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РЕАБИЛИТАЦИЯ В КАРДИОЛОГИИ И КАРДИОХИРУГИИ

https://doi.org/10.17650/1818-8338-2015-9-2-13-22

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Аннотация

На сегодняшний день неоспорима эффективность реабилитационных программ после операций на сердце, инфаркта миокарда и в ряде случаев при ишемической болезни сердца (ИБС). Исследования показали, что физические тренировки, которые лежат в основе кардиореабилитации больных ИБС, снижают смертность от сердечно-сосудистых заболеваний. В обзоре обсуждаются накопленные научные данные о современных подходах к проведению кардиореабилитации: цели, показания, противопоказания, ее организация, достоинства. Подробно описываются контролируемые тренировки больных ИБС, составление комплексной программы кардиореабилитации, виды контроля при кардиотренировках. Рассматривается 2-й (стационарный) этап физической реабилитации после кардиохирургических вмешательств, протоколы которого остаются субъективными и часто оспариваются. Обычно физическая реабилитация после аортокоронарного шунтирования заключается в выполнении дыхательных упражнений, так как имеются мнения о том, что в течение по крайней мере 3 мес после операции следует избегать физических упражнений, при которых создается касательный вектор силы в грудине или вокруг нее. Но если избегать подъема тяжестей в первые недели после операции, то это приводит к более выраженной атрофии мышц грудной клетки. 

Существуют данные о том, что раннее (1–2 нед после операции) начало адаптированной программы кардиореабилитации безопасно и ускоряет восстановление, не увеличивая проблем с грудиной. Мы считаем, что реабилитацию после кардиохирургических операций необходимо начинать на стационарном этапе, а контроль нагрузочных реабилитационных программ следует проводить, используя изменения гемодинамики во время нагрузки, расчитывая энергозатраты, применяя опросник SF-36. 

Об авторе

Н. В. Гальцева
ФГБУ «Федеральный центр сердечно-сосудистой хирургии» Минздрава России; Россия, 440071, Пенза, ул. Стасова, 6
Россия

 



Список литературы

1. Law M.R., Watt H.C., Wald N.J. The underlying risk of death after myocardial infarction in the absence of treatment. Arch Intern Med 2002;162(21):2405–10.

2. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol 2011;58(23):2432–46.

3. Naughton J. Exercise training for patients with coronary artery disease. Cardiac rehabilitation revisited. Sports Med 1992;14(5):304–19.

4. Романова В.П. Факторы, обуславливающие выбор эффективных программ реабилитации больных, перенесших острый инфаркт миокарда. Вестник новых медицинских технологий 2010;17(4):87–91. [Romanоva V.P. Factors, causing the choice of efficient rehabilitation programs for the patients, who undergo the acute myocardial infarction. Vestnik novykh meditsinskikh tekhnologiy = New medical technologies herald 2010;17(4):87–91. (In Russ.)].

5. Boden W.E., O'Rourke R.A., Teo K.K. et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007;356(15):1503–16.

6. Hambrecht R., Walther C., Möbius-Winkler S. et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation 2004;109(11):1371–8.

7. Katritsis D.G., Ioannidis J.P. Percutaneous coronary intervention versus conservative therapy in nonacute coronary artery disease: a meta-analysis. Circulation 2005;111(22):2906–12.

8. Panagopoulou E., Montgomery A., Benos A. Quality of life after coronary artery bypass grafting: evaluating the influence of preoperative physical and psychosocial functioning. J Psychosom Res 2006;60(6):639–44.

9. Bradshaw P.J., Jamrozik K.D., Gilfillan I.S., Thompson P.L. Asymptomatic long-term survivors of coronary artery bypass surgery enjoy a quality of life equal to the general population. Am Heart J 2006;151(2):537–44.

10. Marwick T.H., Zuchowski C., Lauer M.S. Functional status and quality of life in patients with heart failure undergoing coronary bypass surgery after assessment of myocardial viability. J Am Coll Cardiol 1999;33(3):750–8.

11. Hammill B.G., Curtis L.H., Schulman K.A., Whellan D.J. Relationship between cardiac rehabilitation and long-term risks of death and myocardial infarction among elderly Medicare beneficiaries. Circulation 2010;121(1):63–70.

