增强型体外反搏对心力衰竭合并认知障碍患者的疗效研究

Effect of Enhanced External Counterpulsation on Quality of Life, Cardiac Function, and Cognitive Function in Patients with Heart Failure and Cognitive Impairment

摘要

目的：观察增强型体外反搏（enhanced external counterpulsation，EECP）对心力衰竭合并认知障碍患者生活质量、心功能及认知功能的影响。方法：选取2024年10月—2025年1月就诊于河北北方学院附属第一医院90例心力衰竭合并认知障碍患者随机分为对照组和观察组各45例，对照组给予心衰常规治疗，观察组在此基础联合EECP。治疗7周后比较两组明尼苏达心力衰竭生活质量问卷（Minnesota living with heart failure questionnaire，MLHFQ）、左室射血分数（left ventricular ejection fraction，LVEF）、6分钟步行试验距离（6-minute walking distance，6MWD）、舒张早期与晚期充盈速度比值（E/A值）、纽约心功能分级（New York heart association，NYHA分级）、左室舒张末期内径（left ventricular end-diastolic dimension，LVEDD）、N末端脑钠肽前体（N-terminal pro-B-type natriuretic peptide，NT-proBNP）、高敏C反应蛋白（high-sensitivity C-reactive protein，hs-CRP）、30天再住院率、日常生活活动能力（activities of daily living，ADL）量表评分、蒙特利尔认知评估量表（Montreal cognitive assessment，MoCA）评分的差异。结果：治疗后，两组MLHFQ评分均下降，观察组下降更显著（P<0.05）。心功能方面，观察组LVEF、6MWD、E/A值及NYHA分级改善更优，LVEDD、NT-proBNP及hsCRP下降幅度大于对照组（P<0.05），但两组30天再住院率差异无统计学意义（P>0.05）。认知方面，观察组MoCA评分升高，ADL评分改善优于对照组（P<0.05）；对照组MoCA评分无显著变化。结论：EECP有益于心力衰竭合并认知障碍患者的生活质量、心功能及认知功能改善。

Abstract

Objective: To observe the effects of enhanced external counterpulsation (EECP) on quality of life, cardiac function, and cognitive function in patients with heart failure complicated cognitive impairment. Methods: Ninety patients were randomly assigned to either a control group or an observation group, with 45 patients in each. The control group received standard heart failure treatment, while the observation group received EECP in addition to the standard treatment. After 7 weeks of treatment, comparisons were made between the two groups regarding the Minnesota living with heart failure questionnaire (MLHFQ) score, left ventricular ejection fraction (LVEF), 6-minute walking distance (6MWD), ratio of early to late diastolic ventricular filling velocities (E/A ratio), New York Heart Association (NYHA) functional classification, left ventricular end-diastolic dimension (LVEDD), N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, high-sensitivity C-reactive protein (hs-CRP) levels, 30-day readmission rate, activities of daily living (ADL) scale score, and Montreal cognitive assessment (MoCA) score. Results: After treatment, the MLHFQ scores decreased in both groups, with a more significant decrease observed in the EECP group (P<0.05). Regarding cardiac function, the EECP group showed superior improvement in LVEF, 6MWD, E/A ratio, and NYHA classification, as well as a greater reduction in LVEDD, NT-proBNP, and hs-CRP levels compared to the control group (P<0.05). However, no statistically significant difference was found in the 30-day readmission rate between the two groups (P>0.05). Regarding cognitive function, the MoCA scores increased and ADL scores improved more significantly in the EECP group compared to the control group (P<0.05); the control group showed no significant change in MoCA scores. Conclusion: EECP is beneficial for improving quality of life, cardiac function, and cognitive function in patients with heart failure complicated by cognitive impairment.

关键词

增强型体外反搏 / 心力衰竭 / 认知障碍 / 疗效评估

Key words

enhanced external counterpulsation / heart failure / cognitive impairment / therapeutic evaluation

参考文献

[1] 王华, 刘宇佳, 杨杰孚. 心力衰竭流行病学[J]. 临床心血管病杂志, 2023, 39(4): 243-247.

[2] Gianluigi Savarese, Peter Moritz Becher, Lars H Lund, et al. Global burden of heart failure: a comprehensive and updated review of epidemiology[J]. Cardiovasc Res, 2023, 118(17): 3272-3287.

[3] 梁红, 吕巍, 杨依萌. 认知障碍与心力衰竭的研究进展[J]. 中国老年学杂志, 2021, 41(22): 5149-5154.

[4] Arno Villringer, Ulrich Laufs. Heart failure, cognition, and brain damage[J]. Eur Heart J, 2021, 42(16): 1579-1581.

[5] Fernando D Testai, Philip B Gorelick, Pei—Ying Chuang, et al. Cardiac contributions to brain health: A scientific statement from the American Heart Association[J]. Stroke, 2024, 55(12): e425-e438.

[6] Kewarin Jinawong, Nattayaporn Apaijai, Nipon Chattipakorn, et al. Cognitive impairment in myocardial infarction and heart failure[J]. Acta Physiol (Oxf), 2021, 232(1): e13642.

[7] Stefan D Anker, Stephan von Haehling. Inflammatory mediators in chronic heart failure: an overview[J]. Heart, 2004, 90(4): 464-470.

[8] Chimagomedova A S, Dzhioeva Z R, Akhilgova Z M, et al. [Cognitive impairment in heart failure: the role of microcirculation abnormalities][J]. Zh Nevrol Psikhiatr Im S S Korsakova, 2020, 120(10. Vyp. 2): 54-60.

