Safety of Monitoring Exercise for Early Hospital-based Cardiac Rehabilitation
Safety of Monitoring Exercise for Early Hospital-based Cardiac Rehabilitation
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DOI：
10.5535/arm.2012.36.2.262
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发表时间：
2012-04-01
影响因子：
1.3
通讯作者：
Lim, Min Ho
中科院分区：
文献类型：
--
作者：
Kim, Chul;Moon, Chang Jin;Lim, Min Ho
目的调查我院心脏康复（CR）门诊10年间心脏监护运动所致心血管并发症的发生情况，并对医院早期CR监测运动训练的安全性进行分析。方法选取2000年1月至2009年12月参加我院心脏康复（CR）运动项目的所有心脏患者作为研究对象。我们对心脏事件的运动风险进行分层，并根据个体化处方进行监测运动。我们测量了10年来所有心脏并发症，包括死亡、症状、异常血流动力学反应和运动训练期间的心电图（ECG）异常。本研究共纳入975例患者（68%为男性，平均年龄58.9±10.6岁）。CR的初始适应症为近期经皮腔内冠状动脉成形术（PTCA）（75%）、心脏手术后（冠状动脉搭桥术，13.2%）、瓣膜手术和其他心脏手术（4.2%）和其他（7.6%）。结果研究人群进行了13,934患者小时的监测运动。在运动期间（0/13,934运动小时）未发生死亡、心脏骤停或急性心肌梗死（AMI）。59名患者在13,934个运动小时（1/199个运动小时）中经历了70次心血管事件；单纯心绞痛17例（1/820运动小时），单纯心电图异常31例（1/449运动小时），心绞痛合并心电图异常12例（1/ 1161运动小时），血流动力学反应异常10例（1/ 1393运动小时）。结论早期基于医院的CR是足够安全的，在13,934患者小时的监测运动中没有发生死亡、心脏骤停或AMI。然而，在开始监测运动之前，需要对运动引起的心血管事件进行风险分层，适当的运动处方和强化的心电图监测。
Objective To survey the cardiovascular complications induced by cardiac monitoring exercise during 10 years of our cardiac rehabilitation (CR) clinic and report on the safety of monitoring exercise training for early hospital-based CR.Method All cardiac patients who participated in our exercise program from January 2000 through December 2009 were recruited as study subjects. We stratified the exercise risks of cardiac events and conducted the monitoring exercise with individualized prescriptions. We measured all cardiac complications, including death, symptoms, abnormal hemodynamic responses, and electrocardiogram (ECG) abnormality during exercise training, for 10 years. A total of 975 patients (68% male; mean age, 58.9 +/- 10.6) were included in this study. Initial indications for CR were recent percutaneous transluminal coronary angioplasty (PTCA) (75%), post-cardiac surgery (coronary bypass graft, 13.2%), valvular surgery and other cardiac surgery (4.2%), and others (7.6%).Results The study population underwent 13,934 patient-hours of monitoring exercise. No death, cardiac arrest or acute myocardial infarction (AMI) occurred during exercise (0/13,934 exercise-hours). Fifty-nine patients experienced 70 cardiovascular events during the 13,934 exercise-hours (1/199 exercise-hours); there were 17 cases of angina only (1/820 exercise-hours), 31 cases of ECG abnormalities only (1/449 exercise-hours), 12 cases of angina with ECG abnormalities (1/1,161 exercise-hours), and 10 cases of abnormal hemodynamic responses (1/1,393 exercise-hours).Conclusion Early hospital-based CR is safe enough that no death, cardiac arrest or AMI occurred during the 13,934 patient-hours of monitoring exercise. However, risk stratification for exercise-induced cardiovascular events, proper exercise prescriptions, and intensive ECG monitoring are required prior to initiation of the monitoring exercise.