运动干预对非体外冠状动脉旁路移植术后中年患者健康相关生存质量的影响研究

doi:10.12114/j.issn.1007-9572.2021.00.499

摘要/Abstract

摘要： 背景　冠状动脉旁路移植术已经成为治疗冠心病的重要方法，随着手术技术和器械的改进，国内每年接受该手术的患者逾30 000例，且数量持续增加。既往医生对术后患者更多的关注其生理指标的康复效果，而忽视了患者心理康复的相关问题。目的　探讨运动干预对非体外冠状动脉旁路移植术（OPCAB）后中年患者健康相关生存质量（HRQOL）的影响。方法　选择2014年1月—2017年6月在首都医科大学附属北京安贞医院心脏外科单一手术组行OPCAB的中年患者348例作为研究对象，并按照术后6~18个月是否能够达到运动标准分为运动组（144例）和对照组（204例）。于术后6个月和18个月分别测定患者的射血分数（EF）及左心室舒张末期内径（LVEDD），并应用简明健康调查量表（SF-36）进行测评，记录生理机能（PF）、生理角色限制（RP）、躯体疼痛（BP）、总体健康（GH）、活力（VT）、社会功能（SF）、情感角色限制（RE）、心理健康（MH）、生理健康内容（PHC）、心理健康内容（MHC）评分及SF-36总分，比较两组间术后6个月及术后18个月各指标间有无差异。结果　术后6个月，两组间EF、LVEDD、PF评分、RP评分、BP评分、GH评分、VT评分、SF评分、RE评分、MH评分、PHC评分、MHC评分、SF-36总分比较，差异均无统计学意义（P>0.05）。术后18个月，运动组EF、PF评分、RP评分、BP评分、GH评分、VT评分、SF评分、RE评分、MH评分、PHC评分、MHC评分、SF-36总分均高于对照组（P<0.05）；术后18个月，两组间LVEDD比较，差异无统计学意义（P>0.05）。对照组及运动组术后18个月的EF、PF评分、RP评分、BP评分、GH评分、VT评分、SF评分、RE评分、MH评分、PHC评分、MHC评分、SF-36总分均高于术后6个月，LVEDD低于术后6个月（P<0.05）。结论　达标的运动干预可以明显提升OPCAB后中年患者的HRQOL。

关键词: 冠心病；冠状动脉旁路移植术, 非体外循环；中年人；健康相关生存质量；运动疗法；生活质量

Abstract: Background　Coronary artery bypass grafting has become an important treatment for coronary artery disease（CHD）．With the improvement of surgical techniques and instruments，more than 30 000 cases of CHD receive this procedure every year in China，and the number is increasing．Post-procedure levels of physiological indicators have been well noted，while problems related to psychological rehabilitation have been ignored by clinicians previously．Objective　To investigate the effect of exercise intervention on health-related quality of life in middle-aged patients after off-pump coronary artery bypass grafting（OPCAB）．Methods　A total of 348 middle-aged patients with OPCAB were selected from the single operation group from Department of Cardiac Surgery，Beijing Anzhen Hospital，Capital Medical University from January 2014 to June 2017，and divided into exercise group（144 cases）and control group（204 cases）according to whether they could meet the exercise criteria 6 to 18 months after surgery．Two groups were compared at postoperative 6 and 18 months，respectively，in terms of ejection fraction（EF）and left ventricular end-diastolic diameter（LVEDD），the scale sore and domain scores 〔physical functioning（PF），physical role functioning（RP），bodily pain（BP），general health perceptions（GH），vitality（VT），social role functioning（SF），emotional role functioning（RE），mental health（MH）〕 and physical component summary（PCS）and mental component summary（MCS）scores of the 36-Item Short Form Health Survey（SF-36）．Results　At 6 months after operation，there were no significant differences in the mean values of EF and LVEDD，mean scores of PF，RP，BP，GH，VT，SF，RE，MH，PCS and MCS，as well as the scale score of the SF-36 between the two groups（P>0.05）．Eighteen months after operation，except the mean value of LVEDD was still similar in both groups（P>0.05），other 12 indictors in the exercise group were all much better than those in the control group（P<0.05）．Compared to the results of 6 months post-procedure，the mean value of LVEDD decreased significantly and mean scores of other 12 indicators increased significantly at 18 months post-procedure in both groups（P<0.05）．Conclusion　In middle-aged patients after OPCAB，the standard exercise intervention may significantly improve the health-related quality of life．

