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周 方,赵志刚,潘化平,王 磊.电针联合有氧运动对冠心病患者心率及运动能力的影响[J].中国康复医学杂志,2016,(6):647~653
电针联合有氧运动对冠心病患者心率及运动能力的影响    点此下载全文
周 方  赵志刚  潘化平  王 磊
南京中医药大学康复医学系,南京,210023
基金项目:全国高校博士点基金项目(20123237120008)
DOI:
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摘要:
      摘要 目的:观察电针联合有氧运动对冠心病患者心率恢复及运动能力的影响,并通过对心率变异性和氧化应激的检测探讨其作用机制。 方法:招募确诊的冠心病患者行心肺运动试验(CPET),将120例心率恢复异常(试验终止1min时的心率恢复值(HRR1)≤12次/分)的患者纳入研究,并随机分为有氧运动组(A组)、电针组(B组)、电针联合有氧运动组(C组)、对照组(D组)。有氧运动组以强度为60%—75%最大运动能力的有氧运动训练,每次30—60min;电针组选取内关、郄门穴进行电针针刺治疗,每次留针30min;C组运动治疗方案同A组,运动治疗结束后1h进行电针治疗,电针治疗方案同B组;D组照常生活,常规治疗。各组治疗均为每周5次,共12周。所有患者在12周治疗前后,进行CPET评估心率恢复及运动能力情况,心率变异性指标(低频指标LF、高频指标HF、低高频指标比值LF/HF、正常心搏间期标准差SDNN)评估自主神经功能,静脉血中超氧化物歧化酶SOD、一氧化氮NO、脂质过氧化物LOOH含量检测评估氧化应激水平。 结果:治疗前,4组患者的HRR1、峰值功率(PP)、峰值摄氧量(VO2peak)、无氧阈(AT)、心率变异性指标(LF、HF、LF/HF、SDNN)、氧化应激水平(SOD、NO、LOOH含量)均无显著差异(P>0.05)。12周治疗后,心率恢复情况,C组HRR1优于A组、B组、D组(P<0.05),B组HRR1优于A组、D组(P<0.05),A组的HRR1优于D组(P<0.05)。运动能力方面,A组、C组的PP、VO2peak、AT均优于B组、D组(P<0.05),且C组的PP、VO2peak、AT优于A组但无显著性意义(P>0.05),B组PP、VO2peak、AT与D组比较无显著差异(P>0.05)。C组的心率变异性指标改善优于A组、B组、D组。C组的氧化应激水平改善优于A组、B组、D组。 结论:与单纯有氧运动治疗或单纯电针治疗相比,二者结合的联合治疗方法可以更显著地改善患者的心率恢复情况和运动能力,同时患者的自主神经功能和氧化应激水平也得到了明显改善。
关键词:有氧运动  电针  冠心病  心率  运动能力
Effects of electro-acupuncture combined with aerobic exercise on heart rate recovery and exercise capacity of patients with coronary heart disease    Download Fulltext
Dept. of Rehabilitation Medicine,Nanjing University of Traditional Chinese Medicine, 210023
Fund Project:
Abstract:
      Abstract Objective:To observe the effect of electro-acupuncture combined with aerobic exercise on heart rate recovery and exercise capacity of patients with coronary heart disease(CHD) and explore its mechanism by detecting heart rate variability(HRV)and oxidative stress. Method:In the study,a total of 120 patients with diagnosed CHD and abnormal heart rate recovery(HRR1 at 1min after test ≤12times/min) were recruited for cardiopulmonary exercise test(CPET). All subjects were randomly divided into aerobic exercise group (group A), electro-acupuncture group (group B), electro acupuncture combined with aerobic exercise group (group C) and control group (group D).The aerobic exercise group performed aerobic exercise at the intensity of 60%—75% of maximum exercise capacity for 30—60min per time. Neiguan acupoint(PC6)and Ximen acupoint (PC4)were selected in the electro-acupuncture group for 30min per time. The group C was given the same exercise therapy protocol as the group A, and acupuncture treatment as the group B 1 hour after exercise therapy. The group D experienced the normal daily life and regular treatment. Each group underwent treatments five times per week for twelve weeks. For all subjects, CPET was used to assess heart rate recovery and exercise capacity. Heart rate variability including low frequency (LF), high frequency (HF),low frequency and high frequency ratio (LF/HF) and standard deviation of normal-to-normal interval(SDNN) was used to evaluate autonomic nervous function. Superoxide dismutase (SOD), nitric oxide (NO),lipid peroxide (LOOH) in venous blood were used to evaluate the oxidative stress level. Result: There was no significant difference in HRR1, peak power (PP), VO2peak, anaerobic threshold (AT), heart rate variability index (LF, HF, LF/HF, SDNN),oxidative stress level (SOD, NO, LOOH) among four groups before treatment (P>0.05). After twelve weeks, HRR1 in the group C was better than the one in the group A, group B and group D (P<0.05). HRR1 in the group B was better than the one in the group A and group D (P<0.05), and group A had better HRR1 than the group D (P<0.05). Meanwhile, PP, VO2 peak and AT in the group C was better than the one in the group A, but the difference was not significant(P>0.05). There was no significant difference of PP,VO2 peak and AT between the group B and group D (P>0.05). Heart rate variability in the group C was better than the group A, group B and group D. Oxidative stress level in the group C was better than the group A, group B and group D. Conclusion: Compared with single aerobic exercise treatment or single electro-acupuncture treatment, the two combined treatment method can more significantly improve heart rate recovery and exercise capacity. Furthermore, the autonomic nervous function and oxidative stress level were improved markedly as well.
Keywords:aerobic exercise  electro-acupuncture  coronary heart disease  heart rate  exercise capacity
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