12. Myers J., Prakash M., Froelicher V. et al. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 2002;346(11):793–801.

13. Kavanagh T., Mertens D.J., Hamm L.F. et al. Peak oxygen intake and cardiac mortality in women referred for cardiac rehabilitation. J Am Coll Cardiol 2003;42(12):2139–43.

14. Сумин А.Н., Кобякова О.В., Галимзянов Д.М. Прогностическое значение показателей диастолической функции левого желудочка и мышечного статуса у пожилых пациентов, перенесших инфаркт миокарда. Кардиология 2007;47(6):21–6. [Sumin A.N., Kobyakova O.V., Galimzyanov D.M. Prognostic value of left ventricular diastolic function and muscle status in older patients who undergo the myocardial infarction. Kardiologiya = Cardiology 2007;47(6):21–6. (In Russ.)].

15. Heran B.S., Chen J.M., Ebrahim S. et al. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2011;7:CD001800.

16. Taylor R.S., Brown A., Ebrahim S. et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 2004;116(10):682–92.

17. Leon A.S., Franklin B.A., Costa F. et al. Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2005;111(3):369–76.

18. Bethell H.J. Cardiac rehabilitation: from Hellerstein to the millennium. Int J Clin Pract 2000;54(2):92–7.

19. de Macedo R.M., Faria-Neto J.R., Costantini C.O. et al. Phase I of cardiac rehabilitation: A new challenge for evidence based physiotherapy. World J Cardiol 2011;3(7):248–55.

20. Naughton J., Lategola M.T., Shanbour K. A physical rehabilitation program for cardiac patients: a progress report. Am J Med Sci 1966;252(5):545–53.

21. Аронов Д.М., Бубнова М.Г. Проблемы внедрения новой системы кардиореабилитации в России. Российский кардиологический журнал 2013;4(102):14–22. [Aronov D.M., Bubnova M.G. Problems of implementation of new cardiac rehabilitation system in Russia. Rossiyskiy kardiologicheskiy zhurnal = Russian journal of cardiology 2013;4(102):14–22. (In Russ.)].

22. Bjarnason-Wehrens B. Kardiologische Rehabilitation in Europa. Clin Res Cardiol 2009:4(2):82–8.

23. Аронов Д.М., Арабидзе Г.Г., АхремАхремович Р.М. и др. О режиме двигательной активности при остром инфаркте миокарда. Клиническая медицина 1977; 55(6):23–9. [Aronov D.M., Arabidze G.G., Akhrem-Akhremovich R.M. et al. On motion behavior state at acute myocardial infarction. Klinicheskaya meditsina = Clinical medicine 1977;55(6):23–9. (In Russ.)].

24. Balady G.J., Williams M.A., Ades P.A. et al. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. J Cardiopulm Rehabil Prev 2007;115(20):2675–82.

25. Thomas R.J., King M., Lui K. et al. AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/ secondary prevention services. J Cardiopulm Rehabil Prev 2007;27(5):260–90.

26. Smith S.C.Jr., Benjamin E.J., Bonow R.O. et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation 2011;124(22):2458–73.

27. Thompson P.D., Buchner D., Pina I.L. et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). J Circulation 2003;107(24):3109–16.

28. Wannamethee S.G., Shaper A.G., Walker M. Physical activity and mortality in older men with diagnosed coronary heart disease. Circulation 2000;102(12):1358–63.

29. Yusuf S., Hawken S., Ounpuu S. et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004;364(9438):937–52.

30. Bjarnason-Wehrens B., Schulz O., Gielen S. et al. Leitlinie körperliche Aktivität zur Sekundärprävention und Therapie kardiovaskulärer Erkrankungen. Clin Res Cardiol Suppl 2009;4:1–44.

31. Ueno A., Tomizawa Y. Cardiac rehabilitation and artificial heart devices. J Artif Organs 2009;12(2):90–7.

32. Womack L. Cardiac rehabilitation secondary prevention programs. Clin Sports Med 2003;22(1):135–60.

33. Broustet J.P., Monpère C. Cooperative survey of the results of coronary surgery during cardiac rehabilitation (in French). Arch Mal Coeur Vaiss 1994;87(10):1267–73.