Key words: Coronary disease；Coronary artery bypass, off-pump ；Middle aged；Health-related quality of life；Exercise therapy；Quality of life

赵铁夫,王盛宇,张春晓,等. 运动干预对非体外冠状动脉旁路移植术后中年患者健康相关生存质量的影响研究[J]. 中国全科医学, 2021, 24(14): 1752-1757. DOI: 10.12114/j.issn.1007-9572.2021.00.499.
ZHAO Tiefu,WANG Shengyu,ZHANG Chunxiao, et al. Health-related Quality of Life of Middle-aged Patients with Exercise Intervention after Off-pump Coronary Artery Bypass Grafting　[J]. Chinese General Practice, 2021, 24(14): 1752-1757. DOI: 10.12114/j.issn.1007-9572.2021.00.499.

参考文献

［1］《中国心血管健康与疾病报告》编写组．《中国心血管健康与疾病报告2019》要点解读［J］．中国心血管杂志，2020，25（5）：401-410．DOI：10.3969/j.issn.1007-5410.2020.05.001．
The Writing Committee of the Report on Cardiovascular Health and Diseases in China．Interpretation of Report on Cardiovascular Health and Diseases in China 2019［J］．Chin J Cardiovasc Med，2020，25（5）：401-410．DOI：10.3969/j.issn.1007-5410.2020.05.001．
［2］穆军升，周帆，张健群，等．80岁以上老年患者冠状动脉旁路移植术65例临床分析［J］．中国胸心血管外科临床杂志，2011，18（5）：464-465．http：//d.wanfangdata.com.cn/periodical/zgxxxgwk98201105023．
［3］柏本健，魏维强，解洪涛，等．体外循环和非体外循环冠状动脉旁路移植术的早期疗效比较［J］．中国胸心血管外科临床杂志，2010，17（3）：244-246．
BAI B J，WEI W Q，XIE H T，et al．Short-term clinical comparison of on-pump and off-pump coronary artery bypass grafting［J］．Chin J Clin Thorac Cardiovasc Surg，2010，17（3）：244-246．
［4］BRAUNWALD E，ANTMAN E M，BEASLEY J W，et al．ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction——summary article：a report of the American College of Cardiology/American Heart Association task force on practice guidelines（Committee on the Management of Patients With Unstable Angina）［J］．J Am Coll Cardiol，2002，40（7）：1366-1374．DOI：10.1016/s0735-1097（02）02336-7．
［5］SMITH S C Jr，BENJAMIN E J，BONOW R O，et al．AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease：2011 update：a guideline from the American heart association and American college of cardiology foundation［J］．Circulation，2011，124（22）：2458-2473．DOI：10.1161/CIR.0b013e318235eb4d．
［6］WARE J E Jr，GANDEK B．Overview of the SF-36 health survey and the international quality of life assessment（IQOLA）project［J］．J Clin Epidemiol，1998，51（11）：903-912．DOI：10.1016/s0895-4356（98）00081-x．
［7］KIEBZAK G M，PIERSON L M，CAMPBELL M，et al．Use of the SF36 general health status survey to document health-related quality of life in patients with coronary artery disease：effect of disease and response to coronary artery bypass graft surgery［J］．Heart Lung，2002，31（3）：207-213．DOI：10.1067/mhl.2002.124299．
［8］DEMPSTER M，DONNELLY M．Measuring the health related quality of life of people with ischaemic heart disease［J］．Heart，2000，83（6）：641-644．DOI：10.1136/heart.83.6.641．
［9］刘朝杰，李宁秀，任晓晖，等．36条目简明量表在中国人群中的适用性研究［J］．华西医科大学学报，2001，32（1）：39-42．
LIU C J，LI N X，REN X H，et al．Feasibility of using short form 36 in Chinese population［J］．Journal of West China University of Medical Sciences，2001，32（1）：39-42．
