广西医学

目的探讨经皮冠状动脉介入术（PCI）后心肺康复运动在老年急性ST段抬高型心肌梗死（ASTEMI）患者中的应用效果，以及窦性心率震荡对患者预后的影响。方法（1）将60例行急诊PCI的老年ASTEMI患者随机分为对照组（n=30）和康复组（n=30）。两组患者均在PCI后接受常规治疗，同时康复组患者接受12周的心肺康复运动。比较两组患者干预前后的左室射血分数（LVEF）、6 min步行试验距离，以及PCI后干预12周内的主要心血管不良事件发生情况。（2）根据主要心血管不良事件发生情况，将60例患者分为预后不良组（n=20）和预后良好组（n=40）。比较两组患者的临床资料，并采用多因素Logistic回归模型分析患者PCI后预后的影响因素。结果（1）干预后，两组患者6 min步行试验距离及LVEF均较干预前改善，且康复组优于对照组，主要心血管不良事件总发生率也低于对照组（P＜0.05）。（2）预后不良组干预前震荡初始大于预后良好组，干预前震荡初始为老年ASTEMI患者PCI后预后的影响因素（P＜0.05）。结论 PCI后开展心肺康复运动有利于更好地改善老年ASTEMI患者的心肺功能及预后。窦性心率震荡异常与老年ASTEMI患者PCI后预后不良存在一定的关联，震荡初始增大的患者PCI后预后不良的风险增加。

ObjectiveTo explore the application effect of cardiopulmonary rehabilitation exercise after percutaneous coronary intervention (PCI) in elderly patients with acute ST-segment elevation myocardial infarction (ASTEMI), and the influence on sinus heart rate turbulence for patients′ prognosis. Methods(1) Sixty elderly ASTEMI patients who underwent emergency PCI were randomly divided into control group (n=30) or rehabilitation group (n=30). Both groups received routine treatment after PCI; simultaneously, the rehabilitation group received 12 weeks of cardiopulmonary rehabilitation exercise. The pre- and post-intervention left ventricular ejection fraction (LVEF), 6-minute walk test distance, and major cardiovascular adverse events within 12 weeks of intervention after PCI were compared between patients of the two groups. (2) According to the occurrence of major cardiovascular adverse events, 60 patients were divided into adverse prognosis group (n=20) or favorable prognosis group (n=40). The clinical data were compared between the two groups, and the multivariate Logistic regression model was used to analyze the influencing factors for prognosis in patients after PCI. Results(1) After intervention, the 6-minute walk test distance and LVEF of the two groups were ameliorated as compared with before intervention, and the rehabilitation group yielded superior indices as above to compare with the control group, as well as the total incidence rate of major cardiovascular adverse events was lower than that of the control group (P＜0.05). (2) The adverse prognosis group exhibited a larger pre-intervention turbulence onset as compared with the favorable prognosis group, and the pre-intervention turbulence onset was the influencing factor for prognosis of elderly ASTEMI patients after PCI (P＜0.05). ConclusionCardiopulmonary rehabilitation exercise after PCI is beneficial for preferably improving cardiopulmonary function and prognosis of elderly ASTEMI patients. There is correlation between abnormal sinus heart rate turbulence and adverse prognosis in elderly ASTEMI patients after PCI to a certain extent. Patients with enlarged turbulence onset have an increased risk of adverse prognosis after PCI.