踏车锻炼对慢性阻塞性肺疾病患者运动耐力和中枢驱动的影响

Effect of treadmill training on exercise tolerance and central drive in patients with chronic obstructive pulmonary disease

目的探讨踏车锻炼对慢性阻塞性肺疾病（COPD）患者运动耐力和中枢驱动的影响。方法选择南方医科大学珠江医院呼吸内科自2009年10月至2010年10月收治的中、重度COPD缓解期COPD患者22例，其中康复组（12例）接受12周中等强度踏车运动训练，对照组（10例）不接受训练。在训练前后分别进行常规肺通气功能、弥散功能和肺容量测定以及运动心肺功能测试及高强度持续恒定功率运动试验，监测运动过程中呼吸流量、容量和膈肌肌电的变化。比较患者试验前后运动耐力和呼吸困难评分的变化。结果康复组患者锻炼后运动时间比锻炼前延长，峰运动功率增加，差异均有统计学意义（P〈0．05）；等时间点呼吸频率（RR）、分钟通气量（VE）、平均吸气流速（VT／Ti）、膈肌电电压的均方根（RMS）、Borg评分较锻炼前下降，差异均有统计学意义（P〈0．05）；COPD患者ABorg分别与△VE、△VT／Ti、△RMS呈正相关关系（P〈0．05）。结论下肢运动训练可显著改善COPD患者的运动耐力．降低COPD患者在相同运动强度下的通气需求和中枢驱动，改变了COPD患者的呼吸应答方式，从而减轻了COPD患者呼吸困难的主观感觉。

Objective To evaluate the effect of treadmill training on exercise tolerance and central drive in patients with chronic obstructive pulmonary disease （COPD）. Methods Twenty-two patients with moderate/severe COPD under paracmasis, admitted to our hospital from October 2009 to October 2010, were chosen in our study; treatment group （n=12） undertook a middle-intensity cycle ergometer exercise training program for 12 weeks; while control group （n=10） did not undertake this training program. Before and after the training program, the patients were performed pulmonary ventilation function, pulmonary diffusion function and pulmonary capacity measurements and constant work rate capacity test; the changes of diaphragmatic electromyogram （EMGdi）, respiratory flow and volume were monitored during the training program. Changes of exercise tolerance and dyspnea scores were measured before and after the exercise tests. Results Both peak work rate and endurance time after training increased significantly as compared with those before training in the treatment group （P〈 0.05）. Significant reductions in respiratory rate （RR） at isotime, minute ventilation （VE）, mean inspiratory volume per second （VT/Ti） and root mean square （RMS） were noted, and the scores of Borg dyspnea scale decreased significantly （P〈0.05）. The ABorg were positively correlated with △VE, AVT/Ti and ARMS, respectively （P〈0.05）. Conclusion The exercise tolerance of COPD patients improvs significantly by lower limb exercise training. During a given level of exercises, the requirement of ventilation and central drive of COPD patients is reduced, meanwhile, the respiratory response patterns are changed, which might directly reduce the feeling of dypspnea in COPD patients.