［10］万崇华，方积乾，史明丽，等．MOS SF-36量表用于药物成瘾者生命质量测定的对比研究［J］．中国行为医学科学，1998，7（4）：241．
WAN C H，FANG J Q，SHI M L，et al．A comparative study on measuring quality of life for drug addicts by SF-36 scale［J］．Chin J Behav Med Sci，1998，7（4）：241．
［11］LEON A S，FRANKLIN B A，COSTA F，et al．Cardiac rehabilitation and secondary prevention of coronary heart disease：an American heart association scientific statement from the council on clinical cardiology（subcommittee on exercise，cardiac rehabilitation，and prevention）and the council on nutrition，physical activity，and metabolism（subcommittee on physical activity），in collaboration with the American association of cardiovascular and pulmonary rehabilitation［J］．Circulation，2005，111（3）：369-376．DOI：10.1161/01.CIR.0000151788.08740.5C．
［12］European Association of Cardiovascular Prevention and Rehabilitation Committee for Science Guidelines，EACPR，CORRà U，et al．Secondary prevention through cardiac rehabilitation：physical activity counselling and exercise training：key components of the position paper from the cardiac rehabilitation section of the European association of cardiovascular prevention and rehabilitation［J］．Eur Heart J，2010，31（16）：1967-1974．DOI：10.1093/eurheartj/ehq236．
［13］FLETCHER G F，ADES P A，KLIGFIELD P，et al．Exercise standards for testing and training：a scientific statement from the American heart association［J］．Circulation，2013，128（8）：873-934．DOI：10.1161/CIR.0b013e31829b5b44．
［14］中华医学会心血管病学分会预防学组，中国康复医学会心血管病专业委员会．冠心病患者运动治疗中国专家共识［J］．中华心血管病杂志，2015，43（7）：575-588．DOI：10.3760/cma.j.issn.0253-3758.2015.07.004．http：//med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_zhxxgb201507004．
［15］赵铁夫，王盛宇，张春晓，等．运动对非体外循环冠状动脉旁路移植术后患者焦虑抑郁状态干预效果的研究［J］．心肺血管病杂志，2020，39（10）：1217-1221．
ZHAO T F，WANG S Y，ZHANG C X，et al．Effect of exercise on anxiety and depression in patients after off-pump coronary artery bypass transplantation ［J］．J Cardiovascular and Cardiovascular Diseases，2020，39（10）：1217-1221．
［16］TANAKA H，DINENNO F A，MONAHAN K D，et al．Aging，habitual exercise，and dynamic arterial compliance［J］．Circulation，2000，102（11）：1270-1275．DOI：10.1161/01.cir.102.11.1270．
［17］白瑾，赵威，刘燕娥，等．急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗运动后心率恢复与运动耐量及远期预后相关［J］．中国介入心脏病学杂志，2018，26（2）：74-79．DOI：10.3969/j.issn.1004-8812.2018.02.004．
BAI J，ZHAO W，LIU Y E，et al．Post-exercise heart rate recovery relates to exercise capacity and prognosis in ST- elevation myocardial infarction treated with primary PCI［J］．Chin J Interv Cardiol，2018，26（2）：74-79．DOI：10.3969/j.issn.1004-8812.2018.02.004．
［18］LAMONTE M J，DURSTINE J L，YANOWITZ F G，et al．Cardiorespiratory fitness and C-reactive protein among a tri-ethnic sample of women［J］．Circulation，2002，106（4）：403-406．DOI：10.1161/01.cir.0000025425.20606.69．
