抗阻-耐力运动结合认知-行为团体心理疗法对冠心病患者术后疗效及脂质代谢的影响

马依热·买买提; 热依拉·阿吾提; 尼加提·阿布都热合曼; 帕热旦木·托乎提; 郭驹

doi:10.16766/j.cnki.issn.1674-4152.003052

抗阻-耐力运动结合认知-行为团体心理疗法对冠心病患者术后疗效及脂质代谢的影响

doi: 10.16766/j.cnki.issn.1674-4152.003052

1.
新疆医科大学第一附属医院重症医学二科，新疆乌鲁木齐 830011
2.
新疆医科大学第一附属医院肾脏疾病中心血液透析科

基金项目:

新疆维吾尔自治区自然科学基金资助项目 2022D01C227

详细信息

通讯作者:
郭驹，E-mail：guoju_1110@163.com

中图分类号: R473.54 R541.4
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- 文章访问数: 143
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- 被引次数: 0
出版历程
- 收稿日期: 2022-06-28
- 网络出版日期: 2023-08-26

Effects of resistance-endurance exercise combined with cognitive-behavioral group psychotherapy on postoperative efficacy and lipid metabolism in patients with coronary heart disease

1.
Department of Critical Care Medicine, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China

摘要

摘要: 目的探究抗阻-耐力运动结合认知-行为团体心理疗法对冠心病患者术后疗效及脂质代谢的影响，为临床干预提供参考。方法选取2019年1月—2020年1月于新疆医科大学第一附属医院就诊的冠心病患者100例，应用随机数字表法分为对照组(50例)和观察组(50例), 对照组予以常规干预，观察组予以抗阻-耐力运动+认知-行为团体心理疗法。比较2组术后疗效、脂质代谢、炎性细胞因子[超敏C反应蛋白(hs-CRP)、白细胞介素(IL-6)、内皮素-1(ET-1)]、心功能指标[左室射血分数(LVEF)、N端B型脑钠肽前体(NT-proBNP)、6 min步行距离(6MWT)]及负性情绪[焦虑自评量表(SAS)和抑郁自量表(SDS)]。结果观察组总有效率明显高于对照组(88.00% vs. 70.00%，P < 0.05)；干预后，观察组TG、TC、LDL-C及血清hs-CRP、IL-6、ET-1水平均明显低于对照组(P < 0.05)，HDL-C明显高于对照组(P < 0.05)；干预后，观察组NT-proBNP明显低于对照组(P < 0.05)，LVEF、6MWT明显高于对照组(P < 0.05)；干预后，与对照组相比，观察组SAS和SDS评分均降低(P < 0.05)。结论对冠心病患者给予抗阻-耐力运动和认知-行为团体心理疗法，可有效提高术后疗效，改善脂质代谢，降低炎性细胞因子水平，改善心功能，并减轻患者负性情绪。
- 抗阻-耐力运动 /
- 认知-行为团体心理疗法 /
- 冠心病 /
- 心功能 /
- 脂质代谢 /
- 炎性细胞因子
Abstract: Objective To explore the effect of resistance-endurance exercise combined with cognitive-behavioral group psychotherapy on postoperative efficacy and lipid metabolism in patients with coronary heart disease, and to provide reference for clinical intervention. Methods A total of 100 patients with coronary heart disease admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2019 to January 2020 were selected and randomly divided into control group (50 cases) and observation group (50 cases) according to the random number table method. Routine intervention was given to the control group, while the observation group was given resistance-endurance exercise + cognitive-behavioral group psychotherapy. The curative effect, lipid metabolism, postoperative inflammatory cytokines [hypersensitive C-reactive protein (hs-CRP) and interleukin (IL-6), endothelin-1 (ET-1)], cardiac function index [left ventricular ejection fraction (LVEF), N-terminal pro-brain natriuretic peptide (NT-proBNP), 6 min walking distance (6MWT)] and negative emotion [self-rating anxiety scale (SAS) and self-rating depression scale (SDS)] of the two groups were compared. Results The total effective rate of the observation group was significantly higher than that of the control group (88.00% vs. 70.00%, P < 0.05). After the intervention, triglyceride, total cholesterol, low density lipoprotein cholesterol and serum hs-CRP, IL-6 and ET-1 levels in the observation group were significantly lower than those in the control group (P < 0.05), and high density lipoprotein cholesterol was significantly higher than that in the control group (P < 0.05); NT-proBNP in the observation group was significantly lower than that in the control group (P < 0.05), and LVEF and 6MWT were significantly higher than those in the control group (P < 0.05); SAS and SDS scores of the observation group decreased compared with those of the control group (P < 0.05). Conclusion For patients with coronary heart disease, resistance-endurance exercise and cognitive-behavioral group psychotherapy can effectively improve postoperative efficacy, improve lipid metabolism, reduce the level of inflammatory cytokines, improve cardiac function, and reduce negative emotions in patients.
- Resistance-endurance exercise /
- Cognitive-behavioral group psychotherapy /
- Coronary heart disease /
- Cardiac function /
- Lipid metabolism /
- Inflammatory cytokines

