心梗后心脏康复治疗

1、 运动处方运动处方 随访随访 营养指导营养指导 危险因素危险因素 矫正矫正 心理干预心理干预 功能评估功能评估 不运不运动动的不利影响的不利影响 Age 糖尿病 肥胖 Genetics动脉硬化 Hypercoagulability Smoking 高血压 Novel Risk Factors 炎症血脂异常 缺少运动 Note: Minutes per week spent in moderate-intensity sports activity (low-active, 135 min/wk; intermediately active, 136-195 min/wk; and highly

2、 active, 195 min/wk) Total Body FatIntra-abdominal Fat Irwin ML et al. JAMA 2003;289:323-330 173 sedentary, overweight (BMI 24 kg/m2) post-menopausal women randomized to moderate intensity exercise vs. stretching for 1 year 中等度的运动减少肥胖 Exercise Evidence: Effect on Body Composition NS 5% 20% 15% 34%*

3、8% 20%* Change from Baseline 202 171 199 174 197 190 200 188 TG Men Women 39 56 41 55 40 50 37 47 HDL-C Men Women 118 102 131 120 134 135 138 155 LDL-C Men Women Year and Lipid Level (mg/dL) 196 193 210 209 213 223 214 239 TC Men Women 531BaselineLipids Warner JG et al. Circulation 1995;92:773-777 *

4、P=0.0001 for change in women vs men P=0.03 for change in women vs men HDL-C=High density lipoprotein cholesterol, LDL-C=Low density lipoprotein cholesterol, TG=Triglyceride Exercise Evidence: 运运动对动对血脂的影响血脂的影响 Hu FB et al. JAMA 2003;289:1785-91 Nurses Health Study 运动降低肥胖和糖尿病的发生率 Exercise Evidence: 运运

5、动对动对肥胖和糖尿病的影响肥胖和糖尿病的影响 Manson JE et al. NEJM 2002;347:716-25 Quintiles of activity (MET-hour/week*) Walking Relative Risk of CHD Vigorous exercise* Relative Risk of CHD P=0.00 4 P=0.008 1 2 345 Womens Health Initiative Observational Study 1 2 3 4 5 *Average active hours per week energy expenditure p

6、er activity *Includes aerobics, aerobic dancing, jogging, tennis, and swimming laps CHD=Coronary heart disease Exercise Evidence: 运运动对动对冠心病的影响冠心病的影响 Wannamethee SG et al. Circulation 2000;102:1358-1363 CHD=Coronary heart disease, CVD=Cardiovascular disease 中等度的运动降低冠心病患者的死亡率 Observational study of se

7、lf-reported physical activity in 772 men with CHD Physical Activity: 运运动对动对冠心病患者冠心病患者预预后的影响后的影响 * * Effect of cardiac rehabilitation in randomized controlled trials following a MI Oldridge NB et al. JAMA 1988;260:945-950 *p195 min/wk) Total Body FatIntra-abdominal Fat Irwin ML et al. JAMA 2003;289:3

8、23-330 173 sedentary, overweight (BMI 24 kg/m2) post-menopausal women randomized to moderate intensity exercise vs. stretching for 1 year 中等度的运动减少肥胖 Exercise Evidence: Effect on Body Composition Clark AM et al. Ann of Intern Med 2005;143:659-72 Meta-analysis of 63 randomized clinical trials evaluati

9、ng cardiac secondary prevention programs with or without exercise programs 心心脏脏康复康复: 二二级预级预防的益防的益处处降低降低CV事事 件件 All cause mortalityRecurrent myocardial infarction 心脏康复有利于降低心血管事件的发生率 CV=Cardiovascular 康复治疗能够显著改善患者的抑郁和低落情绪。康复治疗能够显著改善患者的抑郁和低落情绪。 图中显示的是研究人群中参加康复治疗前后表现图中显示的是研究人群中参加康复治疗前后表现 出抑郁和低落的患者比例出抑郁和低落的患者比例 The American Journal of Medicine, 2007 两种运动试验 的终点指标 Cardiology Journal, 2008 急性心肌梗死急性心肌梗死 介入或非介入治疗介入或非介入治疗 重症监护治疗重症监护治疗 无并发症心梗无并发症心梗有并发症心梗有并发症心梗 院内