［19］张磊，严玉，刘崟，等．8周有氧运动改善肥胖诱导心肌纤维化过程中核因子E2相关因子2通路的作用［J］．中国组织工程研究，2021，25（17）：2650-2656．
ZHANG L，YAN Y，LIU Y，et al．An 8-week aerobic exercise improves obesity-induced myocardial fibrosis：role of nuclear factor-erythroid 2 p45-related factor 2 pathway［J］．Chin J Tissue Engineering Research，2021，25（17）：2650-2656．
［20］BATISTA D F，GON?ALVES A F，RAFACHO B P，et al．Delayed rather than early exercise training attenuates ventricular remodeling after myocardial infarction［J］．Int J Cardiol，2013，170（1）：e3-4．DOI：10.1016/j.ijcard.2013.10.044．
［21］吴方南，李卓，田振军．有氧运动通过心肌细胞吞运内皮细胞来源外泌体抑制细胞凋亡［J］．体育科学，2020，40（10）：82-90．DOI：10.16469/j.css.202010009．
WU F N，LI Z，TIAN Z J．Aerobic exercise suppresses apoptosis by promoting endothelial exosomes from cardiomyocytes［J］．China Sport Sci，2020，40（10）：82-90．DOI：10.16469/j.css.202010009．
［22］JIANG H K，MIAO Y，WANG Y H，et al．Aerobic interval training protects against myocardial infarction-induced oxidative injury by enhancing antioxidase system and mitochondrial biosynthesis［J］．Clin Exp Pharmacol Physiol，2014，41（3）：192-201．DOI：10.1111/1440-1681.12211．
［23］赵梦真，刘伟利，张勋．运动康复对冠心病冠脉介入术后患者短期预后的影响［J］．中国循证心血管医学杂志，2020，12（2）：225-229．DOI：10.3969/j.issn.1674-4055.2020.02.24．
ZHAO M Z，LIU W L，ZHANG X．Effect of exercise rehabilitation on short-term prognosis of patients with coronary heart disease after coronary intervention［J］．Chin J Evidence-Bases Cardiovascular Medicine，2020，12（2）：225-229．DOI：10.3969/j.issn.1674-4055.2020.02.24．
［24］BERNARDO I，BOZINOVSKI S，VLAHOS R．Targeting oxidant-dependent mechanisms for the treatment of COPD and its comorbidities［J］．Pharmacol Ther，2015，155：60-79．DOI：10.1016/j.pharmthera.2015.08.005．
［25］刘春霞，范晓青．系统心肺康复训练对冠心病病人运动耐力和生活质量的影响［J］．全科护理，2017，15（9）：1025-1028．DOI：10.3969/j.issn.1674-4748.2017.09.001．
LIU C X，FAN X Q．Influence of systematic cardiopulmonary rehabilitation training on exercise endurance and quality of life in patients with coronary heart disease［J］．Chin Gen Pract Nurs，2017，15（9）：1025-1028．DOI：10.3969/j.issn.1674-4748.2017.09.001．
［26］American Association of Cardiovascular and Pulmonary Rehabilitation．Guidelines for cardiac rehabilitation and secondary，prevention programs ［M］．5th ed．Nabucco：Human Kinetics Publishers，2013：228．
［27］POLLOCK M L，FRANKLIN B A，BALADY G J，et al．AHA Science Advisory. Resistance exercise in individuals with and without cardiovascular disease：benefits，rationale，safety，and prescription：an advisory from the committee on exercise，rehabilitation，and prevention，council on clinical cardiology，American heart association；position paper endorsed by the American college of sports medicine［J］．Circulation，2000，101（7）：828-833．DOI：10.1161/01.cir.101.7.828．
［28］HASKELL W L．Cardiovascular complications during exercise training of cardiac patients［J］．Circulation，1978，57（5）：920-924．DOI：10.1161/01.cir.57.5.920．