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表 1 2组冠心病患者一般资料比较

Table 1. Comparison of general data between the two groups of patients with coronary heart disease

组别	例数	性别(例)		年龄(x±s，岁)	病程(年)	文化水平(例)			合并基础疾病(例)
组别	例数	男性	女性	年龄(x±s，岁)	病程(年)	初中	高中	大学及以上	高血压	高血脂	糖尿病
观察组	50	29	21	67.96±3.58	1.78±0.28	15	24	11	22	6	13
对照组	50	23	27	68.87±3.96	1.83±0.31	13	28	9	18	10	8
统计量		1.442^a		1.205^b	0.846^b	0.002^c			0.667^a	1.190^a	1.507^a
P值		0.230		0.231	0.399	0.976			0.414	0.275	0.220
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 2组冠心病患者临床疗效比较[例(%)]

Table 2. Comparison of clinical efficacy between the two groups of patients with coronary heart disease [cases(%)]

组别	例数	显效	好转	无效	总有效
观察组	50	25(50.00)	19(38.00)	6(12.00)	44(88.00)
对照组	50	19(38.00)	16(32.00)	15(30.00)	35(70.00)
注：2组总有效率比较，χ²=4.882，P=0.027。

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表 3 2组冠心病患者脂质代谢指标水平比较(x±s，mmol/L)

Table 3. Comparison of lipid metabolism indexes between the two groups of patients with coronary heart disease (x±s, mmol/L)

组别	例数	TG		TC		LDL-C		HDL-C
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
观察组	50	1.85±0.40	1.21±0.25^a	4.44±1.05	3.69±0.51^a	2.83±0.54	1.88±0.41^a	0.60±0.14	1.23±0.23^a
对照组	50	1.81±0.38	1.54±0.33^a	4.38±0.98	4.00±0.58^a	2.87±0.59	2.29±0.46^a	0.63±0.15	0.91±0.19^a
t值		0.513	5.636	0.295	2.838	0.354	4.705	1.034	7.585
P值		0.609	<0.001	0.768	0.006	0.724	<0.001	0.304	<0.001
注：与同组干预前比较，^aP<0.05。

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表 4 2组冠心病患者血清炎性细胞因子水平比较(x±s)

Table 4. Comparison of serum inflammatory cytokines levels between the two groups of patients with coronary heart disease (x±s)

组别	例数	hs-CRP(mg/L)		IL-6(pg/mL)		EF-1(pg/mL)
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
观察组	50	16.21±2.45	4.36±1.36^a	65.42±5.65	6.85±1.58^a	172.56±19.25	72.45±12.58^a
对照组	50	15.78±2.64	7.56±2.21^a	64.15±6.45	14.25±3.75^a	168.74±17.65	94.56±14.25^a
t值		0.844	8.720	1.047	12.859	1.034	8.225
P值		0.401	<0.001	0.298	<0.001	0.304	<0.001
注：与同组干预前比较，^aP<0.05。

