發(fā)布時間：2018-04-10 04:05

  本文選題：慢性心力衰竭　切入點：心肺功能　出處：《遼寧中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:觀察常規(guī)藥物治療聯(lián)合太極拳運動對慢性心力衰竭患者心肺功能參數(shù)、NT-pro BNP、左室射血分數(shù)的作用,以及對明尼蘇達心衰生活質量評分的影響,探討太極拳運動在慢性心力衰竭患者康復治療中的作用。資料與方法:選取2015年6月至2016年4月于遼寧省人民醫(yī)院心內科住院治療的慢性心力衰竭(心功能II-III級)患者60例,男31例,女29例,平均年齡61.2±6.1(50-70)歲,按隨機數(shù)字表隨機分為常規(guī)治療組(對照組)和太極拳組(試驗組),兩組根據(jù)《2016ESC急慢性心力衰竭診斷和治療指南》進行診斷及治療,采用美國紐約心臟病學會的心功能分級標準進行分級。對照組依據(jù)上述指南進行常規(guī)藥物治療,太極拳組在常規(guī)藥物治療基礎上增加6個月的24式太極拳鍛煉,每周鍛煉3-5次,每次30min。記錄年齡、性別、身高、體重、BMI、血壓等一般情況以及治療前后心肺功能參數(shù)、NT-pro BNP、左室射血分數(shù)(LVEF)以及明尼蘇達心衰生活質量評分,并進行比較。結果:1.心肺功能指標:治療前常規(guī)治療組與太極拳組無氧閾值(AT)、峰值攝氧量(VO2max)、氧脈比(AT:9.08±0.53ml/kg.min vs.8.96±0.49ml/kg.min,P0.05;VO2max:14.55±1.04 ml/kg.min vs.14.66±1.05ml/kg.min,P0.05;氧脈比:8.40±0.47 ml/bpm vs.8.57±0.52ml/bpm,P0.05)無顯著性差異;治療后常規(guī)治療組與太極拳組AT、VO2max及氧脈比(AT:9.57±0.63ml/kg.min vs.10.38±0.48ml/kg.min,P0.05;VO2max:15.49±0.87ml/kg.min vs.16.72±1.05ml/kg.min,P0.05;氧脈比:9.48±0.52ml/bpm vs.10.25±1.23ml/bpm,P0.05)均升高,與常規(guī)治療組相比,太極拳組升高更顯著;治療前后常規(guī)治療組與太極拳組AT、VO2max、氧脈比(AT:9.08±0.53ml/kg.min vs.9.57±0.63ml/kg.min,8.96±0.49ml/kg.min vs.10.38±0.48ml/kg.min,P0.05);VO2max:14.55±1.04 ml/kg.min vs.15.49±0.87ml/kg.min,14.66±1.05ml/kg.min vs.16.72±1.05ml/kg.min,P0.05;氧脈比:8.40±0.47 ml/bpm vs.9.48±0.52ml/bpm,8.57±0.52ml/bpm vs.10.25±1.23ml/bpm,P0.05)比較有統(tǒng)計學差異。2.NT-pro BNP:治療前常規(guī)治療組與太極拳組NT-pro BNP值(435.9±199.7ng/l vs.415.0±240.8ng/l,P0.05)比較無統(tǒng)計學差異;治療后常規(guī)治療組與太極拳組NT-pro BNP值均下降(338.9±213.6ng/l vs.203.1±231.6ng/l,P0.05),與常規(guī)治療組相比,太極拳組降低更顯著;治療前后常規(guī)治療組與太極拳組NT-pro BNP值(435.9±199.7ng/l vs.338.9±213.6ng/l,415.0±240.8ng/l vs.203.1±231.6ng/l,P0.05)比較有統(tǒng)計學差異。3.左室射血分數(shù):治療前常規(guī)治療組與太極拳組LVEF值(0.42±0.06 vs.0.40±0.07,P0.05)比較無統(tǒng)計學差異;治療后常規(guī)治療組與太極拳組LVEF值(0.44±0.08vs.0.42±0.03,P0.05)均升高,但無統(tǒng)計學差異;治療前后常規(guī)治療組與太極拳組LVEF值(0.42±0.06 vs.0.44±0.08,0.40±0.07 vs.0.42±0.03,P0.05)比較亦無統(tǒng)計學差異。4.明尼蘇達心衰生活質量評分表:治療前常規(guī)治療組與太極拳組評分(43.39±9.18vs.46.66±10.94,P0.05)比較無統(tǒng)計學差異;治療后常規(guī)治療組與太極拳組評分均降低(33.96±9.58 vs.25.22±6.97,P0.05),與常規(guī)治療組相比,太極拳組降低更顯著;治療前后常規(guī)治療組與太極拳組評分(43.39±9.18 vs.33.96±9.58,46.66±10.94vs.25.22±6.97,P0.05)有統(tǒng)計學差異。結論:1.藥物聯(lián)合太極拳運動,能進一步的提高慢性心力衰竭患者的無氧閾值、峰值攝氧量和氧脈比,降低NT-pro BNP水平。2.通過藥物聯(lián)合太極拳運動能更好的改善慢性心力衰竭患者的運動耐量,提高患者的生存質量。3.心肺功能指標能準確客觀的評價慢性心力衰竭患者的狀況。
[Abstract]:Objective: To observe the routine drug therapy combined with Taijiquan exercise parameters on cardiopulmonary function in patients with chronic heart failure NT-pro BNP, left ventricular ejection fraction, and the influence on the quality of life score of heart failure in Minnesota, to explore the Taijiquan exercise rehabilitation in patients with chronic heart failure Kang. Materials and methods: from June 2015 to April 2016 Liaoning Provincial People's Hospital Department of Cardiology hospitalized chronic heart failure (NYHA class II-III) 60 cases, male 31 cases, female 29 cases, mean age 61.2 + 6.1 (50-70) years old, were randomly divided into routine treatment group (control group) and Taijiquan group (experimental group), two groups according to the <2016ESC "guidelines for diagnosis and treatment of chronic heart failure diagnosis and treatment, the New York Heart Association standard classification of cardiac function classification. The control group on the basis of the above guidelines for routine drug treatment The Tai Chi Group, an increase of 24 Style Taijiquan exercise for 6 months on the basis of conventional drug treatment, exercise 3-5 times a week, every time 30min. record the age, gender, height, weight, BMI, blood pressure and other general situation before and after the treatment of heart and lung function parameters, NT-pro BNP, left ventricular ejection