OCC 2016：稳定性冠心病心脏康复运动处方专家共识--运动疗法与药物相辅相成

2016-05-28 milly酱 MedSci原创

及早运动康复的重要意义 1912年Dr.James Bryan Herrick提出心肌梗死定义以及绝对卧床2个月治疗理念，进而在1930s，Mallory White 进一步强化卧床6--8周发现梗死心急组织需要6周才能形成稳固的疤痕组织，Redwood等发现延长卧床时间会导致体力减退、步行时心动过速、直立性低血压、血栓栓塞肺活量下降、负氮平衡和治愈时间延迟，而体力活动可使心率减慢、血压升高、并

2016年5月28日，在第十届东方心脏病会议上，广东省心血管病研究所，广东省人民医院郭兰教授做了题为《稳定性冠心病心脏康复运动处方专家共识》的主题报告，从及早运动康复的重要意义到运动处方定制的基本原则再到保证运动的安全性做了详实的报告，现梅斯医学小编进行整理。

及早运动康复的重要意义

1912年Dr.James Bryan Herrick提出心肌梗死定义以及绝对卧床2个月治疗理念，进而在1930s，Mallory White 进一步强化卧床6--8周发现梗死心急组织需要6周才能形成稳固的疤痕组织，Redwood等发现延长卧床时间会导致体力减退、步行时心动过速、直立性低血压、血栓栓塞肺活量下降、负氮平衡和治愈时间延迟，而体力活动可使心率减慢、血压升高、并增加氧利用和身体耐力。

图1 卧床降低心功能和体能

图2 卧床与远期预后不良相关

大血管治疗及小血管或冠脉痉挛治疗中，现有稳定性冠心病治疗手段有药物治疗，手术治疗及非药物治疗。非药物治疗又包含仪器治疗：体外反馈，体外震波和自身修复：运动，饮食，调整心里，戒烟限酒，但无论是在大血管治疗，小血管或冠脉痉挛治疗中，运动显然是被忽视的。在一定范围内，健康获益与运动量成正相关（如下图）。

图3 在一定范围内，健康获益与运动量成正相关

运动风险与获益共存运动处方定制的基本原则

身体活动的风险主要存在于伤害肌肉骨骼系统，肌肉酸痛，脱水，电解质紊乱，若过度训练严重者会造成运动能力下降，免疫力下降，心肌梗死，猝死等。那么如何制定有效安全的运动处方？

