目标心率指导肺康复对COPD肺功能和短期预后的影响

The influence of pulmonary function and short-term prognosis by pulmonary rehabilitation under target heart rate in chronic obstructive pulmonary disease patients

目的 研究计算目标心率指导COPD患者作下肢亚极量运动康复后在肺功能和短期预后方面的影响.方法 2013年1月至2014年2月在上海市浦东新区人民医院住院治疗好转的COPD患者40例,随机分为肺康复组20例和对照组20例.肺康复组在医院完成为期12周,每周3次,每次30 min的下肢亚极量运动康复锻炼.通过心肺运动试验测得最大运动心率,计算相当亚极量运动强度时的目标心率=70％×（最大运动心率-安静心率）＋安静心率,要求踏车运动时逐渐提高运动强度以达到目标心率并持续运动.对康复前后的肺功能比较,并随访出院后1年内的急性加重次数和首次急性加重间隔时间.结果 康复组和对照组康复前后的FVC％ pred、FEV1％ pred和FEV1/FVC差异无统计学意义（P＞0.05）,康复组的深吸气量占预计值百分比（IC％pred）在康复前后由（49.4±5.9）％提高到（60.0±8.9）％,有显著提高（P＜0.01）,对照组差异无统计学意义.康复组在出院后1年内的急性加重次数[（1.1±1.0）次]较对照组[（2.1±1.4）次]减少（P＜0.05）.康复组在出院后的首次急性加重间隔时间[（34.0±14.2）周]较对照组[（24.5±14.6）周]有显著性延长（P＜0.01）.结论 目标心率指导下肢亚极量运动康复能提高患者的IC,增加运动过程中的肺通气量,减少急性加重次数,延迟再次加重发作的时间,可行有效.

Objective To investigate the effects of target heart rate by caculated directing lower extremity sub-maximal exercise rehabilitation with COPD patients.Methods Forty cases of outpatients in People＇s Hospital of Shanghai Pudong District from Junuary 2013 to February 2014 were assigned randomly to pulmonary rehabilitation group and control group with 20 each.The pulmonary rehabilitation group accomplished lower extremity sub-maximal exercise rehabilitation about 30 minites for 3 times each week in 12 weeks.Measuring maximum exercise heart rate.Each case did not stop cycling until the exercise intensity increased to sub-maximal exercise target heart rate by formula：（maximum heart ratequiet heart rate） × 70%.Compared pulmonary function before and after rehabilitation.The frequency of acute exacerbation and the first time of acute exacerbation were followed up for 1 years after discharge.Results There was no significant difference of FVC% pred,FEV1% pred and FEV1/FVC between two groups The values of IC% predafter exercises （60.0 ± 8.9） % were significantly higher than before （49.4 ± 5.9） % in the pulmonary rehabilitation group （P 〈0.01） while there was no significant difference in contrast group.The frequency of acute exacerbation in the pulmonary rehabilitation group [（1.1 ± 1.0） times] was significantly lower than contrast group [（2.1±1.4） times] （P 〈0.05）.The first time of acute exacerbation in the pulmonary rehabilitation group （34.0±14.2） weeks was significantly longer than contrast group （24.5t14.6） weeks （P 〈0.01）.Conclusions Lower extremity submaximal exercise rehabilitation under target heart rate guidance could increase patient＇s IC,improve lung ventilation during exercise,reduce the frequency of acute exacerbation,delay to aggravate the attack again feasiblely and effectively.