Effects of three therapeutic schedules on cardiac functionand prognosis in patients undergoing percutaneous coronary intervention
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摘要:目的
观察3种不同治疗方案在经皮冠状动脉介入术(PCI)后患者的疗效，探讨增强型体外反搏(EECP)及心脏康复治疗对PCI后患者心功能及预后评估的价值。
方法选取PCI后患者150例作为研究对象，随机分为A组、B组、C组，每组50例。A组接受常规药物治疗, B组接受常规药物联合心脏康复治疗, C组接受常规药物治疗+心脏康复+EECP治疗。观察3组患者治疗前后胆红素血脂综合指数{低密度脂蛋白胆固醇(LDL-C)/[高密度脂蛋白胆固醇(HDL-C)+总胆红素(TBIL)]}、同型半胱氨酸(Hcy)、左心室射血分数(LVEF)、6分钟步行试验[6 min步行距离(6MWD)]及SF-36量表评分变化情况; 记录并比较3组心血管不良事件发生情况。
结果治疗后, LDL-C/(HDL-C+TBIL)及Hcy水平低于治疗前，且A组、B组、C组呈降低趋势，差异有统计学意义(P < 0.05); 6MWD、LVEF、SF-36量表各项评分高于治疗前, A组、B组、C组LVEF、6MWD呈增加趋势，差异有统计学意义(P < 0.05); SF-36量表评分中, C组社会功能评分与B组比较，差异无统计学意义(P>0.05), C组社会功能评分高于A组，差异有统计学意义(P < 0.05); 其余各项评分A组、B组、C组呈增高趋势，差异有统计学意义(P < 0.05)。3组心血管不良事件发生率呈显著降低趋势，差异有统计学意义(C组 < B组 < A组, P < 0.05)。
结论在药物治疗基础上，联合心脏康复+EECP治疗能够显著改善PCI后患者心功能、生活质量及预后，同时治疗效果显著优于心脏康复训练及单纯药物治疗。
Abstract:ObjectiveTo observe the efficacy of three different therapeutic schedules in patients undergoing percutaneous coronary intervention (PCI), and to explore the value of enhanced external counterpulsation (EECP) and cardiac rehabilitation in evaluating cardiac function and prognosis of patients after PCI.
MethodsA total of 150 patients after PCI were selected as research objects, and randomly divided into group A, group B and group C, with 50 cases in each group. The group A received conventional drug therapy, the group B received conventional drug combined with cardiac rehabilitation therapy, and the group C received conventional drug therapy, cardiac rehabilitation and EECP. The bilirubin lipid composite index {low-density lipoprotein cholesterol (LDL-C)/[high-density lipoprotein cholesterol (HDL-C) and total bilirubin (TBIL)]}, homocysteine (Hcy), left ventricular ejection fraction (LVEF), 6-minute walk test[6-minute walk distance (6MWD)] and SF-36 Scale score were observed before and after treatment in the three groups; the incidence of adverse cardiovascular events was recorded and compared among the three groups.
ResultsAfter treatment, the levels of LDL-C/(HDL-C and TBIL) and Hcy were significantly lower than those before treatment, and the levels of LDL-C/(HDL-C and TBIL) and Hcy in the groups A, B and C were significantly decreased (P < 0.05); the 6MWD, LVEF and item score of SF-36 Scale were significantly higher than those before treatment, and LVEF and 6MWD in the groups A, B and C were significantly increased (P < 0.05); in the SF-36 Scale scores, there was no significant difference in the social function score between group C and group B (P>0.05), and the social function score of the group C was significantly higher than that of the group A (P < 0.05); the other scores in the groups A, B and C showed significant increase trend (P < 0.05). The incidence of adverse cardiovascular events in the three groups was significantly decreased (group C < group B < group A, P < 0.05).
ConclusionOn the basis of drug therapy, cardiac rehabilitation combined with EECP can significantly improve cardiac function, quality of life and prognosis of patients after PCI, and the therapeutic effect is significantly better than cardiac rehabilitation training and drug therapy alone.
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表 1 3组一般资料比较(x±s)[n(%)][M(P25, P75)]
一般资料 分类 A组(n=50) B组(n=50) C组(n=50) 性别 男 29 30 28 女 21 20 22 年龄/岁 56.10±6.50 56.18±6.50 56.72±6.31 体质量指数/(㎏/㎡) 24.88±1.92 24.56±1.70 24.53±1.83 糖化血红蛋白/% 5.84±0.47 5.82±0.46 5.80±0.45 吸烟史 19(38.00)a 22(44.00)a 20(40.00)a 高血压病 26(52.00)a 25(50.00)a 27(54.00)a 糖尿病病 18(36.00)a 19(38.00)a 20(40.00)a 支架植入/枚 2(2, 3)b 2(1, 3)b 2(2, 3)b a是卡方检验, b是非参数H检验。 
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表 2 3组[LDL-C/(HDL-C+TBIL)]、Hcy水平比较(x±s)
组别 n 胆红素血脂综合指数 同型半胱氨酸/(μmmol/L) 治疗前 治疗后 治疗前 治疗后 A组 50 0.31±0.06 0.19±0.05* 17.48±5.47 14.16±3.59* B组 50 0.33±0.05 0.17±0.04*# 17.62±5.40 12.84±3.21*# C组 50 0.32±0.05 0.14±0.04*#△ 18.18±5.71 11.43±2.90*#△ 与治疗前比较, *P < 0.05; 与A组比较, #P < 0.05; 与B组比较, △P < 0.05。
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表 3 3组LVEF、6MWD比较(x±s)
组别 n 6 min步行距离/m 左室射血分数/% 治疗前 治疗后 治疗前 治疗后 A组 50 382.84±43.21 434.72±42.99* 55.30±6.32 57.00±4.83* B组 50 390.16±36.22 453.36±45.83*# 55.56±4.37 58.88±3.20*# C组 50 399.40±35.68 472.46±48.88*#△ 56.10±4.74 60.44±3.36*#△ 与治疗前比较, *P < 0.05; 与A组比较, #P < 0.05; 与B组比较, △P < 0.05。
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表 4 3组SF-36量表各项评分比较(x±s)
分 项目 A组(n=50) B组(n=50) C组(n=50) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 生理机能 51.20±12.48 61.70±9.40* 49.90±12.72 66.70±9.40*# 50.80±10.32 82.40±8.41*#△ 生理职能 42.60±8.92 50.00±10.73* 44.90±11.01 58.22±11.49*# 43.25±11.74 66.85±13.57*#△ 躯体疼痛 50.57±10.35 59.10±9.67* 52.69±12.82 64.82±10.85*# 49.21±11.21 71.46±12.78*#△ 一般健康 49.86±12.49 62.72±11.77* 45.86±11.38 71.62±13.08*# 50.34±10.52 77.74±10.34*#△ 精力 50.40±13.66 66.30±11.33* 48.90±12.01 71.50±12.17*# 50.70±12.37 76.38±11.35*#△ 社会功能 51.43±16.43 72.75±20.84* 56.25±21.76 87.95±20.39*# 53.75±20.24 93.45±20.88*# 情感职能 44.66±13.66 56.34±11.42* 47.46±13.07 66.84±12.23*# 49.13±10.39 76.27±10.07*#△ 精神健康 41.76±14.07 52.20±9.39* 38.48±11.96 58.56±8.03*# 40.72±11.59 72.28±10.41*#△ 与治疗前比较, *P < 0.05; 与A组比较, #P < 0.05; 与B组比较, △P < 0.05。
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