首先要进行运动前危险评估

.患者的病史：心血管及其他脏器疾病

.心血管危险因素

.平常生活方式及运动习惯

.常规辅助检查：心肌损伤标志物、超声心动图、体质成分分析

.心理评估

.影响运动的因素

.运动负荷试验：肌力、平衡、柔韧性检测

其次基于运动频率、强度、时间期限及运动类型制定运动处方，运动处方包括以下内容：

.运动种类：有氧运动、阻力运动、柔韧性运动、平衡训练

.运动时间：30-60分钟，包括热身运动、整理运动时间

.运动频率：有氧运动每周3-5次为最佳

.运动强度（有氧运动）

-无氧阈法：心肺运动试验找到无氧阈或最大摄氧量的40%--60%

-心率计算：（最大心率-静息心率）*0.5-0.7+静息心率

-靶心率法：静息心率+20-30次/分

-BORG指数：11-13级，轻松到稍有疲劳感

如何保证运动的安全性

1，严格遵守操作规范

.在开始运动康复之前向患者详细介绍运动处方内容

.定期对患者进行运动耐量评估

.准备心脏急救应急预案，所有参加心脏康复的医务人员需定期接受心脏急救训练，定期参与病例讨论

.运动场地需要有心电监护和心肺复苏设备，包括心脏电除颤仪和急救药物

2，患者教育

.指导患者了解运动康复过程中身体的警告信号，包括胸部不适或其他类似心绞痛症状，轻度头痛或头晕，心律不齐，体重增加和气喘

.对患者出现身体不适及时评估和治疗

.强调遵循运动处方运动的重要性，即运动强度不超过目标心率或自感用力程度，注意运动时间和运动设备的选择

.强调运动时热身运动和整理你运动的重要性，与运动安全性有关

.提醒患者根据环境的变化调整运动水平，比如冷热，湿度和海拔变化

3，运动过程中

.运动前要评估每个患者最近身体健康状况、体重、血压、药物依从性和心电图的变化

.根据病情决定是否使用心电、血压和血氧监测

.根据运动前的临床状态调整运动处方的强度和持续时间

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2016-12-09 艳阳天2016

很想学习运动处方，对于运动爱好者，运动必定是他生命的乐趣

114 0
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2017-02-07 jiangfeng5067

#稳定性#

60 0
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beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94194, encryptionId=a0d894194ec, topicName=运动疗法)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=951d2500061, createdName=12498717m66(暂无昵称), createdTime=Mon May 30 11:40:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1353030, encodeId=414d13530301b, content=<a href='/topic/show?id=1d931321816' target=_blank style='color:#2F92EE;'>#OCC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13218, encryptionId=1d931321816, topicName=OCC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon May 30 11:40:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87489, encodeId=6b7b8e489fa, content=康复新领域, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d331664955, createdName=老段, createdTime=Mon May 30 06:52:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87470, encodeId=d7238e4709f, content=的确这样, beContent=null, objectType=article, channel=null, level=null, likeNumber=187, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Mon May 30 06:41:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87471, encodeId=f20c8e4716e, content=需要运动, beContent=null, objectType=article, channel=null, level=null, likeNumber=201, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Mon May 30 06:41:00 CST 2016, time=2016-05-30, status=1, ipAttribution=)]
2016-07-15 medscijoin

#康复运动#

82 0
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encodeId=6b7b8e489fa, content=康复新领域, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d331664955, createdName=老段, createdTime=Mon May 30 06:52:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87470, encodeId=d7238e4709f, content=的确这样, beContent=null, objectType=article, channel=null, level=null, likeNumber=187, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Mon May 30 06:41:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87471, encodeId=f20c8e4716e, content=需要运动, beContent=null, objectType=article, channel=null, level=null, likeNumber=201, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Mon May 30 06:41:00 CST 2016, time=2016-05-30, status=1, ipAttribution=)]
2016-08-15 杏林小道

没太看明白，是在院康复运动，还是可以院外自己运动

107 0
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encodeId=6b7b8e489fa, content=康复新领域, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d331664955, createdName=老段, createdTime=Mon May 30 06:52:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87470, encodeId=d7238e4709f, content=的确这样, beContent=null, objectType=article, channel=null, level=null, likeNumber=187, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Mon May 30 06:41:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87471, encodeId=f20c8e4716e, content=需要运动, beContent=null, objectType=article, channel=null, level=null, likeNumber=201, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Mon May 30 06:41:00 CST 2016, time=2016-05-30, status=1, ipAttribution=)]
2017-04-09 snowpeakxu

#专家共识#

132 0
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encodeId=6b7b8e489fa, content=康复新领域, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d331664955, createdName=老段, createdTime=Mon May 30 06:52:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87470, encodeId=d7238e4709f, content=的确这样, beContent=null, objectType=article, channel=null, level=null, likeNumber=187, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Mon May 30 06:41:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87471, encodeId=f20c8e4716e, content=需要运动, beContent=null, objectType=article, channel=null, level=null, likeNumber=201, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Mon May 30 06:41:00 CST 2016, time=2016-05-30, status=1, ipAttribution=)]
2016-05-30 12498717m66(暂无昵称)

