有氧運動訓練對急性心肌梗塞後患者心率變異度之效果：統合分析

Meta Analysis of Aerobic Exercise Training on Heart Rate Variability after Acute Myocardial Infarction

鍾維勵(Wei-Li Chung) ； 江昶勳(Chang-Hsun Chiang) ； 呂昭賢(Chao-Hsien Lu) ； 許妙如(Miao-Ju Hsu) ； 蔡美文(Mei-Wun Tsai)

《物理治療》 33卷2期 (2008/04) Pp. 109-120

摘要

背景及目的：有氧運動訓練是否有助於提升心血管自律神經功能的調節，在急性心肌梗塞後患者仍無一致結論，因此本研究目的為利用統合分析探討有氧運動訓練對心肌梗塞後患者心率變異度之效果，及了解影響其成效的可能影響因素。方法：搜尋符合下列條件的臨床試驗文獻：非複雜性急性心肌梗塞患者、有氧運動介入、有對照組設計、成果測量包括心率變異度之自律神經相關指標、有介入前後之相關數據者，進行系統性的文獻回顧及統合分析。結果：納入6篇研究共230受測者進行統合分析，心肌梗塞後病人接受有氧運動訓練相對於無運動介入或一般日常活動者，可以顯著地降低低頻百分比及低高頻比例，整體心率變異度及高頻功率等副交感神經活性的增加則未達顯著，但在心肌梗塞後整體心率變異度偏低或心臟功能分級較差的患者，其整體心率變異度及高頻功率有顯著地的成效。結論：有氧運動可改善心肌梗塞後患者之心率變異度，使交感神經活性降低而使交感及副交感神經趨向平衡，而此可能有助於避免致死性心律不整之發生，進而提高存活率。

關鍵字

心肌梗塞 ； 有氧運動 ； 心率變異度

並列摘要

Background and Purpose: Whether aerobic exercise training can benefit the autonomic regulation remains disputable in patients after acute myocardial infraction (AMI). The purposes of this study were to conduct a meta-analysis to investigate the effect of aerobic exercise on heart rate variability (HRV) in patients after AMI, and to identify the possible factors influencing the above effects. Methods: Randomized or case control trials of supervised aerobic exercise for patients with uncomplicated AMI were selected for our systematic reviews and meta-analysis. Outcome measures included any HRV indices of standard deviation of NN intervals (SDNN), high frequency power (HF), normalized low frequency power (LF%), and low-high ratio (LF/ HF). Results: Six studies were finally included with a total number of 230 subjects. Meta-analysis showed supervised aerobic exercise significantly decreased LF% [effect size, d=0.61 (0.18, 1.04)] and LF/HF (d=0.54 (0.26, 0.83)). It also had small effect size on increasing SDNN [d=0.23 (-0.29, 0.75)] and HF [d=0.05(-0.61, 0.70)], but subgroups of lower functional capacity (NYHA≥class 2) and of lower SDNN (≤70ms) after AMI, could enhance SDNN and HF significantly. Conclusions: Aerobic exercise benefits patients after AMI to down-regulate the sympathetic activity and to modify the sympathovagal balance. This result may be value of a protective effect of life-threatening arrhythmia after AMI.

並列關鍵字

Myocardial infraction ； Aerobic exercise ； Heart rate variability