脑卒中早期偏瘫患者运动试验的可行性研究

Feasibility study on customized ergometer stress test for early stroke hemiplegic patients

目的:探讨利用踏车运动对脑卒中早期偏瘫患者进行运动试验的安全性和可行性,从而为脑卒中早期偏瘫患者进行运动试验和有氧训练运动强度的控制提供可行性依据。方法:36例脑卒中后早期(52.0±24.3d)偏瘫患者接受改良下肢踏车心电运动试验,其中10例接受手摇车心电运动试验,起始功率为0W,每3min功率增加2.5W。踏车速度维持在50—70转/min。结果:①36例患者中30例患者(83.3%)顺利完成运动试验;27例患者因疲劳不能坚持作为运动试验终止指标,3例患者因血压过高而终止试验;所有测试患者未出现心肌缺血症状及心电图表现。②30例完成试验的患者其试验终止心率平均为:(127.9±17.0)次/min,与年龄预计最大心率相比有明显差异(P<0.01):是年龄预计最大心率的79.8%。而与年龄预计亚极量心率接近,是年龄预计亚极量心率的94.0%;30例患者的平均运动时间为10.6min。③运动时间与下肢功能Fugl-Meyer评分无相关性(P>0.05),与年龄呈负相关(P=0.005)。④患者休息6min时所测血压与试验前安静时相比无明显差异(P>0.05);测试过程中出现心律失常心电图表现的3例患者在休息6min时心电图均恢复正常。⑤10例进行两种不同运动试验方案的患者在踏车运动中终止心率高于单臂手摇车运动中终止心率(P<0.05)。患者在踏车运动中终止心率及运动时间均高于单臂手摇车运动中终止心率(P<0.05)和运动时间(P=0.01)。结论:踏车运动试验可以作为脑卒中早期偏瘫患者获得有氧训练强度指标的检测手段。

Objective： To study the safety and feasibility of customized ergometer exercise test for early stroke hemiplegic patients and provide the basis for controlling the intensity of exercise test and early aerobic training. Method： Thirty-six early stroke patients were evaluated with customized lower-extremity ergometer,and 10 of them were tested with customized upper-extremity ergometer which was started with workload of zero watt and increased by 2.5W every 3min until the end. The exercise rate of lower extremities was kept at 50—70rpm. Result： ①In all 36 patients, 30 patients finished the test, including 27 cases discontinued the test for the reason of volitional generalized and/or leg fatigue and 3 cases terminated the test because of blood pressure higher than the termination criteria. Nobody showed the symptom and ECG signs of myocardial ischemia. ②The mean heart rate of the test finished cases was （127.9±17.0）beats/min, representing 79% of maximal age-predicted heart rate and 94.0% of submaximal age-predicted heart rate. The mean test time was （10.6±3.68）min. ③There was a negative correlation between the exercise time and the age （P=0.005）, and no correlation with the lower extremity Fugl-Meyer scale （P0.05）. ④There was no significant difference between the blood pressure at 6min after the test and that at rest before the test （P0.05）,and those 3 cases who showed arrhythmia during the test, showed normal ECG at 6min after the test. ⑤For those 10 cases who performed both the lower-extremity and upper-extremity ergometer exercise test, the HRmax obtained from lower-extremity ergometer test was higher than that from upper extremity ergometer exercise test （P0.05）,while they could endure longer exercise time in lower extremity ergometer exercise test（P=0.01）. Conclusion： Lower extremity ergometer exercise test can provide precise intensity index for aerobic training early after stroke.