Review Article 심장재활 홍경표 추진아 Cardiac Rehabilitation Kyung Pyo Hong, M.D., Jin A Choo, R.N. Cardiovascular Institute, Samsung Medical Center,

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1 Review Article 심장재활 홍경표 추진아 Cardiac Rehabilitation Kyung Pyo Hong, M.D., Jin A Choo, R.N. Cardiovascular Institute, Samsung Medical Center, Sungkyunkwan University, College of Medicine, Seoul, Korea 서론 본론 1. 심장재활팀의구성 2. 운동요법의효과 484

2 Fig. 1. 심근경색증, 관동맥우회로술, 관상동맥조영술로관상동맥질환이확인된환자에서운동요법으로최대산소섭취량 (VO2max) 이의미있게향상하였다 5). 3. 운동요법의적응증및금기증 4. 운동요법의위험도평가 Table 1. 심근경색증환자에서재활요법전후최대부하시변수의변화 p mlkgmin p p Lmin p mlbpm p0.5403, NS p0.002 maximal oxygen uptake, VO2maxcardiac outputarteriovenous oxygen difference metabolic equivalent, MET1MET3.5mlkgmin anaerobic threshold maximal O2 pulsevo2heart rate Table 2. 심근경색증환자에서재활요법전후최대하부하시변수의변화 485 변화 6) p mmhgbpm p L/min p p rate-pressure product, RPPheart ratesystolic blood pressure100 minute ventilation, VE rate of perceived exertion620 scale

3 Fig. 2. 노작성협심증에서운동요법의효과 8). Fig. 3. 심장재활군과대조군을 10 년간추적관찰하였을때심 장돌연사의빈도. Table 3. 관상동맥질환에서운동요법의절대적금기증 mmHg 20mmHg , 50mmHg, 0.75cm 2 400mg%, 5. 운동처방 1) 운동처방의원리 Table 5. 운동중심장사의위험이높은환자 40% 3 4METs, 120 ST 2mm Table 4. 운동요법을시행하기전에진찰및운동부하검사가필요한경우 40, %VO2max60% VO2max60% 486

4 Table 6. 관상동맥질환에서운동요법시위험성판정 7METs 50% ST 2mm Thallium 35% 50%, 35% 35%, 10mmHg 24 5METs, ST 1mm 135 ST 2mm Table 7. 심장재활에서운동요법시유의점 ,,,,,,,. 2) 운동처방의실제 6. 운동요법의단계 1) 1단계 (Phase I) 487

5 Table 8. 운동요법의각단계 Length of stay Setting Phase GXT 514days CCUward inpatient Low intensity 13mons Hospitalclinic outpatient SL maximum 612mons Local community center supervised, medical SL maximum Indefinitely Local community center/home unsupervised, maintenance SL maximum CCU=cardiac care unit, GXT=graded exercise test, SL=symptom limited 2) 2단계 (Phase II) 3) 3단계 (Phase III) 488

6 7. 각심장질환에따른고찰 1) 노인 2) 인공심박동기 / 자동제세동기 3) 협심증 4) 관동맥우회로술 5) 판막치환술 6) 심부전증 Table 9. 심부전증에서운동요법을중단하거나조정하여야할경우 40 P2 10mmHg 10, 10mmHg 10mmHg 6mmHg, 489

7 7) 심장이식 8) 당뇨병 8. 정서사회적인중재 결론 References 1) Jonas MA, Oates JA, Ockene JK, Hennekens CH: Statement on smoking and cardiovascular disease for health care professionals. Circulation 86: ,

8 2) Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT, Ports TA, McLanahan SM, Kirkeeide RL, Brand RJ, Gould KL:Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 336: , ) Fletcher GF, Blair SN, Blumenthal J, Caspersen C, Chaitman B, Epstein S, Falls H, Froelicher ES, Froelicher VF, Pina IL:Statement on exercise:benefits and recommendations for physical activity programs for all Americans:A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association. Circulation 86: , ) Redwood DR, Rosing DR, Epstein SE:Circulatory and symptomatic effects of physical training in patients with coronaryartery disease and angina pectoris. N Engl J Med 286:959-65, ) Hartung GH, Rangel R:Exercise training in post-myocardial infarction patients:comparison of results with high risk coronary and post-bypass patients. Arch Phys Med Rehab 62:147-50, ) 추진아 홍경표 제세영 홍선희 박원하 조병렬등 : 심근경색증환자에있어서심장재활의효과. 순환기 27: , ) Sullivan MJ, Higginbotham MB, Cobb FR:Exercise training in patients with severe left ventricular dysfunction:hemodynamic and metabolic effects. Circulation 78: , ) Franklin BA, Rubenfire M:Exercise training in coronary heart disease:mechanisms of improvement. Pract Cardiol 6:84-89, ) Hamalainen H, Luurila OJ, Kallio V, Knuts LR, Arstila M, Kakkila J:Long-term reduction in sudden deaths after a multifactorial intervention programme in patients with myocardial infarction:10-year results of a controlled investigation. Eur Heart J 10:55-62, ) Froelicher V, Jensen D, Genter F, Sullivan M, McKirnan MD, Witztum K, Scharf J, Strong ML, Ashburn W:A randomized trial of exercise training in patients with coronary heart disease. JAMA 252: , ) Oldridge NB, Guyatt GH, Fischer ME, Rimm AA: Cardiac rehabilitation after myocardial infarction:combined experience of randomized clinical trials. JAMA 260: , ) OConnor GT, Buring JE, Yusuf S, Goldhaber SZ, Olmstead EM, Paffenbarger RS Jr, Hennekens CH:An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation 80: , ) Froelicher V, Jensen D, Sullivan M:A randomized trial of the effects of exercise training after coronary artery bypass surgery. Arch Intern Med 145: , ) Fletcher GF, Froelicher VF, Hartley LH, Haskell WL, Pollock ML:Exercise standards:a statement for health professionals from the American Heart Association. Circulation 82: , ) Coats AJ, Adamopoulos S, Meyer TE, Conway J, Sleight P:Effects of physical training in chronic heart failure. Lancet 335:63-66, ) Jondeau G, Katz SD, Zohman L, Goldberger M, McCarthy M, Bourdarias JP, LeJemtel TH:Active skeletal muscle mass and cardiopulmonary reserve:failure to attain peak aerobic capacity during maximal bicycle exercise in patients with severe congestive heart failure. Circulation 86: , ) Rehabilitation after cardiovascular diseases, with special emphasis on developing countries:report of a WHO committee. World Health Organ Tech Rep Ser 831:1-122, ) Balady GJ, Fletcher BJ, Froelicher ES, Hartley LH, Krauss RM, Oberman A, Pollock ML, Taylor CB: Cardiac rehabilitation programs:a statement for healthcare professionals from the American Heart Association. Circulation 90: ,

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