中重度慢性阻塞性肺疾病患者肺康复运动强度的评估

Evaluation of exercise intensity for pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

目的探索反映中重度慢性阻塞性肺疾病(COPD)患者运动强度的较好指标和方法,用于制订和监测个体化运动强度。方法分析30例中重度男性 COPD 患者心肺运动试验中获得的运动强度指标,比较在不同最大摄氧量百分比(VO_(2max)%)运动强度下各指标的分布,采用多元回归方法分析心率和 Borg 指数与 VO_(2max)%的相关关系。结果在取值上,心率储备百分比(HRR%)的实际值接近于 VO_(2max)%,而 HRR%的预计值与 VO_(2max)%相差较远。在不同 VO_(2max)%运动强度下,HRR%实际值比预计值的分布变异更大。Borg 指数越大越能准确反映 COPD 患者的 VO_(2max)%运动强度,Borg指数分别为3分(轻度气促)、4分(中度气促)和5分(比较重的气促)的运动强度分别达到60%、72%和78%VO_(2max)。心率和 Borg 指数与 VO_(2max)%的相关系数分别为0.807和0.834,在已知心率和Borg 指数时,采用 VO_(2max)%运动强度的预计方程式可预计患者实际达到的运动强度。结论 HRR%实际值能更好地反映 VO_(2max)%运动强度,建议采用心肺运动试验中获得的实际最大心率制订中重度男性 COPD 患者的运动强度。Borg 指数是简单适用的运动强度制订和监测指标,建议中重度男性COPD 患者在肺康复运动训练中应达到 Borg 指数4分。VO_(2max)%运动强度的预计方程式可用于运动强度的监测。

Objective To investigate proper methods and parameters of exercise intensity in pulmonary rehabilitation for patients with chronic obstructive pulmonary disease （COPD）. Methods Symptom-limited cardiopulmonary exercise test （CPET） was performed in 30 male patients with moderate to severe COPD by cycle ergometer. Exercise intensity parameters, including the measured heart rate reserve （HRR%max）, the predictive heart rate reserve （HRR%prod） and the Borg scale were obtained. The distribution of these parameters ranged from 10% to 90% VO2max were compared. Multiple regression analysis was applied to analyze the relationship among heart rate（ HR）, the Borg scale and VO2max %. Results The HRR%meas was close to VO2max%. The coefficient of variation （CV） of HRR%meas was larger than HRR%pred. The larger was the Borg scale, the smaller was the distribution of VO2max%. While the Borg scale were 3, 4, and 5, the exercise intensity achieved 60%, 72%, and 78% VO2max, respectively. Predicted equation （VO2max% = 1.026 × HR ＋27.688 × Borg -0. 179 × HR × Borg -63. 313, r =0. 920, P = 0.00） was obtained. Conclusion HRR%meas Was a better parameter than HRR% pred for prescribing the exercise intensity. The Borg scale is a simple and applicable method to prescribe and monitor the exercise intensity. It is suggested that Borg scale should reach 4 （ moderate dyspnea ） in pulmonary rehabilitation for the male patients with moderate to severe COPD. Predicted equation for VO2max% is recommended for monitoring the exercise intensity.