心肺运动试验制定运动强度对慢性心力衰竭患者心脏运动康复治疗效果影响的临床研究

Effects of Exercise Intensity Deduced from Cardiopulmonary Exercise Testing on Exercise Rehabilitation Efficacy among Patients with Chronic Heart Failure:A Clinical Study

目的观察心脏运动康复对慢性心力衰竭(CHF)患者心肺功能和生活质量的影响,探讨不同运动强度下心脏运动康复的效果差异。方法选择2014年9月—2016年5月在首都医科大学附属北京康复医院治疗的临床诊断为CHF的患者15例。按照随机原则和患者参与意愿将患者分为3组:对照组(n=5)患者进行除心脏运动康复治疗之外的常规治疗指导;中等负荷组(n=5)和高负荷组(n=5)患者根据心肺运动试验(CPET)客观定量评估,精准制定个体化运动处方进行心脏运动康复治疗,30 min/d,5 d/周,共12周。中等负荷组功率自行车运动强度为80%无氧阈水平,高负荷组功率自行车运动强度为无氧阈以上Δ50%功率强度。记录3组患者一般资料,治疗前后CPET指标、超声心动图指标、6 min步行距离(6MWD)、生活质量(QoL)评分。结果所有患者安全无并发症完成症状限制性极限运动CPET,中等负荷组和高负荷组患者完成12周全程心脏运动康复治疗。组间比较显示,治疗前,3组患者无氧阈、峰值摄氧量、峰值氧脉搏、最大功率、超声心动图指标、6MWD和QoL评分比较,差异均无统计学意义(P>0.05)。治疗后,中等负荷组患者无氧阈(ml/min、ml·min^(-1)·kg^(-1))、最大功率(%pred)、6MWD较对照组升高,QoL评分较对照组降低(P<0.05);高负荷组患者无氧阈(ml/min、ml·min^(-1)·kg^(-1))、峰值摄氧量(ml/min、ml·min^(-1)·kg^(-1)、%pred)、峰值氧脉搏(ml/次)、最大功率(W、%pred)、6MWD较对照组升高,QoL评分较对照组降低(P<0.05);高负荷组患者无氧阈(ml/min)、峰值摄氧量(ml/min、ml·min^(-1)·kg^(-1))、峰值氧脉搏(ml/次)较中等负荷组升高(P<0.05)。治疗前后比较显示,对照组患者治疗后CPET指标、超声心动图指标、6MWD、QoL评分与治疗前比较,差异均无统计学意义(P>0.05);中等负荷组患者治疗后无氧阈(ml/min、ml·min^(-1)·kg^(-1)、%pred)、最大功率(W、%pred)、左心室射血分数(LVEF)、6MWD较治疗前升高,QoL评分较治疗前降低(P<0.05);高负荷组患者无氧阈(ml/min、ml·min^(-1)·kg^(-1)、%pred)、峰值摄氧量(ml/min、ml·min^(-1)·kg^(-1)、%pred)、峰值氧脉搏(ml/次、%pred)、最大功率(W、%pred)、LVEF、6MWD较治疗前升高,QoL评分较治疗前降低(P<0.05)。结论心脏运动康复能显著改善CHF患者心肺功能、运动耐力和生活质量,高负荷运动强度心脏运动康复治疗能更有效改善患者心肺功能,且安全性较好。

Objective To investigate the effects of exercise rehabilitation（ ER） on cardiopulmonary function and quality of life（ QoL） among patients with chronic heart failure（ CHF）,and to explore exercise rehabilitation efficacy under different exercise intensity. Methods 15 patients who were diagnosed with CHF in Beijing Rehabilitation Hospital of Capital Medical University from September 2014 to May 2016,were recruited and randomly divided into three groups： patients in control group（ n = 5） were treated with conventional therapy without exercise,the overall function of patients in moderate exercise load group（ ML group,n = 5） and high exercise load group（ HL group,n = 5） were evaluated objectively and quantitatively by using cardiopulmonary exercise testing（ CPET）, and patients in these two groups underwent ER according to individualized moderate intensity exercise prescription（ 30 min / day,5 days / week,lasted for 12 weeks）, patients in ML group exercised using 80% anaerobic threshold（ AT） intensity of cycle ergometer,patients in HL group exercised using exercise intensity of Δ50% power above AT. General information,CPET results,echocardiogram results,6 minute walking distance（ 6MWD） and QoL score of three groups were recorded respectively before and after treatment. Results All patients finished symptom limited extreme exercise CPET safely without complications,patients in ML and HL group finished 12-weeks ER. Before treatment,there were no significant difference in AT,peak oxygen uptake,peak oxygen pulse,peak load power,echocardiogram results,6MWD and QoL score among three groups（ P〉0. 05）. After treatment,AT（ ml / min,ml·min^-1·kg^-1,peak load power（ % pred） and 6MWD of patients in ML group were significantly higher than those of patients in control group,QoL score of patients in ML group was significantly lower than that of patients in control group（ P〈0. 05）. AT（ ml / min,ml · min^-1·kg^-1,peak oxygen uptake（ ml/min,ml·min^-1·kg^-1% pred）,peak oxygen pulse（ ml/time）,peak load power（ W,% pred） and 6MWD of patients in HL group were significantly higher than those of patients in control group,QoL score of patients in HL group was significantly lower than that of patients in control group（ P〈0. 05）. AT（ ml / min,ml · min^-1·kg^-1,peak oxygen uptake（ ml/min,ml·min^-1·kg^-1% pred） and peak oxygen pulse（ ml/time） of patients in HL group were significantly higher than those of patients in ML group（ P〈0. 05）. There were no significant difference in CPET indexes,echocardiogram results,6MWD and QoL score in control group between before and after treatment（ P〉0. 05）. AT（ ml / min,ml·min^-1·kg^-1% pred）,peak load power（ W,% pred）,left ventricular ejection fraction（ LVEF）,6MWD and QoL score of patients in ML group after treatment were significantly higher than those before treatment,QoL score of patients in ML group after treatment was significantly lower that before treatment（ P〈0. 05）. AT（ ml / min,ml · min^-1·kg^-1% pred）,peak oxygen uptake（ ml / min, ml · min^-1·kg^-1%pred）,peak oxygen pulse（ ml/time,% pred）,peak load power（ W,%pred）,LVEF and 6MWD of patients in HL group after treatment were significantly higher than those before treatment,QoL score of patients in HL group after treatment was significantly lower than that before treatment（ P〈0. 05）. Conclusion ER can improve the cardiopulmonary function,exercise tolerance and QoL of CHF patients significantly,high- load ER is more effective in improving cardiopulmonary function safely