Effects and Mechanisms of Exercise Training on Patients with Chronic Heart Failure due to Valvular Heart Disease

一些报告已经证明，运动训练可以改善主要由缺血性或扩张型心肌病引起的慢性心力衰竭患者的运动能力和外周血管功能。然而，很少有人知道运动是否对接受心脏手术的心脏瓣膜病患者也有这些有益的影响。对35例（男/女= 22/13，平均年龄60岁）患有心脏瓣膜病（主动脉瓣/二尖瓣返流= 19/16）的患者在开胸手术前和术后3个月测量前臂和小腿血流。将患者分为运动训练组（Ex组，n = 10）和对照组（Co组，n =25）。运动训练包括术后3个月每周2-3次有监督的30分钟运动。体积描记法测量前臂和小腿的基础血流量（BF）、5 min动脉闭塞诱导的峰值反应性充血血流量（RHBF）和总偿还血流量（TDR）。所有患者均接受心肺运动试验。各组上肢RHBF反应无差异。峰值VO_2的增加与下肢RHBF的增加相关（r = 0.40，p &lt; 0.05），运动前、运动后3个月及安静后3个月运动参数和血流量的变化见下表：&lt;<table>&gt;结论心脏手术后的运动训练对提高运动能力有一定的作用，至少部分涉及运动能力的提高。增加下肢血管舒张储备能力。

Several reports have demonstrated that exercise training improves exercise capacity and peripheral vascular function in patients with chronic heart failure mainly due to ischemic or dilated cardiomyopathy. However, little is yet known whether exercise also have these beneficial effects in patients with valvular heart disease who underwent cardiac surgery. Forearm and calf blood flow was measured in 35 patients (men/women = 22/13, mean age 60 years) with valvular heart disease (aortic/mitral regurgitation = 19/16) before and 3 months after open-chest surgery. Patients were divided into exercise-training group (Ex ; n = 10) and control group (Co ; n =25). Exercise training consists of supervised 30 min exercise 2-3 times in a week continuing 3 months after surgery. Plethysmography was used to measure basal blood flow (BF), 5 min arterial occlusion-induced peak reactive hyperemic blood flow (RHBF) and total debt repayment flow (TDR) in both forearm and calf. All patients underwent a cardiopulmonary exercise test. Response of RHBF in the upper limb were not different between groups. Increase in peakVO_2 was correlated with increase in lower limb RHBF (r = 0.40, p < 0.05).Changes in exercise parameters amd blood flow before and 3 month after training and sedentary were shown in the table in the below : <<table>> Conclusion Exercise training in patients who have received cardiac surgery may have beneficial effect on enhancing exercise capacity, involving at least, in part, increase in lower limb vasodilatory reserve capacity.