#运动疗法#

113 0
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createdBy=e0a1165, createdName=jiangfeng5067, createdTime=Tue Feb 07 15:40:00 CST 2017, time=2017-02-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1943079, encodeId=4b1019430e9c2, content=<a href='/topic/show?id=21fa49455fa' target=_blank style='color:#2F92EE;'>#康复运动#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49455, encryptionId=21fa49455fa, topicName=康复运动)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f73a255, createdName=medscijoin, createdTime=Fri Jul 15 20:40:00 CST 2016, time=2016-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=98782, encodeId=79ec98e8272, content=没太看明白，是在院康复运动，还是可以院外自己运动, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/KR3mVqvUy9Vicq7uo2J2OKUCmXoh2vtLX94A6IowU3aL5NIn8SkhRrs1MD0b6bUib9fPaYgbkGeIDV16YmONWnZg/132, createdBy=87481707523, createdName=杏林小道, createdTime=Mon Aug 15 09:01:00 CST 2016, time=2016-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1844480, encodeId=f2ca1844480a5, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Sun Apr 09 19:40:00 CST 2017, time=2017-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1331863, encodeId=447b133186352, content=<a href='/topic/show?id=a0d894194ec' target=_blank style='color:#2F92EE;'>#运动疗法#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94194, encryptionId=a0d894194ec, topicName=运动疗法)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=951d2500061, createdName=12498717m66(暂无昵称), createdTime=Mon May 30 11:40:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1353030, encodeId=414d13530301b, content=<a href='/topic/show?id=1d931321816' target=_blank style='color:#2F92EE;'>#OCC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13218, encryptionId=1d931321816, topicName=OCC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon May 30 11:40:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87489, encodeId=6b7b8e489fa, content=康复新领域, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d331664955, createdName=老段, createdTime=Mon May 30 06:52:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87470, encodeId=d7238e4709f, content=的确这样, beContent=null, objectType=article, channel=null, level=null, likeNumber=187, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Mon May 30 06:41:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87471, encodeId=f20c8e4716e, content=需要运动, beContent=null, objectType=article, channel=null, level=null, likeNumber=201, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Mon May 30 06:41:00 CST 2016, time=2016-05-30, status=1, ipAttribution=)]
2016-05-30 zhaojie88

#OCC#

95 0
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beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94194, encryptionId=a0d894194ec, topicName=运动疗法)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=951d2500061, createdName=12498717m66(暂无昵称), createdTime=Mon May 30 11:40:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1353030, encodeId=414d13530301b, content=<a href='/topic/show?id=1d931321816' target=_blank style='color:#2F92EE;'>#OCC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13218, encryptionId=1d931321816, topicName=OCC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon May 30 11:40:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87489, encodeId=6b7b8e489fa, content=康复新领域, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d331664955, createdName=老段, createdTime=Mon May 30 06:52:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87470, encodeId=d7238e4709f, content=的确这样, beContent=null, objectType=article, channel=null, level=null, likeNumber=187, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Mon May 30 06:41:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87471, encodeId=f20c8e4716e, content=需要运动, beContent=null, objectType=article, channel=null, level=null, likeNumber=201, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Mon May 30 06:41:00 CST 2016, time=2016-05-30, status=1, ipAttribution=)]
2016-05-30 老段

康复新领域

143 0
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beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94194, encryptionId=a0d894194ec, topicName=运动疗法)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=951d2500061, createdName=12498717m66(暂无昵称), createdTime=Mon May 30 11:40:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1353030, encodeId=414d13530301b, content=<a href='/topic/show?id=1d931321816' target=_blank style='color:#2F92EE;'>#OCC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13218, encryptionId=1d931321816, topicName=OCC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon May 30 11:40:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87489, encodeId=6b7b8e489fa, content=康复新领域, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d331664955, createdName=老段, createdTime=Mon May 30 06:52:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87470, encodeId=d7238e4709f, content=的确这样, beContent=null, objectType=article, channel=null, level=null, likeNumber=187, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Mon May 30 06:41:00 CST 2016, time=2016-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=87471, encodeId=f20c8e4716e, content=需要运动, beContent=null, objectType=article, channel=null, level=null, likeNumber=201, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Mon May 30 06:41:00 CST 2016, time=2016-05-30, status=1, ipAttribution=)]
2016-05-30 milkshark

的确这样

187 0
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attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Mon May 30 06:41:00 CST 2016, time=2016-05-30, status=1, ipAttribution=)]
2016-05-30 milkshark

需要运动

201 0

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OCC 2016：稳定性冠心病心脏康复运动处方专家共识--运动疗法与药物相辅相成

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