有氧运动对阵发性房颤患者射频消融术后复发、运动功能和生活质量的影响
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摘要
目的:探讨有氧运动干预对阵发性房颤患者射频消融术后复发、左心结构、运动功能及生活质量的影响。方法:收集我科行射频消融术的阵发性房颤患者122例,分为观察组60例和对照组62例,对观察组进行有氧步行运动干预,比较2组干预前后的房颤复发率、左心结构、运动功能及生活质量改善情况。结果:2组干预前后组间窦性心率人数比较均差异无统计学意义,但在术后1年时,观察组窦性心率人数比例高于对照组(P <0. 05)。观察组术后1年左心房内径(LAD)、左心室射血分数(LVEF)及左心室重量指数(LVMI)均优于对照组(均P <0. 05),6min步行试验的运动距离与对照组比较无显著性差异,但Borg呼吸困难评分低于对照组(P <0. 05);观察组术后1年除躯体疼痛外各生活质量方面评分均显著高于对照组(均P <0. 05)。结论:有氧运动可以降低阵发性房颤患者射频消融术后复发率,改善左心结构和运动耐力并提高其生活质量。
Objective: To discuss the effect of aerobic walking exercise after radiofrequency ablation on postoperative recurrence,left cardiac structure and function,movement function and life quality of paroxysmal atrial fibrillation patients.Methods: One hundred and twenty-two patients with paroxysmal atrial fibrillation who underwent the radiofrequency ablation in our department were chosen and divided into the experimental group and control group. The experimental group was given aerobic exercise intervention trial. The recurrent rate of atrial fibrillation,left cardiac structure and function,movement function and life quality before and after intervention between the two groups were compared. Results: There was no statistically significant difference between the two groups in the number of patients with sinus heart rate before and after intervention,but the recurrent rate of atrial fibrillation in experimental group was slightly higher than control group( 30. 6%vs. 21. 7%). The left atrial diameter( LAD),left atrial ejection fraction( LVEF) and left ventricular mass index( LVMI) in experimental group one year after intervention were all better than control group( P < 0. 05). There was no significant difference in the walking distance of 6 minutes walking test between two groups,but the Borg score in experimental group was significantly higher than in control group( P < 0. 05). The life quality score in experimental group was all higher than in control group except body pain one year after intervention( P < 0. 05). Conclusion: Aerobic walking exercise could reduce the recurrence rate of paroxysmal atrial fibrillation after radiofrequency ablation,and improve the left cardiac structure and function,exercise tolerance and life quality.
Objective: To discuss the effect of aerobic walking exercise after radiofrequency ablation on postoperative recurrence,left cardiac structure and function,movement function and life quality of paroxysmal atrial fibrillation patients.Methods: One hundred and twenty-two patients with paroxysmal atrial fibrillation who underwent the radiofrequency ablation in our department were chosen and divided into the experimental group and control group. The experimental group was given aerobic exercise intervention trial. The recurrent rate of atrial fibrillation,left cardiac structure and function,movement function and life quality before and after intervention between the two groups were compared. Results: There was no statistically significant difference between the two groups in the number of patients with sinus heart rate before and after intervention,but the recurrent rate of atrial fibrillation in experimental group was slightly higher than control group( 30. 6%vs. 21. 7%). The left atrial diameter( LAD),left atrial ejection fraction( LVEF) and left ventricular mass index( LVMI) in experimental group one year after intervention were all better than control group( P < 0. 05). There was no significant difference in the walking distance of 6 minutes walking test between two groups,but the Borg score in experimental group was significantly higher than in control group( P < 0. 05). The life quality score in experimental group was all higher than in control group except body pain one year after intervention( P < 0. 05). Conclusion: Aerobic walking exercise could reduce the recurrence rate of paroxysmal atrial fibrillation after radiofrequency ablation,and improve the left cardiac structure and function,exercise tolerance and life quality.
引文
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[15]丁绍祥.心房颤动时心房肌结构重构和电重构的作用及意义[J].中国循环杂志,2014,29(2):155-157.
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[17] Myrstad M,Nystad W,Graff-Iversen S,et al. Effect of years of endurance exercise on risk of atrial fibrillation and atrial flutter[J]. Am J Cardiol,2014,114(8):1229-1233.
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[20] Drca N,Wolk A,Jensen-Urstad M,et al. Physical activity is associated with a reduced risk of atrial fibrillation in middle-aged and elderly women[J]. Heart,2015,101(20):1627-1630.
[21]刘朝硕,邱接,刘启明.运动与心房颤动关系的研究进展[J].中国介入心脏病学杂志,2015,23(7):409-411.
[22] Spruit MA,Pitta F,Mc Auley E,et al. Pulmonary Rehabilitation and Physical Activity in Patients with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med,2015,192(8):924-933.
[23] Zopf EM,Baumann FT,Pfeifer K. Physical activity and exercise recommendations for cancer patients during rehabilitation[J]. Rehabilitation(Stuttg),2014,53(1):2-7.
[24]沈玉芹,蒋金法,王乐民,等.有氧运动康复对慢性心力衰竭患者运动耐力的影响[J].中华医学杂志,2011,91(38):2678-2682.
[25] Gierat-Haponiuk K,Haponiuk I,Szalewska D,et al. Effect of complex cardiac rehabilitation on physical activity and quality of life during long-term follow-up after surgical correction of congenital heart disease[J]. Kardiol Pol,2015; 73(4):267-273.
