有氧运动联合认知行为治疗对慢性心力衰竭患者认知功能损伤的改善作用-现代医学

有氧运动联合认知行为治疗对慢性心力衰竭患者认知功能损伤的改善作用

单位：1. 江苏省荣军医院康复科, 江苏无锡 214000;
2. 无锡市精神卫生中心功能科, 江苏无锡 214000

分类号：R541.6

出版年·卷·期（页码）：2019·47·第二期（141-145）

摘要：

目的：探讨有氧运动及其联合认知行为治疗（CBT）对慢性心力衰竭（CHF）患者认知功能损伤的改善作用。方法：使用蒙特利尔认知评估量表（MoCA）对2017年至2018年在江苏省荣军医院住院治疗及无锡市山北街道社区康复的CHF患者进行评估，选取认知功能损伤的CHF患者90例，根据各自需要完善强心、利尿、扩血管等常规临床抗心衰治疗，随机分成有氧运动干预组、有氧运动联合CBT干预组及对照组，每组30例。采用MoCA、汉密顿焦虑量表（HAMA）、汉密顿抑郁量表（HAMD）评价3组患者在有氧运动干预及其联合CBT干预3个月前后得分并进行比较，同时比较3组患者左心室射血分数（LVEF）的变化。结果：干预前，有氧运动干预组和对照组、有氧运动联合CBT干预组和对照组、有氧运动干预组和有氧运动联合CBT干预组分别进行MoCA评分、HAMA评分、HAMD评分及LVEF比较，差异均无统计学意义（P>0.05）；干预后有氧运动干预组及有氧运动联合CBT干预组MoCA评分、HAMA评分、HAMD评分及LVEF均优于对照组，存在统计学差异（P<0.05），有氧运动联合CBT干预组MoCA评分、HAMA评分、HAMD评分均优于有氧运动干预组，有统计学差异（P<0.05）。结论：有氧运动对CHF患者认知功能损伤具有明显的改善作用，在其基础上联合CBT能够进一步促进认知功能的恢复，全面提高患者生活质量。

Objective:To investigate the effect of aerobic exercise and its combined cognitive behavior therapy on cognitive impairment in patients with chronic heart failure.Methods:The Montreal Serious Assessment Scale (MoCA) was used to evaluate CHF patients hospitalized in Rongjun Hospital of Jiangsu Province and community rehabilitation in Shanbei Street of Wuxi City from 2017 to 2018. 90 patients with cognitive impairment were selected and 90 patients were treated with conventional clinical anti heart failure according to their need to improve their heart, diuresis and vasodilator, and randomly divided into the aerobic exercise intervention group. Aerobic exercise combined with CBT intervention group and control group, 30 cases in each group. MoCA, Hamilton Anxiety Scale(HAMA) and Hamilton Depression Scale(HAMD) were used to evaluate and compare the scores of the threegroups before and after 3 months of aerobic exercise intervention and the combined CBT intervention, and the changes of left ventricular ejection fraction(LVEF) in the 3 groups were compared.Results:Before intervention, MoCA score, HAMA score, HAMD score and LVEF were compared between the aerobic exercise intervention group and the control group, the aerobic exercise combined with CBT intervention group and the control group, the aerobic exercise intervention group and the aerobic exercise combined CBT intervention group. There was no statistical difference (P>0.05). After intervention, MoCA score, HAMA score, HAMD score and LVEF score in the aerobic exercise intervention group and the aerobic exercise combined with CBT intervention group were better than those in the control group (P<0.05). The MoCA score and HAMA score in the aerobic exercise combined with CBT intervention group were significantly higher than those in the control group (P<0.05). HAMD score was better than that in the aerobic exercise intervention group (P<0.05). Conclusion:Aerobic exercise can significantly improve the cognitive impairment of CHF patients.When combined with CBT, it can further promote the recovery of cognitive function and improve the quality of life of the patients.

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