The Effect Of Passive Leg Movement On Early Cardiac Rehabilitation After Interventional Therapy In Elderly Patients With Acute Myocardial Infarction

Objective:To explore the effectiveness and safety of passive lower limb movement(PLM)in early cardiac rehabilitation(CR)after interventional therapy in elderly patients with acute myocardial infarction(AMI).Methods:From June 2019 to January 2020,67 elderly patients with AMI(age ≥ 60 years old)who met the study admission criteria and accepted the study voluntarily with informed consent were selected as the subjects.The patients were randomly divided into two groups: the conventional treatment group(33 patients)and the PLM group(34 patients).In the PLM group,PLM was performed on the basis of routine treatment 6 hours after interventional treatment,30 rpm,lasting for 20 minutes,twice a day for 5 days.During hospitalization,the total steps in the two groups were recorded and fixed exercise prescription was given at the time of discharge.Collect the general information the data of cardiac function index(MCO,LVEF),Myocardial injury markers(CK,CK-MB,hs-TnI),blood lipid index(TC,TG,HDL-C,LDL-C),mental state and the rate of rehospitalization due to symptoms at admission,discharge and 30 days after discharge.Spss23.0 statistical software was used for data processing,and the two groups of test data were statistically analyzed and compared.Results:1、General information:There was no significant difference between the two groups in age,gender,comorbidity,cardiac function classification,the location of myocardial infarction,the number of coronary stenosis,the number of stent implantation,the number of steps in hospital and drug treatment plan(P > 0.05).2、Markers of myocardial injury:There was no significant difference in CK,CK-MB and hs-TnI between the two groups(P > 0.05).Compared with the admission,the CK(PLM group:181.49 ±194.40 U / L vs 735.63 ± 899.00 U / L,P < 0.05;conventional treatment group:249.23 ± 272.75 U / L vs 996.88 ± 861.33 U / L,P < 0.05),CK-MB(PLM group :35.64 ± 44.78 U / L vs 76.42 ± 88.28 U / L,P < 0.05;conventional treatment group: 47.13 ± 42.86 U / L vs 112.36 ± 106.72 U / L,P < 0.05),hs-TnI(PLM group:3.81 ± 4.21 ng / ml vs 21.45 ± 19.93 ng / ml,P < 0.05;conventional treatment group:5.45 ± 3.17 ng / ml vs 31.44 ± 19.76 ng / ml,P < 0.05)of the two groups was significantly lower at the time of discharge.There was no significant difference in CK,CK(181.49±194.40 U/L vs 249.23±272.75 U/L,P>0.05)、CK-MB(35.64±44.78 U/L vs 47.13±42.86U/L,P>0.05)and hs-TnI(3.81±4.21 ng/ml vs 5.45±3.17 ng/ml,P>0.05)between the two groups.3、Cardiac function:There was no significant difference in MCO between the two groups(P > 0.05).Compared with the admission,the MCO of the PLM group decreased significantly at30 days after discharge(7196.62 ± 1145.51 vs 7982.76 ± 1665.86,P < 0.05).There was no significant difference at 30 days after discharge in the conventional treatment group(7832.17 ± 603.77 vs 8138.83 ± 942.08,P > 0.05).Compared with the conventional treatment group,there was no significant difference in the MCO of the LPM group at 30 days after discharge(7196.62 ± 1145.51 vs 7832.17 ± 603.77,P >0.05).There was no significant difference in LVEF between the two groups(P > 0.05).Compared with the admission,the LVEF of the LPM group was significantly higher(59.06 ± 6.29% vs 57.09 ± 6.40%,P < 0.05)at 30 days after discharge,and there was no significant difference(56.67 ± 6.54% vs 57.67 ± 6.19%,P > 0.05)at 30 days after discharge.There was no significant difference in LVEF between the two groups(59.06 ± 6.29% vs 56.67 ± 6.54%,P > 0.05).4、Blood lipids:There was no significant difference in TG,TC,LDL-C and HDL-C between the two groups on the day of PCI.Compared with the admission,the TC of the two groups decreased at 30 days after discharge(PLM group :3.27 ± 0.63mmol/l vs 4.52 ± 0.88mmol/l,P < 0.05;conventional treatment group: 4.01 ± 1.05mmol/l vs 4.72 ± 1.11mmol/l,P < 0.05).Compared with the conventional treatment group,the TC of the PLM group decreased significantly(3.27 ± 0.63 mmol / L vs 4.01 ± 1.05 mmol / L,P < 0.05)at 30 days after discharge.There was no significant difference in TG between the two groups at 30 days after discharge(PLM group :1.42 ± 1.03 mmol / L vs 1.48 ± 1.03 mmol / L,P > 0.05;conventional treatment group: 1.65 ± 0.79 mmol / L vs 1.13 ± 1.33 mmol / L,P >0.05).There was no significant difference in TG between the two groups(1.42 ± 1.03 vs 1.65 ± 0.79,P > 0.05).HDL-C was significantly higher in the two groups at 30 days after discharge than at the time of admission(PLM group:1.18 ± 0.41mmol/l vs 0.96 ± 0.30mmol/l,P< 0.05;conventional treatment group :1.10 ± 0.27mmol/l vs 0.96 ± 1.99mmol/l,P <0.05).Compared with the conventional treatment group,there was no significant difference in HDL-C between the PLM group and the conventional treatment group(1.18 ± 0.41 mmol / L vs 1.10 ± 0.27 mmol / L,P > 0.05).LDL-C in the two groups decreased at 30 days after discharge compared with that at admission(PLM group:2.10 ± 0.61mmol/l vs 2.91 ± 0.70mmol/l,P < 0.05;conventional treatment group :2.32 ± 0.87mmol/l vs 3.00 ± 1.08 mmol / L,P < 0.05).Compared with the conventional treatment group,there was no significant difference in LDL-C between the PLM group(2.10 ± 0.61 mmol / L vs 2.32 ± 0.87 mmol / L,P > 0.05).5、SAS and SDS:There were no significant differences in SAS and SDS scores between the two groups before intervention.Compared with the admission,the SAS scores of the two groups decreased at 30 days after discharge(PLM group: 49.29 ± 5.48 vs 54.29 ± 6.59,P < 0.05;conventional treatment group: 52.21 ± 5.87 vs 53.26 ± 6.24,P < 0.05).Compared with the conventional treatment group,the SAS score of the PLM group was significantly lower at 30 days after discharge(49.29 ± 5.48 vs 52.21 ± 5.87,P < 0.05).Compared with the admission,the SDS scores of the two groups decreased at 30 days after discharge(PLM group: 35.32 ± 9.87 vs 41.58 ± 9.22,P < 0.05;conventional treatment group: 37.36 ± 8.72 vs 42.58 ± 10.23,P < 0.05).Compared with the conventional treatment group,there was no significant difference in SDS score of PLM group(35.32 ± 9.87 vs 37.36 ± 8.72,P > 0.05).6、The treatment rate of symptoms within 30 days after discharge:There was no obvious difference between the two groups(2.94%VS9.10%,P>0.05).Conclusion:PLM in early cardiac rehabilitation can effectively improve the cardiac function,anxiety and depression of elderly patients undergoing emergency interventional therapy due to AMI,and improve the treatment compliance and enthusiasm of diagnosis and treatment.It is suggested that the exercise therapy can be used safely and effectively in the early CR of elderly AMI patients after PCI.