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1、心肌梗塞后的運(yùn)動(dòng)和康復(fù)治療這些問(wèn)題讓心梗后患者困惑我能不能運(yùn)動(dòng)？我應(yīng)該怎么運(yùn)動(dòng)？我什么時(shí)候可以回到工作崗位？我可以做哪些家務(wù)？我什么時(shí)候可以回到以前正常的生活？心臟康復(fù)的概念和分期心臟康復(fù)（CardiacRerehabilitation,CR）始于上世紀(jì)80年代1995年AHCRP指南提出：CR由藥物治療、合理運(yùn)動(dòng)、危險(xiǎn)因素干預(yù)、健康教育、生活習(xí)慣干預(yù)等多因素構(gòu)成旨在減少心血管疾病帶來(lái)的身心方面的負(fù)面影響降低猝死和再梗死風(fēng)險(xiǎn)控制癥狀減緩疾病進(jìn)程改善患者生活質(zhì)量綜合的康復(fù)治療方案心臟康復(fù)的內(nèi)容心臟康復(fù)的核心內(nèi)容1.患者病情
2、評(píng)估7.戒煙2.營(yíng)養(yǎng)支持8.精神狀態(tài)干預(yù)3.體重管理9.運(yùn)動(dòng)耐量管理4.血壓管理10.身體鍛煉5.血脂管理11.預(yù)防性藥物治療6.血糖管理12.病情數(shù)據(jù)管理不運(yùn)動(dòng)的不利影響Age糖尿病肥胖Genetics動(dòng)脈硬化HypercoagulabilitySmoking高血壓NovelRiskFactors炎癥血脂異常缺少運(yùn)動(dòng)Note:Minutesperweekspentinmoderate-intensitysportsactivity(low-active,135min/wk;intermediatelyactive,13
3、6-195min/wk;andhighlyactive,>195min/wk)TotalBodyFatIntra-abdominalFatIrwinMLetal.JAMA2003;289:323-330173sedentary,overweight(BMI>24kg/m2)post-menopausalwomenrandomizedtomoderateintensityexercisevs.stretchingfor1year中等度的運(yùn)動(dòng)減少肥胖ExerciseEvidence:EffectonBodyCompositi
4、onNS?5%?20%??15%?34%*?8%?20%*ChangefromBaseline202171199174197190200188TGMenWomen3956415540503747HDL-CMenWomen118102131120134135138155LDL-CMenWomenYearandLipidLevel(mg/dL)196193210209213223214239TCMenWomen531BaselineLipidsWarnerJGetal.Circulation1995;92:773-777*P
5、=0.0001forchangeinwomenvsmen?P=0.03forchangeinwomenvsmenHDL-C=Highdensitylipoproteincholesterol,LDL-C=Lowdensitylipoproteincholesterol,TG=TriglycerideExerciseEvidence:運(yùn)動(dòng)對(duì)血脂的影響HuFBetal.JAMA2003;289:1785-91Nurse’sHealthStudy運(yùn)動(dòng)降低肥胖和糖尿病的發(fā)生率ExerciseEvidence:運(yùn)動(dòng)對(duì)肥胖和糖尿病的
6、影響MansonJEetal.NEJM2002;347:716-25Quintilesofactivity(MET-hour/week**)WalkingRelativeRiskofCHDVigorousexercise*RelativeRiskofCHDP=0.004P=0.00812345Women’sHealthInitiativeObservationalStudy12345**Averageactivehoursperweek?energyexpenditureperactivity*Includesaerob
7、ics,aerobicdancing,jogging,tennis,andswimminglapsCHD=CoronaryheartdiseaseExerciseEvidence:運(yùn)動(dòng)對(duì)冠心病的影響WannametheeSGetal.Circulation2000;102:1358-1363CHD=Coronaryheartdisease,CVD=Cardiovasculardisease中等度的運(yùn)動(dòng)降低冠心病患者的死亡率Observationalstudyofself-reportedphysicalactivityi
8、n772menwithCHDPhysicalActivity:運(yùn)動(dòng)對(duì)冠心病患者預(yù)后的影響**EffectofcardiacrehabilitationinrandomizedcontrolledtrialsfollowingaMIOldridgeNBetal.JAMA1988;260:945-950*p<0.0125