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表 5 2组冠心病患者心功能指标比较(x±s)

Table 5. Comparison of cardiac function indexes between the two groups of patients with coronary heart disease (x±s)

组别	例数	LVEF(%)		NT-proBNP(pg/ml)		6MWT(m)
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
观察组	50	51.26±5.65	64.12±5.12^a	378.56±26.54	196.54±25.48^a	396.54±48.54	556.74±57.58^a
对照组	50	51.21±6.15	57.54±5.89^a	381.54±29.52	265.87±29.65^a	399.87±51.26	488.54±62.15^a
t值		0.042	5.962	0.531	12.540	0.334	5.692
P值		0.966	<0.001	0.597	<0.001	0.739	<0.001
注：与同组干预前比较，^aP<0.05。

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表 6 2组冠心病患者负性情绪比较(x±s，分)

Table 6. Comparison of negative emotions between the two groups of patients with coronary heart disease (x±s, points)

组别	例数	SAS		SDS
组别	例数	干预前	干预后	干预前	干预后
观察组	50	53.54±4.87	42.26±4.21^a	55.75±6.10	44.20±4.79^a
对照组	50	53.29±4.60	47.33±4.51^a	55.39±5.96	48.77±5.46^a
t值		0.263	5.811	0.298	4.449
P值		0.792	<0.001	0.766	<0.001
注：与同组干预前比较，^aP<0.05。

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参考文献(20)

