Abstract: Objective　To investigate the effect of four-level incremental exercise on patients with high-risk coronary artery disease undergoing percutaneous coronary intervention (PCI) under extracorporeal membrane oxygenation (ECMO) combined with intra aortic balloon counterpulsation (IABP). Methods　A total of 11 patients with high-risk coronary artery disease treated by PCI under the joint protection of ECMO and IABP in The First Affiliated Hospital of Henan University of CM from January 2018 to December 2020 were treated with four-level incremental exercise, including 9 males and 2 females, aged (66±18) years. They were retrospectively summarized and intervened by early step-by-step exercise, level 1 exercise from the end of surgery to the time of ECMO extraction, level 2 exercise from the time of ECMO extraction to 48 hours after ECMO extraction, level 3 exercise from 48 hours after ECMO extraction to moving out of coronary heart disease care unit (CCU), and level 4 exercise after moving out of CCU. After four-level incremental exercise, the postoperative application of instruments, catheter application, complications, deep venous thrombosis score before surgery and before discharge (after incremental exercise), lower limb muscle strength, score of Self-rating Anxiety Scale, and score of Insomnia Severity Index Scale were summarized and evaluated. Comparison of the measurement data used paired t test. Results　Among the 11 patients, the longest application time of ECMO was 139 hours and the longest application time of IABP was 206 hours. Catheter application: the central venous catheter was used in 11 cases, the urinary catheter was retained in 9 cases, and the noninvasive ventilator was used in 2 cases. Exercise outcomes: 7 patients successfully completed the training, and 4 patients completed it after blood transfusion treatment. The score of deep venous thrombosis before discharge was significantly lower than that before surgery [(10.00±1.26) vs. (11.51±1.37), P=0.012], the score of Self-rating Anxiety Scale before discharge was significantly lower than that before surgery [(48.54±8.67) vs. (67.27±11.58), P<0.001], and the score of Insomnia Severity Index Scale before discharge was significantly lower than that before surgery [(13.18±3.97) vs. (17.18±4.81), P=0.045]. Conclusions　Under the comprehensive evaluation and monitoring, the four-level incremental exercise training method can improve the cardiopulmonary exercise in patients with high-risk coronary artery disease undergoing PCI under the support and protection of ECMO combined with IABP, improve the exercise endurance of lower limbs, reduce the complications, and improve the quality of life. Early exercise training can be carried out under the strict evaluation and monitoring.

Key words: Coronary artery disease, Exercise training, Extracorporeal membrane oxygenation, Intra-aortic balloon counterpulsation

摘要： 目的　探讨四级递增运动对体外膜肺氧合（extracorporeal membrane oxygenation，ECMO）联合主动脉球囊反搏（intra aortic balloon counterpulsation，IABP）支持下高危冠心病患者行经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）的效果。方法　采用四级递增运动训练方法，对2018年1月至2020年12月在河南中医药大学第一附属医院接受治疗的11例ECMO联合IABP共同保护下PCI治疗的高危冠心病患者，男性9例、女性2例，年龄（66±18）岁。回顾总结对其进行早期分步运动训练干预，一级运动术后至ECMO拔出前，二级运动ECMO拔出后至拔出后48 h，三级运动ECMO拔出后48 h至搬出冠心病监护室（CCU），四级运动搬出CCU后。经过四级递增运动训练，总结评价患者术后器械应用情况、导管应用情况、并发症、术前及递增运动训练后出院前的深静脉血栓评分、下肢肌力、焦虑自评量表评分、失眠严重程度指数量表评分等。计量资料的比较采用配对t检验。结果　11例患者，应用ECMO最长时间139 h，IABP最长206 h；导管应用情况：11例应用中心静脉导管，9例留置有尿管，2例应用无创呼吸机。运动结局：7例患者顺利完成运动训练，4例在输血治疗后完成；深静脉血栓评分术前与出院前对比差异有统计学意义［（11.51±1.37）分比（10.00±1.26）分，P=0.012］，在焦虑自评量表结局改善差异有统计学意义［（67.27±11.58）分比（48.54±8.67）分，P<0.001］，失眠严重程度指数量表结局改善差异有统计学意义［（17.18±4.81）分比（13.18±3.97）分，P=0.045］。结论　在全面评估和监护下，四级递增运动训练方法能够对高危冠心病行PCI患者在ECMO联合IABP的器械支持保护下，改善其心肺运动，提升下肢运动耐力，减少并发症，提升生活质量，可以在严密评估和监护下开展早期运动训练。

关键词: 冠心病, 运动训练, 体外膜肺氧合, 主动脉球囊反搏