病的疗效。

方法 将64例患者随机分成观察组和对照组（每组32例），两组均予常规药物治疗；观察组加用心脏康复及体外反搏治疗，对两组患者治疗8周后的6 min步行距离、血浆N-末端脑钠肽前体（BNP）、CA125及心脏彩超左室舒张末期内径（LVEDd）、射血分数（EF）、心排血量（CO）进行比较。

结果 ①治疗后，两组患者6 min步行距离较治疗前均增加，观察组步行距离大于对照组，差异有统计学意义（P<0.05）；两组患者BNP、CA125较治疗前均下降，观察组下降幅度大于对照组，差异有统计学意义（P<0.05）。②治疗后，两组患者心脏彩超EF、CO較治疗前均增加，观察组增加幅度大于对照组，差异有统计学意义（P<0.05）；两组患者LVEDd较治疗前均下降，观察组下降幅度大于对照组，差异有统计学意义（P<0.05）。

结论 心脏康复结合体外反搏治疗能明显改善扩张型心肌病患者的活动能力，改善心功能，提高患者的生活质量，具有推广应用价值。

【关键词】 扩张型心肌病；心脏康复；体外反搏

中图分类号：R542.2 文献标识码：A DOI：10.3969/j.issn.1003-1383.2017.03.015

【Abstract】 Objective To observe the curative effect of cardiac rehabilitation combined with external counterpulsation in the treatment of dilated cardiomyopathy（DCM）.

Methods 64 patients were randomly divided into observation group and control group with 32 cases in each group.Both groups were given conventional drug therapy，and the observation group were given extra cardiac rehabilitation and external counterpulsation treatment.After 8 weeks of treatment，all patients6 min walking distance，plasma BNP，CA125 and left ventricular diastolic diameter（LVEDd），ejection fraction（EF） and cardiac output（CO）were compared.

Results ①After treatment，the 6 min walking distances of the two groups were longer than those before treatment，and that of the observation group was longer than that of the control group，difference was statistically significant （P<0.05）； The BNP and CA125 of the two groups were significantly lower than those before treatment （P<0.05），and those of the observation group decreased more significantly，so difference was statistically significant（P<0.05）.②After 8 weeks of treatment，the echocardiographic EF and CO of the two groups increased compared with those before treatment，and those of the observation group increased more significantly，so difference was statistically significant（P<0.05）.The LVEDd of the two groups decreased compared with those before treatment，and that of the observation group decreased more significantly，difference was statistically significant（P<0.05）.

Conclusion Cardiac rehabilitation combined with external counterpulsation can significantly improve the activity abilities，the cardiac function and the quality of life of patients with DCM，and thus it has value of popularization and application.

【Key words】 DCM；cardiac rehabilitation；external counterpulsation

扩张型心肌病（dilated carduomyopathy，DCM）是一种以单心腔或双心腔扩大为特征，表现为心肌收缩功能减退，常伴有心律失常等症，最后发展为心力衰竭，甚至猝死的常见心肌疾病[1]。其病因迄今不明，与家族遗传有关，近年研究发现病毒感染是其重要的发病原因，作为一种排他性疾病，其诊断不仅要依靠心电图、心脏彩超、心脏标志物、冠脉造影等检查，同时临床表现也是该病的重要诊断依据。DCM发展到慢性心衰时预后较差，5年生存率只有40%左右，给社会和家庭带来很大的经济负担[2]。……