《中国康复理论与实践》 ›› 1999, Vol. 5 ›› Issue (02): 49-53.

• 论著 •    下一篇

等长收缩运动治疗冠心病患者作用机理探讨

周士枋; 励建安; 赵伟英; 蓝敏   

  1. 南京医科大学第一附属医院
  • 收稿日期:1998-06-20 出版日期:1999-06-25 发布日期:1999-06-25

Mechanism of Isometric Exercise in Cardiac Rehabilitation

Zhou Shifang,Li Jianan,Zhao Weiying,et al   

  1. Chinese Journal of Rehabilitation Theory & Practice.-1999,5(2):49~53
  • Received:1998-06-20 Published:1999-06-25 Online:1999-06-25

摘要: 等长收缩运动是日常生活中不可缺少的运动形式之一,由于运动训练效应的特异性,不训练即可产生不适应性。过去认为等长收缩运动强度较难掌握,又可能同时存在Valsalva效应而产生过强的心血管反应,可能对心脏病患者不利,从而在康复治疗中未得到应有的重视。本文通过对18名健康青年(平均23.7岁)进行等长收缩运动,应用β阻滞剂和阿片肽拮抗剂模拟特定的神经调控环境,发现等长收缩运动时的心血管反应受交感神经和阿片肽双重调节。我们还对20名冠心病患者(冠脉造影有1支以上血管病变13例,其余为陈旧性心肌梗塞或稳定性心绞痛患者)和10名年龄相似的健康者进行短暂最大强度等长收缩运动、持续3分钟等长收缩运动和动力性运动,观察运动对阿片肽、血流动力学和心功能的影响。结果表明:等长收缩运动不同时伴有Valsalva动作,对冠心病患者无害,相反可因舒张压升高而起到提高冠脉灌注量的效果。等长收缩运动时的血流动力学反映和心功能变化较动力性运动弱。它与运动绝对负荷无关,而可能与中枢命令强弱有关。研究表明,等长收缩运动,特别是主观极量持续等长收缩运动时中枢命令较强,内源性阿片肽释放较多,可能有助于降低交感神经兴奋性,减少冠心病患者的运动风险。

关键词: 等长收缩运动, 冠心病, 康复

Abstract: Isometric exercise(IE) is an essential component of daily living activities.Lack of IE may result in deconditioning of IE capacity.IE has not been used in cardiac rehabilitation because of poor understanding in cardiovascular response to IE and the Valsalva Maneuver associated with IE.Eingteen healthy young subjects aged 23.7 yrs on average was studied by administration of beta blocker and antagonist of opioids during IE.The result demonstrated that the regulation of cardiovasular response during IE is attributed to both sympathetic system and opioids activity.Twenty patients with coronary artery disease (CAD) were also studied during brief maximal IE,sustained maximal IE and dynamic exercise(DE).The patients included 13 cases with more than one vessel lesions and 7 post myocardial infarction and/or angina.Ten age matched apparent healthy subjects were examined as the control group.The result showed that IE without the Valsalva Maneuver in patients with CAD might increase coronary artery perfusion by enhancing diastolic pressure and prolonging diastolic period,which had no harmful effect on CAD.Hemodynamic responses and cardiac function were weaker during IE than DE.The intensity of the responses to IE was correlated to the central command but not to the absolute work load.It is concluded that significant release of endogenous opioids due to strong central command during IE,especially perceived maximal sustained IE,may help to attenuate activity of sympathetic system,thus reducing risk of exercise in patients with CAD.

Key words: Isometric exercise(IE), coronary artery disease(CAD), rehabilitation