有氧运动疗法对老年卧床患者心率变异性的影响(英文)

Effects of aerobic kinesitherapy on the heart rate variability in elderly bedridden patients

背景:许多研究显示有氧运动疗法可增加迷走神经张力,迷走神经张力决定着稳定的心率,可提高心率变异性,减少心血管事件的发生。目的:观察有氧运动疗法对老年卧床患者迷走神经张力的维持和对心率变异性相关指标的影响。设计:随机对照观察。单位:北京航天中心医院高干病房和解放军烟台疗养院综合内科。对象:选择2002-02/2004-01航天中心医院高干内科和解放军烟台疗养院综合内科卧床老年患者45例。随机分成2组。治疗组23例,均为男性,平均年龄(69.5±8.0)岁;对照组22例,均为男性,平均年龄(71.4±6.5)岁。干预:两组患者均给予改善循环和营养神经药物等治疗,在此基础上,治疗组采用有氧运动疗法:以靶心率为指标,即以通过运动获得的个人最高安全心率70%～85%作为每次运动的靶心率,开始时每次运动10～15min,每运动4～6min测一次心率或脉搏,运动以患者心率增加不超过20次/min、患者感觉不疲乏为度,以后逐渐增加运动时间,直至每次活动持续时间30～40min,2次/d,每周治疗不少于5d。两组分别于治疗前和治疗20周后检查24h动态心电图,观察心率变异性各参数指标的变化。主要观察指标:两组患者治疗前和治疗20周后心率变异性各参数指标(以正常R-R间期标准差评估迷走神经活性大小;以总功率谱评估心率变异性大小;以均值标准差评估交感-迷走神经平衡性;以低频段评估交感神经双重调节作用;以均方根评估短期内心率变化和迷走神经功能变化;以爱丁堡指数评估迷走神经活动作用;以高频评估迷走神经调节作用;以低频/高频评估交感神经活性效应)。结果:参与试验者46例,45例达到试验终点进入结果分析,1例死亡。①治疗组治疗20周后心率变异性指标中正常R-R间期标准差、均值标准差、均方根、爱丁堡指数、高频及总功率谱明显高于治疗前(t=12.5～38.4,P<0.01)。②对照组卧床20周后的心率变异性降低(P<0.01)。结论:有氧运动疗法能增强卧床不起老年患者迷走神经的功能活性和交感-迷走神经平衡性,提高心率变异性,有助于降低心血管事件的发生。

BACKGROUND： Some researches show that aerobic kinesitherapy can strengthen the vagal tone that determines heart rate stability, increase the heart rate variability, and reduce the occurrence of cardiovascular events. OBJECTIVE： To observe the effect of aerobic kinesitherapy on vagal tone maintenance and the relevant indices of heart rate variability in elderly bedridden patients. DESIGN： A randomized controlled observation. SETTING： The Cadre Ward of Beijing Aerospace Central Hospital and Department of Comprehensive Internal Medicine, Yantai Convalescent Hospital of PLA. PARTICIPANTS： Totally 45 bedridden elderly male patients were selected from the patients admitted in the Cadre Ward of Beijing Aerospace Central Hospital and Department of Comprehensive Internal Medicine, Yantai Convalescent Hospital of PLA from February 2002 to January 2004. The patients were randomly divided into in treatment group （n =23, mean age of 69.5±8.0 years） and control group （n =22, mean age of 71.4±6.5）. INTERVENTIONS： The therapeutic methods were similar in the two groups, ie. medications for amelioration of the circulation and neurotrophic treatment. On the basis of these treatments, the patients in the treatment group also had aerobic kinesitherapy through limb and trunk exercises with assistance to improve oxygen consumption of the body and increase the heart rate. In each session of exercise, the patients were supposed to attain the target heart rate of 70% to 85% of the personal highest safe heart rate. At the beginning, each session of exercise lasted for 10-15 minutes and the heart rate or pulse was measured every 4-6 minutes, with the patients＇ heart rate allowed to increase by no more than 20/minute and the patients not feeling tired. The subsequent exercise time gradually increased but not over 30-40 minutes, twice a day for no less than 5 days a week. Before and after the 20-week treatment, 24-hour dynamic electrocardiogram was examined to analyze the changes in the indices of heart rate variability. MAIN OUTCOME MEASURES： Before and after the 20-week treatment, the indices for heart rate variability were analyzed. The standard deviation of successive normal-to-normal R-R interval was determined for assessing the magnitude of vagus nerve activity, total power spectrum for the degree of heart rate variability, standard deviation of the mean value for the balance between the sympathetic nerve and vagus, low frequency for the dual regulation of the sympathetic nerves, root-mean-square derivations for short-term vagal function and heart rate changes, Edinburgh index for the sudden heart rate variation and the vagal activativity, high frequency for vagal regulation, and ratio of low frequency and high frequency for sympathetic nerve activity. RESULTS： This study involved initially 46 patients, 45 of whom completed the study and 1 patient died. After the 20-week treatment in treatment group, standard deviation of successive normal-to-normal R-R interval, standard deviation of the mean value, root mean square, Edinburgh index, high frequency and total power spectrum of heart rate variability were increased compared with those before treatment （t =12.5-38.4, P 〈 0.01）. The indices of heart rate variability was decreased in the control group 20 weeks later （P 〈 0.01）. CONCLUSION： Aerobic kinesitherapy can improve the vagus nerve activity and the sympathetic-vagal balance, raise heart rate variability and reduce the occurrence of cardiovascular events.