[26] Lund K,Sibilitz KL,Berg SK,et al. Physical activity increases survival after heart valve surgery[J]. Heart,2016,102(17):1388-1395.
[27]沈玉芹,蒋金法,王乐民,等.有氧运动康复对慢性心力衰竭患者运动心排血量及相关参数的影响[J].中华心血管病杂志,2011,39(8):700-705.
[2] Camm AJ,Lip GY,De Caterina R,et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation:an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association[J]. Eur Heart J,2012,33(21):2719-2747.
[3]徐海霞,陆齐,黄荫浩,等.阵发性心房颤动患者射频消融术后复发的预测因素分析[J].中国循环杂志,2017,20(12):883-885.
[4] Santos C,Rodrigues F,Santos J,et al. Pulmonary Rehabilitation in COPD:Effect of 2 Aerobic Exercise Intensities on Subject-Centered Outcomes--A Randomized Controlled Trial[J]. Respir Care,2015,60(11):1603-1609.
[5]沈玉芹,宋浩明,王乐民.慢性心力衰竭患者的有氧运动康复治疗[J].中华内科杂志,2010,49(4):342-344.
[6] January CT,Wann LS,Alpert JS,et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation:Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society[J]. Journal of the American College of Cardiology,2014,64(21):2246-2280.
[7]周自强,胡大一,陈捷,等.中国心房颤动现状的流行病学研究[J].中华内科杂志,2004,43(7):491-494.
[8] Staerk L,Sherer JA,Ko D,et al. Atrial Fibrillation:Epidemiology,Pathophysiology,and Clinical Outcomes[J]. Circ Res,2017,120(9):1501-1517.
[9]陈爱华,宋旭东,杨平珍.房颤射频消融治疗的现状与困境[J].解放军医学杂志,2015,40(2):85-91.
[10] Kwok CS,Anderson SG,Myint PK,et al. Physical activity and incidence of atrial fibrillation:A systemytic review and meta-analysis[J]. Int J Cardiol,2014,177(2):467-476.
[11] Brekke HK,Bertz F,Rasmussen KM,et al. Diet and exercise interventions among overweight and obese lactating women:randomized trial of effects on cardiovascular risk factors[J]. PLo SOne,2014,9(5):88250-88336.
[12] Aizer A,Gaziano JM,Cook NR,et al. Relation of vigorous exercise to risk of atrial fibrillation[J]. Am J Cardiol,2009,103(11):1572-1577.
[13] Pathak PK,Middeldorp ME,Lau DH,et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation:The arrest-af cohort study[J]. J Am Coll Cardiol,2014,64(21):2222-2231.
[14] Turagam MK,Velagapudi P,Kocheril AG. Atrial fibrillation in athletes[J]. Am J Cardiol,2012,109(3):296-302.
[15]丁绍祥.心房颤动时心房肌结构重构和电重构的作用及意义[J].中国循环杂志,2014,29(2):155-157.
[16] Everett BM,Conen D,Buring JE,et al. Physical activity and the risk of incident atrial fibrillation in women[J]. Circ Cardiovasc Qual Outcomes,2011,4(3):321-327.
[17] Myrstad M,Nystad W,Graff-Iversen S,et al. Effect of years of endurance exercise on risk of atrial fibrillation and atrial flutter[J]. Am J Cardiol,2014,114(8):1229-1233.
[18] Bosomworth NJ. Atrial fibrillation and physical activity:Should we exercise caution[J]? Can Fam Physician,2015,61(12):1061-1670.
[19] Drca N,Wolk A,Jensen-Urstad M,et al. Atrial fibrillation is associated with different levels of physical activity levels at different ages in men[J]. Heart,2014,100(13):1037-1042.
[20] Drca N,Wolk A,Jensen-Urstad M,et al. Physical activity is associated with a reduced risk of atrial fibrillation in middle-aged and elderly women[J]. Heart,2015,101(20):1627-1630.
[21]刘朝硕,邱接,刘启明.运动与心房颤动关系的研究进展[J].中国介入心脏病学杂志,2015,23(7):409-411.
[22] Spruit MA,Pitta F,Mc Auley E,et al. Pulmonary Rehabilitation and Physical Activity in Patients with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med,2015,192(8):924-933.
[23] Zopf EM,Baumann FT,Pfeifer K. Physical activity and exercise recommendations for cancer patients during rehabilitation[J]. Rehabilitation(Stuttg),2014,53(1):2-7.
[24]沈玉芹,蒋金法,王乐民,等.有氧运动康复对慢性心力衰竭患者运动耐力的影响[J].中华医学杂志,2011,91(38):2678-2682.
[25] Gierat-Haponiuk K,Haponiuk I,Szalewska D,et al. Effect of complex cardiac rehabilitation on physical activity and quality of life during long-term follow-up after surgical correction of congenital heart disease[J]. Kardiol Pol,2015; 73(4):267-273.
[26] Lund K,Sibilitz KL,Berg SK,et al. Physical activity increases survival after heart valve surgery[J]. Heart,2016,102(17):1388-1395.
[27]沈玉芹,蒋金法,王乐民,等.有氧运动康复对慢性心力衰竭患者运动心排血量及相关参数的影响[J].中华心血管病杂志,2011,39(8):700-705.