[9] Jan Cameron, Robyn Gallagher, Susan J Pressler. Detecting and managing cognitive impairment to improve engagement in heart failure self—care[J]. Curr Heart Fail Rep, 2017, 14(1): 13-22.

[10] Zhou Zhao—feng, Wang Da—jie, Li Xu—mei, et al. Effects of enhanced external counterpulsation on exercise capacity and quality of life in patients with chronic heart failure: A meta—analysis[J]. Medicine (Baltimore), 2021, 100(27): e26536.

[11] 阿尔孜姑·亚库甫, 邢娟, 艾克拜尔·安尼瓦尔. 增强型体外反搏治疗慢性心力衰竭效果的系统评价与Meta分析[J]. 中国胸心血管外科临床杂志, 2024, 31(10): 1531-1537.

[12] 刘苗苗, 樊俊雅, 刘贞, 等. 增强型体外反搏在冠心病合并心功能不全患者心脏康复训练治疗中的应用价值研究[J]. 中国全科医学, 2020, 23(18): 2270-2274.

[13] Francesco Moroni, Enrico Ammirati, Atticus H Hainsworth, et al. Association of white matter hyperintensities and cardiovascular disease: The importance of microcirculatory disease[J]. Circ Cardiovasc Imaging, 2020, 13(8): e10460.

[14] 梁晨阳, 王振常, 鲜军舫, 等. 短暂性脑缺血发作时间与预后的CT灌注成像实验研究[J]. 中国现代医学杂志, 2009, 19(16): 2469-2472.

[15] Elizabeth Hillier, Jason Covone, Kady Fischer, et al. Microvascular dysfunction as a possible link between heart failure and cognitive dysfunction[J]. Circ Heart Fail, 2023, 16(11): e10117.

[16] Abdulbaset Maroofi, Tatiana Moro, Jacopo Agrimi, et al. Cognitive decline in heart failure: Biomolecular mechanisms and benefits of exercise[J]. Biochim Biophys Acta Mol Basis Dis, 2022, 1868(11): 166511.

[17] Mary A Woo, Jennifer A Ogren, Christiane M Abouzeid, et al. Regional hippocampal damage in heart failure[J]. Eur J Heart Fail, 2015, 17(5): 494-500.

[18] Karsten Mueller, Friederike Thiel, Frank Beutner, et al. Brain damage with heart failure: Cardiac biomarker alterations and gray matter decline[J]. Circ Res, 2020, 126(6): 750-764.

[19] Tina Stegmann, Mai L Chu, Veronica A Witte, et al. Heart failure is independently associated with white matter lesions: insights from the population—based LIFE—Adult Study[J]. ESC Heart Fail, 2021, 8(1): 697-704.

[20] Rajesh Kumar, Mary A Woo, Paul M Macey, et al. Brain axonal and myelin evaluation in heart failure[J]. J Neurol Sci, 2011, 307(1—2): 106-113.

[21] Jiang Yang—yang, Wang Lei, Lu Zi—wen, et al. Brain imaging changes and related risk factors of cognitive impairment in patients with heart failure[J]. Front Cardiovasc Med, 2021, 8: 838680.

[22] Anoshia Raza, Kate Steinberg, Joseph Tartaglia, et al. Enhanced external counterpulsation therapy: Past, present, and future[J]. Cardiol Rev, 2017, 25(2): 59-67.

[23] Gaia Cattadori, Chiara Segurini, Anna Picozzi, et al. Exercise and heart failure: an update[J]. ESC Heart Fail, 2018, 5(2): 222-232.

[24] Rohit R Arora, Ankur G Shah. The role of enhanced external counterpulsation in the treatment of angina and heart failure[J]. Can J Cardiol, 2007, 23(10): 779-781.

[25] Güliz Kozdağ, Pervin Işeri, Gökçen Gökçe, et al. Treatment with enhanced external counterpulsation improves cognitive functions in chronic heart failure patients[J]. Turk Kardiyol Dern Ars, 2013, 41(5): 418-428.

[26] Ozlem Soran. A new treatment modality in heart failure enhanced external counterpulsation (EECP)[J]. Cardiol Rev, 2004, 12(1): 15-20.

[27] Rebecca A Gary, Kathryn Brunn. Aerobic exercise as an adjunct therapy for improving cognitive function in heart failure[J]. Cardiol Res Pract, 2014, 2014: 157508.

[28] 黄祥津. 增强型体外反搏对非痴呆性血管性认知障碍患者的疗效及相关机制探讨[D]. 广州: 南方医科大学, 2021.

[29] 张立志. 增强型体外反搏对非痴呆性血管性认知障碍患者血压变异性和血管内皮功能的影响[D]. 广州: 南方医科大学, 2021.

[30] 周国强, 黄宗青, 张志, 等. 增强型体外反搏对缺血性脑卒中患者超敏C反应蛋白和内皮素1的影响[J]. 中国神经精神疾病杂志, 2016, 42(3): 129-133.

[31] Randy W Braith, C Richard Conti, Wilmer W Nichols, et al. Enhanced external counterpulsation improves peripheral artery flow—mediated dilation in patients with chronic angina: a randomized sham—controlled study[J]. Circulation, 2010, 122(16): 1612-1620.

[32] 孙增建. 中药复方联合体外反搏治疗不稳定型心绞痛临床观察及对血清TNF—α、MCP—1的影响[D]. 沈阳: 辽宁中医药大学, 2017.

[33] 刘贞. 增强型体外反搏对不稳定型心绞痛患者血管舒张功能及血浆LP—PLA2水平的影响[D]. 郑州: 郑州大学, 2019.