運動治療對經皮冠狀動脈擴張術後病人的成果研究

The Outcome of Exercise Training for the Patients after Coronary Angioplasty

蔡美文(Mei-Wun Tsai)

指導教授 ： 季瑋珠

國立臺灣大學/公共衛生學院/流行病學研究所/博士(2004年)

https://doi.org/10.6342/NTU.2004.02261

摘要

研究目的：主要就運動治療對經皮冠狀動脈擴張術後病人的效果進行實證醫學的探討，首先包括: 心肺運動功能、健康生活品質、及心率變異度的改善，並期了解影響運動治療介入後之心肺運動功能、健康生活品質及心率變異度變化的預後因素。其次追蹤探討心臟運動治療對經皮冠狀動脈擴張術後病人之血管再狹窄的預防效果，及心肺運動功能或心率變異度變化對血管再狹窄之預後的可能影響。研究方法：計有72位擴張術成功後且符合本研究對象條件的病人，以隨機分派分成運動組（n=37，接受為期8週的門診運動訓練及居家運動）及一般治療的對照組（n=35），所有病人在擴張術後約1個月時接受介入前的研究評估，並分別在8週介入後及介入後3個月再次評估，主要評估項目包括: 心肺運動功能（利用最大運動測試）、健康生活品質（利用SF-36及心絞痛問卷調查）、及心率變異度（利用5分鐘休息之頻譜分析）等。並利用病歷追蹤血管再狹窄的相關檢查結果（追蹤期為術後37.2

關鍵字

經皮冠狀動脈擴張術 ； 心肺運動功能 ； 健康生活品質 ； 心率變異度 ； 血管再狹窄 ； 成果 ； 運動治療

並列摘要

Background and Purposes. Exercise training can promote numerous health benefits among patients with coronary artery disease, but limited evidences are available for patients after percutaneous transluminal coronary angioplasty (PTCA) which exponential evolution has been noted in the recent decade. The aims of this study were to identify the effect of exercise training on cardiopulmonary function, quality of life (HRQOL), and short-term heart rate variability (HRV) after PTCA. The outcome of restenosis was followed up too. And those predictors affected the changes of main outcomes were also assessed.
Setting. Single university medical center.
Methods. Seventy-two patients after successful PTCA were randomly assigned to an exercise group with the 8-week outpatient exercise training (n=37) or a control group with usual care (n=35). Cardiopulmonary function based on metabolic equivalents achieved from ergometric exercise tests, HRQOL by the SF-36 and Seattle Angina Questionnaire (SAQ), HRV using a short-term procedure (5 min in the supine position) were measured at baseline, 8 weeks after treatments (post intervention), and 3 months followed intervention (follow-up). Restenosis was evaluated from chart records of coronary angiography, radionucleide imaging test, and stress exercise tests after PTCA.
Results. At post intervention, patients in the exercise group had significant improvements in peak exercise capacity (+11% vs –2.3%, p=0.001), the SF-36 domain of perceived general health (+4.4 vs –4.3, p=0.003) and SAQ domain of angina stability (+3.6 vs –10.0, p=0.003), and the HRV indices of high frequency (+0.3 vs –0.3 ln(ms2/Hz), p=0.002), RR interval (+33.7 vs –32.6 min, p=0.006) and variance (+0.3 vs –0.4 ln(ms2), p=0.001)when compared to control group. At follow-up, patients in the exercise group showed improvements in peak exercise capacity, diastolic blood pressure during maximal exercise, HRQOL domains of general health, vitality, angina stability, angina frequency and disease perception. The changes of HRQOL domains only in the exercise group had moderate positive correlations with cardiopulmonary function (r = 0.33-0.52). A negative moderate correlation was also found between the changes of low-to-high ratio and peak exercise capacity (r = -0.36). At the end of 37.2

並列關鍵字

heart rate variability ； health-related quality of life ； exercise ； cardiopulmonary function ； restenosis ； percutaneous transluminal coronary angioplasty ； outcome

參考文獻

177. Tsai MW, Chie WC. Reliability and Validity of a Chinese Version of Seattle Angina Questionnaire. Formosan J Med 2002; 6; 495-504.

180. Chiu HC, Chern JY, Shi HY, et al. Physical functioning and health-related quality of life: before and after total hip replacement. Kaohsiung J Med Sci 2000; 16: 285-92.

3. Burnett CN. Principles of aerobic exercise. In. Kisner C, Colby LA eds., Therapeutic Exercise, Foundations and Techniques. 2nd ed., St. Louis: CV Mosby Co., 1990:637-45.

4. Saltin B. Response to exercise after bed rest and after training. Circulation 1968; 38(Suppl VII): 5.

5. Leon AS. Scientific evidence of value of cardiac rehabilitation services with emphasis on patients following MI - section I. Exercise conditioning component. J Cardiopulm Rehabil 1990; 10:79-87.