Intensive Cardiopulmonary Rehabilitation Program for Patients with Severe Heart Failure and Acute Stroke: A Report of Two Cases

嚴重心臟衰竭併急性中風病患之心肺復健計畫：兩病例報告

王琦雁(Chyi-Yann Wang) ； 王志龍(Jue-Long Wang) ； 楊艾倫(Ai-Lun Yang) ； 林克隆(Ko-Long Lin)

《台灣復健醫學雜誌》 35卷1期 (2007/03) Pp. 33-40

https://doi.org/10.6315/2007.35(1)05

摘要

心臟血管疾病是造成中風後復健成果受限的一個主要原因。雖然中風後神經機能的恢復已被廣泛研究，但心臟血管機能如何因應中風後生理活動改變作調整，則很少受到注意。已知的是嚴重心臟衰竭病人行動能力受限，但尚無研究顯示在中風後早期這類病人會受何影響，運動測試是目前評估心臟衰竭病人預後的主流；各式研究已顯示病患以最高攝氧率來表示的運動能力較差者無論其他測試指標如何，都無很好預後。近來，已有一些研究在探討次大量運動測試檢查是否也有評估預後的價值。中風後早期的運動能力已被了解，但中風早期又合併有嚴重心臟衰竭的病人，其運動能力及接受運動訓練後的效果仍不清楚。雖然這類病患其併發症發生的機會可能比一般穩定中風病人高，我們在此提出兩者合併有New York Heart Association (NYHA) Class Ⅲ心臟衰竭的病例，如何在中風後早期經由心肺復健計劃獲得助益；由此治療計劃來驗證嚴重心臟衰竭病患可於中風後早期接受積極運動訓練的觀點。

關鍵字

心臟衰竭 ； 中風 ； 心肺復健

並列摘要

Cardiovascular disease is a major factor restricting successful outcomes after stroke rehabilitation. While neurological recovery after stroke has been extensively investigated, cardiovascular adaptations to physical activities poststroke have received little attention. Severe heart failure patients have been well known for limitation of ambulation, but the influence over acute poststroke patients have rarely been investigated. Exercise testing has become a mainstay for the prognostic assessment of patients with heart failure. Various studies have shown that patients with impaired exercise capacity, as measured by low peak oxygen consumption (Vo2), have an unfavorable outcome, independent of other parameters. Whether parameters from submaximal test have prognostic value have recently been studied. Exercise capacity early after stroke has been known, but what has not been documented is exercise capacity during early poststroke with severe heart failure and the effect of exercise training on those patients. We present two cases of acute poststroke with New York Heart Association (NYHA) Class III heart failure and illustrate how the cardiopulmonary rehabilitation program has helped. Such treatment for this case supports the view that intensive exercise training should be established for acute poststroke with severe heart failure patients, although their cormobility may be higher than that of stable poststroke patients.

並列關鍵字

heart failure ； stroke ； cardiopulmonary rehabilitation