Adaptation process to a low-intensity exercise with cycle ergometer in patients with acute myocardial infarction undergoing phase I cardiac rehabilitation.

背景技术背景：方法和结果：42例男性急性心肌梗死（AMI）患者，年龄62±8岁，分为运动耐量组（A组，n=25）和过度反应组（运动时收缩压升高> 30 mmHg; B组，n=17）。前三天使用自行车测力计监测运动过程中的血流动力学参数。通过心率变异性分析低频和高频成分（低频：0.05-0.2Hz，高频：0.2-1Hz）的功率。焦虑状态采用Spielberger状态-特质焦虑量表进行评估。B组患者年龄大、心功能差、住院时间较A组明显延长（P<0.05）。B组第1天过高的收缩压下降，第3天降至<30 mmHg。运动后第1天和第3天，B组HF的下降幅度明显小于A组（P<0.05和P<0.05）。第1天，B组LF/HF比值显著高于A组（P<0.05）。B组运动前焦虑评分显著高于出院时（P<0.05），而A组运动前焦虑评分无显著变化。结论：影响I期康复期间血压显著升高的因素有年龄、躯体功能失调、自主神经活动失衡和焦虑。

BACKGROUND : There are few studies in which adaptation of patients with acute myocardial infarction (AMI) to phase I rehabilitation program has been assessed.METHODS and RESULTS : Forty-two male patients(62±8 yo) with AMI were classified into the exercise tolerant group (group A, n=25) and the excessive response group (their systolic blood pressure (SBP) increase of>30mmHg during exercise ; group B, n=17). Hemodynamic parameters during exercise using a cycle-ergometer were monitored for the first three days. The power of low and high frequency components (LF:0.05-0.2Hz, HF:0.2-1Hz) was analyzed by heart rate variability. The anxiety status was assessed using the Spielberger's State-Trait Anxiety Inventory. Patients in group B were significantly older, had a lower cardiac function and a longer hospitalization as compared to group A (P<0.05, respectively). The excessive elevation of SBP on Day 1 decreased and became <30mmHg on Day 3 in group B. The decreases in HF during exercise on Days 1 and 3 were significantly smaller in group B than in group A (P<0.05 and P<0.05, respectively). The LF/HF ratio on Day 1 was significantly higher in group B than in group A (P<0.05). In group B, the anxiety score before exercise was significantly higher than that at the time of discharge (P<0.05), while there was no change in group A.CONCLUSION : We concluded that the factors influencing a significant elevation of BP during a phase I rehabilitation, were aging, physical deconditioning, imbalance of autonomic nervous activities and anxiety.