Review Article 28 3 1998 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
Fig. 1. 심근경색증, 관동맥우회로술, 관상동맥조영술로관상동맥질환이확인된환자에서운동요법으로최대산소섭취량 (VO2max) 이의미있게향상하였다 5). 3. 운동요법의적응증및금기증 4. 운동요법의위험도평가 Table 1. 심근경색증환자에서재활요법전후최대부하시변수의변화 p mlkgmin 29.6 6.1 35.2 8.4 31.8 7.9 31.4 7.7 p0.0062 8.6 1.7 10.0 2.2 9.0 2.3 8.9 2.2 p0.0063 Lmin 1.3 0.5 1.5 0.6 1.3 0.5 1.2 0.4 p0.0274 mlbpm 15.3 3.6 17.0 4.3 14.8 3.4 16.1 3.3 p0.5403, NS 825.098.6 964.6176.1 875.7116.8 860.2133.4 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 160.832.5 132.827.0 145.245.4 136.435.2 p0.0305 L/min 33.910.0 28.4 6.7 31.2 5.0 31.5 4.7 p0.037 12.1 1.2 9.6 1.5 11.9 1.1 12.5 1.6 p0.0007 rate-pressure product, RPPheart ratesystolic blood pressure100 minute ventilation, VE rate of perceived exertion620 scale
Fig. 2. 노작성협심증에서운동요법의효과 8). Fig. 3. 심장재활군과대조군을 10 년간추적관찰하였을때심 장돌연사의빈도. Table 3. 관상동맥질환에서운동요법의절대적금기증 200110mmHg 20mmHg 120 38, 50mmHg, 0.75cm 2 400mg%, 5. 운동처방 1) 운동처방의원리 Table 5. 운동중심장사의위험이높은환자 40% 3 4METs, 120 ST 2mm Table 4. 운동요법을시행하기전에진찰및운동부하검사가필요한경우 40, 50 2 40%VO2max60% VO2max60% 486
Table 6. 관상동맥질환에서운동요법시위험성판정 7METs 50% ST 2mm Thallium 35% 50%, 35% 35%, 10mmHg 24 5METs, ST 1mm 135 ST 2mm Table 7. 심장재활에서운동요법시유의점. 2......,,,,,,,. 2) 운동처방의실제 6. 운동요법의단계 1) 1단계 (Phase I) 487
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
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
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