fraction (LVEF) and the quality of life of Minnesota heart failure score, and compared. Results: 1. heart lung function index: before treatment, the conventional treatment group and Taijiquan group anaerobic threshold (AT), peak oxygen uptake (VO2max), oxygen pulse ratio (AT:9.08 + 0.53ml/kg.min vs.8.96 + 0.49ml/kg.min, P0.05 + 1.04 ml/kg.min vs.14.66 + VO2max:14.55; 1.05ml/kg.min, P0.05; oxygen pulse ratio: 8.40 + 0.47 ml/bpm vs.8.57 + 0.52ml/bpm, P0.05) had no significant difference; after treatment, routine treatment group and Taijiquan group AT, VO2max and oxygen pulse ratio (AT:9.57 + 0.63ml/kg.min vs.10.38 + 0.48ml/kg.min, VO2max:15.49 + 0.87ml/kg.min vs.1 P0.05; 6.72 + 1.05ml/kg.min, P0.05; oxygen pulse ratio: 9.48 + 0.52ml/bpm vs.10.25 + 1.23ml/bpm, P0.05) were increased, compared with the conventional treatment group, Taiji group increased more significantly after treatment; the routine treatment group and Taijiquan group AT, VO2max, oxygen pulse ratio (AT:9.08 + 0.53ml/kg.min vs.9.57 + 0.63ml/kg.min, 8.96 + 0.49ml/kg.min + vs.10.38 0.48ml/kg.min, P0.05); VO2max:14.55 + 1.04 ml/kg.min vs.15.49 + 0.87ml/kg.min, 14.66 + 1.05ml/kg.min vs.16.72 + 1.05ml/kg.min, P0.05; oxygen pulse ratio: 8.40 + 0.47 ml/bpm vs.9.48 + 0.52ml/bpm, 8.57 + 0.52ml/bpm vs.10.25 + 1.23ml/bpm, P0.05) were statistically significant difference.2.NT-pro BNP: before treatment, routine treatment group and Taijiquan group NT-pro BNP value (435.9. 199.7ng/l vs.415.0 + 240.8ng/l, P0.05) showed no significant difference; after treatment, routine treatment group and Taijiquan group NT-pro BNP decreased (338.9 + 213.6ng/l + 231 vs.203.1 .6ng/l, P0.05), compared with the conventional treatment group, Taiji group decreased more significantly; the routine treatment group and Taijiquan group NT-pro BNP value before and after treatment (435.9 + 199.7ng/l vs.338.9 415 + 240.8ng/l + 213.6ng/l, vs.203.1 + 231.6ng/l, P0.05) compared with left ventricular ejection fraction:.3. significant difference before treatment and treatment group the Tai Chi Group LVEF (0.42 + 0.06 vs.0.40 + 0.07, P0.05) showed no significant difference; the routine treatment group and Taijiquan group LVEF value after treatment (0.44 + 0.08vs.0.42 + 0.03, P0.05) were increased, but the difference was not statistically significant; the routine treatment group and Taijiquan group LVEF values before and after treatment (0.42 + 0.06 vs.0.44 + 0.08,0.40 + 0.07 vs.0.42 + 0.03, P0.05) is also no significant difference in the.4. Minnesota heart failure quality of life scale: before treatment, the conventional treatment group and Taijiquan group score (43.39 + 9.18vs.46.66 + 10.94, P0.05) and there was no significant difference in treatment; After conventional treatment group and Taijiquan group were significantly reduced (33.96 + 9.58 vs.25.22 + 6.97, P0.05), compared with the conventional treatment group, Taiji group decreased more significantly after treatment; the routine treatment group and Taijiquan group score (43.39 + 9.18 vs.33.96 + 9.58,46.66 + 10.94vs.25.22 + 6.97, P0.05). Conclusion there is significant difference 1. drugs combined with Taijiquan exercise, can further improve the anaerobic threshold in patients with chronic heart failure, peak oxygen uptake and oxygen pulse ratio, reduce the NT-pro level of BNP.2. can better through drugs combined with Taijiquan exercise to improve exercise tolerance in patients with chronic heart failure, improve the quality of life of.3. heart and lung function indices in patients with accurate and objective the evaluation of patients with chronic heart failure.

【學位授予單位】：遼寧中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.6

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