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

一些报告表明，运动训练改善了主要由缺血性或扩张性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，运动是否对心脏手术后的瓣膜心脏病患者也有这些好处还知之甚少。对35例心脏瓣膜病(主动脉瓣/二尖瓣关闭不全19/16例)患者(男22例，女22例，平均年龄60岁)在开胸手术前和术后3个月进行前臂和小腿血流量测定。将患者分为运动训练组(10例)和对照组(25例)。运动训练包括在指导下进行30min的运动，每周2-3次，术后持续3个月。用体积描记法测定前臂和小腿的基础血流量(BF)、5min动脉阻断诱导的峰值反应性充血血流量(RHBF)和总偿债流量(TDR)。所有患者均接受心肺运动试验。上肢RHBF反应组间差异无统计学意义。运动参数和血流量在运动前、训练后3个月和久坐3个月的变化如下表。结论心脏手术后患者运动训练对提高运动能力有一定的作用，至少部分地参与了运动储备能力的提高。

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.