心室或心房中膈缺損患者心肺功能與身體活動之研究

Abstract

心房或心室中膈缺損是常見的兒童心臟異常，佔所有先天性心臟疾病的50%，大多數的患者僅需要簡單的醫療介入即可恢復正常心臟功能，而成長中的先天性心臟病患者的議題是非常值得注意的。本研究分成兩部分，第一部份針對成年後的心房或心室中膈缺損患者進行身體活動量、肺功能及運動耐力檢測，以瞭解幼兒時期的手術修補對成年後的心房或心室中膈缺損患者之心肺功能及運動能力所造成的影響；研究組別包括心房中膈缺損組 (ASD組，12男，16女，平均年齡22.35 ± 2.56歲)、心室中膈缺損組 (VSD組，19男，12女，平均年齡22.75 ± 3.17歲)及健康對照組 (9男，15女，平均年齡22.08 ± 3.02歲)；結果顯示心房中膈缺損及心室中膈缺損的患者身體活動量有較低的趨勢，在肺功能測試的數據各組間並無顯著差別，最大運動能力測試明顯低於健康對照組的部分包括無氧閾值負荷、無氧閾值心跳及最大有氧能力。本研究第二部分招募心房或心室中膈缺損的患者參與綜合心臟復健計畫 (CCR組，15人來自ASD組，14人來自VSD組)，進行為期六週的運動介入課程，前後測數據比較顯示參與者身體活動量有顯著增加，無氧閾值心跳與運動時所達到的最大心跳有顯著的改善。本研究結果顯示，成年後無臨床症狀之心房或心室中膈缺損患者，其運動能力可執行費力的身體活動，且運動能力可經由運動訓練加以改善，建議培養固定的運動習慣與運動興趣；綜合心臟復健計畫可作為協助患者參與運動的媒介，藉由對運動與健康知識的學習，並在指導下進行觀念正確且安全的運動訓練，可增加參與運動的動力與持續力。Ventricular Septal Defects (VSDs) and Atrial Septal Defects (ASDs) are the most common problems found in pediatric heart-related diseases which generally occur in 50% of all children of congenital heart disease. Physical activity, cardiopulmonary function and exercise capacity in the group of grown-up patients with ASDs or VSDs were evaluated through this study. To study the influence of ASDs or VSDs on cardiopulmonary function and exercise capacity, we have performed cardiopulmonary exercise test (CPET) in 28 patients in the ASD group, 31 patients in the VSD group, along with 24 healthy adults were recruited in the control group. Based on the finding, AT MET, AT heart rate, peak MET demonstrated statistically differences between patients with ASDs / VSDs and healthy participants. The comprehensive cardiac rehabilitation (CCR) program was addressed to a group of 29 patients (CCR group, 15 from ASD group and 14 from VSD group). After 6 weeks, CCR group underwent CPET again. Patients in the CCR group showed significantly higher AT heart rate and peak heart rate compared to the initial evaluation. And no significant differences were found in AT heart and peak heart rate compared to the healthy participants. In the presented study, the group of grown-up patients with ASDs or VSDs showed poorer cardiac function when comparing to the healthy group, while no limitation in exercise was observed and CCR program improves the physical activity and exercise capacity. Our findings support no contraindications for physical exercise in this patient group.