34. Stewart K.J., Badenhop D., Brubaker P.H. et al. Cardiac rehabilitation following percutaneous revascularization, heart transplant, heart valve surgery, and for chronic heart failure. Chest 2003;123(6):2104–11.

35. Sullivan M.J., Higginbotham M.B., Cobb F.R. Exercise training in patients with severe left ventricular dysfunction. Hemodynamic and metabolic effects. Circulation 1988;78(3):506–15.

36. Zwisler A.D., Soja A.M., Rasmussen S. et al. Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease: 12-month results of a randomized clinical trial. Am Heart J 2008;155(6):1106–13.

37. Pande R.L., Perlstein T.S., Beckman J.A., Creager M.A. Secondary prevention and mortality in peripheral artery disease: National Health and Nutrition Examination Study, 1999 to 2004. Circulation 2011;124(1):17–23.

38. Scrutinio D., Giannuzzi P. Comorbidity in patients undergoing coronary artery bypass graft surgery: impact on outcome and implications for cardiac rehabilitation. Eur J Cardiovasc Prev Rehabil 2008;15(4):379–85.

39. Naughton J. Exercise training for patients with coronary artery disease. Cardiac rehabilitation revisited. Sports Med 1992;14(5):304–19.

40. Haskell W.L., Lee I.M., Pate R.R. et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 2007;116(9): 1081–93.

41. Grundy S.M., Hansen B., Smith S.C.Jr. et al. Clinical management of metabolic syndrome: report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management. Arterioscler Thromb Vasc Biol 2004;24(2):e19–24.

42. Bonow R.O., Mann D.L., Zipeset D.P. et al. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Saunders; 2012, p.1210–58.

43. European Association of Cardiovascular Prevention and Rehabilitation Committee for Science Guidelines; EACPR, Corrà U., Piepoli M.F. et al. Secondary prevention through cardiac rehabilitation: physical activity counselling and exercise training: key components of the position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur Heart J 2010;31(16):1967–74.

44. Ades P.A., Savage P.D., Harvey-Berino J. The treatment of obesity in cardiac rehabilitation. J Cardiopulm Rehabil Prev 2010;30(5):289–98.

45. Lund L.H., Aaronson K.D., Mancini D.M. Validation of peak exercise oxygen consumption and the Heart Failure Survival Score for serial risk stratification in advanced heart failure. Am J Cardiol 2005;95(6):734–41.

46. Chicco A.J. Exercise training in prevention and rehabilitation: which training mode is best? Minerva Cardioangiol 2008;56(5): 557–70.

47. Rognmo Ø., Hetland E., Helgerud J. et al. High intensity aerobic interval exercise is superior to moderate intensity exercise for increasing aerobic capacity in patients with coronary artery disease. Eur J Cardiovasc Prev Rehabil 2004;11(3):216–22.

48. Warburton D.E., McKenzie D.C., Haykowsky M.J. et al. Effectiveness of highintensity interval training for the rehabilitation of patients with coronary artery disease. Am J Cardiol 2005;95(9):1080–4.

49. Jolly M.A., Brennan D.M., Cho L. Impact of exercise on heart rate recovery. Circulation 2011;124(14):1520–6.

50. Lavie C.J., Milani R.V. Cardiac rehabilitation and exercise training in secondary coronary heart disease prevention. Prog Cardiovasc Dis 2011;53(6):397–403.

51. Milani R.V., Lavie C.J., Mehra M.R. Reduction in C-reactive protein through cardiac rehabilitation and exercise training. J Am Coll Cardiol 2004;43(6):1056–61.

52. Taylor R.S., Brown A., Ebrahim S. et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 2004;116(10):682–92.

53. Maines T.Y., Lavie C.J., Milani R.V. et al. Effects of cardiac rehabilitation and exercise programs on exercise capacity, coronary risk factors, behavior, and quality of life in patients with coronary artery disease. South Med J 1997;90(1):43–9.