[1]	徐晨婕, 侯亚冰, 曹新西, 等. 冠心病及脑卒中的发病率和死亡率与互联网搜索引擎数据的关联分析[J]. 中国慢性病预防与控制, 2020, 28(4): 270-273. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB202004008.htm XU C J, HOU Y B, CAO X X, et al. Correlation between the morbidity and mortality of coronary heart disease or stroke and internet search engine data[J]. Chinese Journal of Prevention and Control of Chronic Diseases, 2020, 28(4): 270-273. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB202004008.htm
[2]	刘西花, 李晓旭, 毕鸿雁, 等. 联合抗阻-耐力运动对冠心病患者心肺功能的影响[J]. 中国康复医学杂志, 2018, 33(8): 915-919, 927. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGKF201808007.htm LIU X H, LI X X, BI H Y, et al. nfluence of combined endurance-resistance training on cardiopulmonary function in patients with coronary heart disease[J]. Chinese Journal of Rehabilitation Medicine, 2018, 33(8): 915-919, 927. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGKF201808007.htm
[3]	张蕊, 张青云, 金鑫, 等. 七步法运动康复联合弹力带抗阻训练对冠心病患者功能性体适能、心功能及心血管不良事件的影响[J]. 中国医师杂志, 2020, 22(8): 1189-1193. ZHANG R, ZHANG Q Y, JIN X, et al. Intervention effect of seven-step exercise rehabilitation combined with elastic band resistance training on functional fitness and cardiovascular adverse events in patients with coronary heart disease[J]. Journal of Chinese Physician, 2020, 22(8): 1189-1193.
[4]	STRAUB J, METZGER C D, PLENER P L, et al. Successful group psychotherapy of depression in adolescents alters fronto-limbic resting-state connectivity[J]. J Affect Disorders, 2017, 209: 135-139. doi: 10.1016/j.jad.2016.11.024
[5]	杨加青, 买孝莲, 高存友, 等. 团体心理治疗在脑卒中失语症患者康复治疗中的应用[J]. 中国健康心理学杂志, 2018, 26(12): 1839-1843. https://www.cnki.com.cn/Article/CJFDTOTAL-JKXL201812024.htm YANG J Q, MAI X L, GAO C Y, et al. Application of Group Psychotherapy in Rehabilitation Treatment of Stroke Patients with Aphasia[J]. China Journal of Health Psychology, 2018, 26(12): 1839-1843. https://www.cnki.com.cn/Article/CJFDTOTAL-JKXL201812024.htm
[6]	葛均波, 徐永健. 内科学[M]. 8版. 北京: 人民卫生出版社, 2013: 376. GE J B, XU Y J. Internal Medicine[M]. 8th Ed. Beijing: People's Medical Publishing House, 2013: 376.
[7]	来桂棵, 朱丽, 汤建民. 短期强化他汀治疗对PCI术后患者的血脂水平、心脏功能及MACE事件的影响[J]. 西安交通大学学报(医学版), 2019, 40(5): 732-735, 754. https://www.cnki.com.cn/Article/CJFDTOTAL-XAYX201905014.htm LAI G K, ZHU L, TANG J M. Effects of short-term intensive statin therapy on blood lipid level, cardiac function and MACE events in patients after percutaneous coronary intervention[J]. Journal of Xi 'an Jiaotong University (Medical Edition), 2019, 40(5): 732-735, 754. https://www.cnki.com.cn/Article/CJFDTOTAL-XAYX201905014.htm
[8]	吴晶, 杨欣, 周月. 多维度协同护理对老年冠心病合并心力衰竭患者负性情绪及生活质量的影响[J]. 中华现代护理杂志, 2018, 24(5): 577-581. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLL202102072.htm WU J, YANG X, ZHOU Y. Effects of multi dimensional collaborative nursing on negative emotion and quality of life in elderly patients with coronary heart disease combined with congestive heart failure[J]. Chinese Journal of Modern Nursing, 2018, 24(5): 577-581. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLL202102072.htm
[9]	许艳梅, 冯玉宝, 苏平, 等. 运动康复对经皮冠状动脉介入治疗术后冠心病患者心功能的影响[J]. 中国循环杂志, 2017, 32(4): 326-330. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH201704007.htm XU Y M, FENG Y B, SU P, et al. Impact of Exercise Rehabilitation on Cardiac Function in Coronary Artery Disease Patients After Percutaneous Coronary Intervention[J]. Chinese Circulation Journal, 2017, 32(4): 326-330. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH201704007.htm
[10]	王蕾. 有氧运动疗法对老年冠心病病人心率波动、心功能指标及SF-36评分的影响[J]. 中西医结合心脑血管病杂志, 2018, 16(1): 77-80. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYY201801020.htm WANG L. Effects of aerobic exercise therapy on heart rate fluctuation, cardiac function index and SF-36 score in elderly patients with coronary heart disease[J]. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease, 2018, 16(1): 77-80. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYY201801020.htm
