王融 王学磊

【摘要】 目的：探討利用心肺运动试验（Cardiopulmonary Exercise Testing， CPX）制定无氧域强度运动处方进行的家庭心脏康复对经皮冠状动脉介入治疗（PCI）术后抑郁患者心理状态及心肺功能影响的临床研究。方法：选取2017年6月-2020年6月在本院心脏康复科门诊就诊的PCI术后抑郁患者60例。按照患者意愿和随机原则将其分为对照组和运动组，每组30例。对照组进行除运动处方治疗之外的常规心脏康复指导，运动组在对照组基础上执行CPX制定无氧域强度的运动处方进行12周步行运动。治疗前后分别进行SDS测定和CPX检查，比较相关指标变化。结果：进行12周心脏康复后，运动组患者最大通气量（MVV）、无氧阈氧耗量（VO2AT）、峰值摄氧量（VO2峰值）、无氧域心率（HRAT）和最大负荷（PeakWR）均较运动前明显增高，SDS评分明显降低，差异均有统计学意义（P<0.05）。对照组MVV、VO2AT、VO2峰值、HRAT和PeakWR均较治疗前有所增高，SDS评分较治疗前降低，但差异均无统计学意义（P>0.05）。12周后与对照组相比，运动组MVV、VO2AT、VO2峰值、HRAT、PeakWR均增加，SDS评分降低，差异均有统计学意义（P<0.05）。结论：以运动为核心的家庭心脏康复显著改善PCI术后抑郁患者心理状态和心肺功能。无氧域强度运动处方安全有效，值得广泛推广。

【关键词】 家庭心脏康复 无氧域 经皮冠状动脉介入治疗 抑郁 心肺功能

[Abstract] Objective： To explore the clinical study on the effect of home-based cardiac rehabilitation with Exercise prescription of anaerobic zone intensity by using Cardiopulmonary Exercise Testing （CPX） on the psychological state and cardiopulmonary function of depressed patients after percutaneous coronary intervention （PCI）. Method： A total of 60 patients with post-PCI depression who were admitted to the outpatient department of cardiac rehabilitation of our hospital from June 2017 to June 2020 were selected. Patients were divided into control group and exercise group according to their will and random principle， 30 cases in each group. The control group received routine cardiac rehabilitation guidance except exercise prescription treatment， and the exercise group performed CPX on the basis of the control group to develop exercise prescription without oxygen domain intensity for 12 weeks of walking exercise. SDS and CPX tests were performed before and after treatment， the changes of related indicators were compared. Result： After 12 weeks of cardiac rehabilitation， the maximum volume of gas （MVV）， anaerobic threshold oxygen consumption （VO2AT）， peak oxygen uptake （VO2peak）， heart rate in the anaerobic domain （HRAT） and maximum load （PeakWR） in the exercise group were significantly higher than those before exercise， and the SDS score was significantly lower， with statistical significance （P<0.05）. In the control group， MVV， VO2AT， VO2peak， HRAT and PeakWR were increased compared with before treatment， and SDS score was decreased compared with before treatment， but the differences were not statistically significant （P>0.05）. After 12 weeks， compared with the control group， MVV， VO2AT， VO2peak， HRAT and PeakWR in the exercise group were increased， and SDS score was decreased， with statistical significance （P<0.05）. Conclusion： Home-based cardiac rehabilitation centered on exercise can significantly improve the mental state and cardiopulmonary function of depressed patients after PCI. The prescription of anaerobic intensity exercise is safe and effective and worthy of widespread promotion.

[Key words] Home-based cardiac rehabilitation Anaerobic zone Percutaneous coronary intervention Depression Cardiopulmonary function

First-authors address： Bayannur Hospital， Bayannur 015000， China

doi：10.3969/j.issn.1674-4985.2021.06.043

經皮冠状动脉介入（PCI）是冠心病的常用治疗方法，其在显著降低急性心肌梗死致残率及致死率的同时，常导致患者产生焦虑、抑郁等心理应激反应[1]。研究证明，运动为核心的心脏康复可显著改善PCI术后患者心理状态及心肺功能[2-3]。500多家心脏康复中心已在国内医院成立，但参与心脏康复的患者呈现出较低的参与性和依从性。家庭心脏康复（home-based cardiac rehabilitation， HBCR）可显著提高患者参与性和依从性，已被澳大利亚、加拿大、英国等多国纳入国家卫生保健体系之中[4]。……