54. McKelvie R.S., Teo K.K., Roberts R. et al. Effects of exercise training in patients with heart failure: the Exercise Rehabilitation Trial (EXERT). Am Heart J 2002;144(1):23–30.

55. Piepoli M.F., Davos C., Francis D.P. et al. Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). BMJ 2004;328(7433):189.

56. O'Connor C.M., Whellan D.J., Lee K.L. et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 2009;301(14):1439–50.

57. El-Ansary D., Waddington G., Adams R. Trunk stabilization exercises reduce sternal separation in chronic sternal instability after cardiac surgery: a randomised cross-over trial. Aust J Physiother 2007;53(4):255–60.

58. Locke T.J., Griffiths T.L., Mould H., Gibson G.J. Rib cage mechanics after median sternotomy. Thorax 1990;45(6):465–8.

59. Crowe J.M., Bradley C.A. The effectiveness of incentive spirometry with physical therapy for high-risk patients after coronary artery bypass surgery. Phys Ther 1997;77(3):260–8.

60. Hulsmann M., Quittan M., Berger R. et al. Muscle strength as a predictor of long-term survival in severe congestive heart failure. Eur J Heart Fail 2004;6(1):101–7.

61. Adams J., Pullum G., Stafford P. et al. Challenging traditional activity limits after coronary artery bypass graft surgery: a simulated lawn-mowing activity. J Cardiopulm Rehabil Prev 2008;28(2):118–21.

62. Bjarnason-Wehrens B., Mayer-Berger W., Meister E.R. et al. Recommendations for resistance exercise in cardiac rehabilitation. Recommendations of the German Federation for Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 2004;11(4):352–61.

63. Zanotti E., Felicetti G., Maini M., Fracchia C. Peripheral muscle strength training in bed-bound patients with COPD receiving mechanical ventilation: effect of electrical stimulation. Chest 2003;124(1):292–6.

64. Meesen R.L., Dendale P., Cuypers K. et al. Neuromuscular electrical stimulation as a possible means to prevent muscle tissue wasting in artificially ventilated and sedated patients in the intensive care unit: A pilot study. Neuromodulation 2010;13(4):315–20.

65. Vermaelen M., Marini J.F., Chopard A. et al. Ubiquitin targeting of rat muscle proteins during short periods of unloading. Acta Physiol Scand 2005;185(1):33–40.

66. Stein R., Maia C.P., Silveira A.D. et al. Phase one cardiopulmonary rehabilitation improves functional capacity and pulmonary function after coronary artery bypass graft surgery: a randomized trial (Abstract). Eur J Cardiovasc Prev Rehabil 2008; 15(Suppl. 1):S106.

67. Guidon M., McGee H. Recruitment to clinical trials of exercise: challenges in the peripheral arterial disease population. Physiotherapy 2013;99(4):305–10.

68. Mazzini M.J., Stevens G.R., Whalen D. et al. Effect of an American Heart Association Get with the Guidelines program-based clinical pathway on referral and enrollment into cardiac rehabilitation after acute myocardial infarction. Am J Cardiol 2008;101(8):1084–7.

69. Temporelli P.L., Giannuzzi P. Cardiac rehabilitation after cardiac surgery: a valuable opportunity that should not be missed. Eur J Cardiovasc Prev Rehabil 2008;15(2):128–9.

70. Suaya J.A., Shepard D.S., Normand S.L. et al. Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Circulation 2007;116(15):1653–62.

71. Karoff M., Held K., Bjarnason-Wehrens B. Cardiac rehabilitation in Germany. Eur J Cardiovasc Prev Rehabil 2007;14(1): 18–27.


Для цитирования:


Гальцева Н.В. РЕАБИЛИТАЦИЯ В КАРДИОЛОГИИ И КАРДИОХИРУГИИ. Клиницист. 2015;9(2):13-22. https://doi.org/10.17650/1818-8338-2015-9-2-13-22

For citation:


Galtseva N.V. REHABILITATION IN CARDIOLOGY AND CARDIOSURGERY. The Clinician. 2015;9(2):13-22. (In Russ.) https://doi.org/10.17650/1818-8338-2015-9-2-13-22

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ISSN 1818-8338 (Print)
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