[11]	黄乾坤, 舒燕萍, 岳雅, 等. 团体认知行为疗法治疗失眠障碍疗效的Meta分析[J]. 神经疾病与精神卫生, 2020, 20(9): 647-654. https://www.cnki.com.cn/Article/CJFDTOTAL-JBJS202009008.htm HUANG Q K, SHU Y P, YUE Y, et al. Meta analysis of clinical efficacy of group cognitive behavioral therapy in the treatment of insomnia[J]. Journal of Neuroscience and Mental Health, 2020, 20(9): 647-654. https://www.cnki.com.cn/Article/CJFDTOTAL-JBJS202009008.htm
[12]	郅季炘. 有氧运动联合抗阻训练对男性肥胖青少年心血管危险因素的影响[J]. 中华物理医学与康复杂志, 2019, 41(6): 447-452. ZHI J X. The effects of aerobic exercise combined with resistance training on cardiovascular risk factors in obese adolescent males[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2019, 41(6): 447-452.
[13]	魏春燕, 赵东荣, 朱雅雯, 等. 团体认知行为疗法对住院精神分裂症患者自杀风险的干预效果观察[J]. 中国临床心理学杂志, 2021, 29(1): 195-199. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLCY202101040.htm WEI C Y, ZHAO D R, ZHU Y W, et al. Group Cognitive Behavioral Therapy for Hospitalized Schizophrenics Observation of Intervention Effects on Suicide Risk[J]. Chinese Journal of Clinical Psychology, 2021, 29(1): 195-199. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLCY202101040.htm
[14]	俞小红, 王红亚, 傅华君. 基于渐进性抗阻训练的健康管理对绝经后骨质疏松女性跌倒风险的影响[J]. 中华全科医学, 2020, 18(8): 1337-1340. doi: 10.16766/j.cnki.issn.1674-4152.001501 YU X H, WANG H Y, FU H J. Effect of health management combined with calcitriol based on progressive resistance training on CTX, BAP and Fall Risk in postmenopausal osteoporosis women[J]. Chinese Journal of General Practice, 2020, 18(8): 1337-1340. doi: 10.16766/j.cnki.issn.1674-4152.001501
[15]	赵梦真, 刘伟利, 张勋. 运动康复对冠心病冠脉介入术后患者短期预后的影响[J]. 中国循证心血管医学杂志, 2020, 12(2): 225-229. https://www.cnki.com.cn/Article/CJFDTOTAL-PZXX202002024.htm ZHAO M Z, LIU W L, ZHANG X. Effect of exercise rehabilitation on short-term prognosis of patients with coronary heart disease after coronary intervention[J]. Chinese Journal of Evidence-Based Cardiovascular Medicine, 2020, 12(2): 225-229. https://www.cnki.com.cn/Article/CJFDTOTAL-PZXX202002024.htm
[16]	张彦月, 李旭, 林文华, 等. 心外膜脂肪组织容积与冠心病介入治疗患者临床预后的关系[J]. 中华医学杂志, 2018, 98(3): 208-212. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXJH202021029.htm ZHANG Y Y, LI X, LIN W H, et al. Relationship between epicardial adipose tissue and clinical prognosis of patients with coronary heartdisease after percutaneous coronary intervention[J]. National Medical Journal of China, 2018, 98(3): 208-212. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXJH202021029.htm
[17]	MA H, WANG Y, XUE Y L, et al. The effect of Xinkeshu tablets on depression and anxiety symptoms in patients with coronary artery disease: results from a double-blind, randomized, placebo-controlled study[J]. Biomed Pharmacother, 2019, 112: 108639. DOI: 10.1016/j.biopha.2019.108639.
[18]	郭红玲, 欧阳艳红, 王圣, 等. 急性ST段抬高型心肌梗死患者的hs-CRP/ALB变化对预后的预测价值[J]. 中国急救医学, 2020, 40(2): 102-107. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJJY202002004.htm GUO H L, OUYANG Y H, WANG S, et al. Prognostic value of hs-CRP/ALB changes in the patients with acute ST-segment elevation myocardial infarction[J]. Chinese Journal of Critical Care Medicine, 2020, 40(2): 102-107. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJJY202002004.htm
[19]	赵国良, 李达, 冯振宇, 等. 冠心病稳定型心绞痛(阳虚脉阻证)病人NO、IL-1、IL-6、vWF水平与冠状动脉病变程度的相关性研究[J]. 中西医结合心脑血管病杂志, 2020, 18(2): 216-218. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYY202002006.htm ZHAO G L, LI D, FENG Z Y, et al. Correlation between the Levels of NO, IL-1, IL-6, vWF and the Degree of Coronary Artery Disease in Patients with Stable Angina Pectoris(Yang Deficiency and Pulse Obstruction Syndrome)[J]. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease, 2020, 18(2): 216-218. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYY202002006.htm
[20]	张申伟, 郭静, 张铮, 等. ET-1、EMP和hs-cTnT在缺血性心脏病中的价值[J]. 检验医学, 2021, 36(1): 30-33. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYY202101007.htm ZHANG S W, GUO J, ZHANG Z, et al. Roles of ET-1, EMP and hs-cTnT in ischemic heart disease[J]. Laboratory Medicine, 2021, 36(1): 30-33. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYY202101007.htm