个体化适度运动改善肺动脉高压患者心肺功能的效果

Effect of Individualized Moderate-intensity Exercise Prescription on Cardiopulmonary Function for Patients with Pulmonary Arterial Hypertension

目的分析病情稳定的肺动脉高压(PAH)患者心肺功能状况,探讨运用心肺运动试验(CEPT)精准制定个体化适度运动处方对PAH患者心肺功能储备及运动耐量的影响。方法 2018年4月至2019年7月,纳入病情稳定的PAH患者(PAH组,n=31)和体检正常的健康人(正常组n=32),入组前均进行CPET。PAH组行6分钟步行试验(6MWT)后,随机分为运动康复组(n=16)和对照组(n=15),运动康复组在规范靶向药物治疗的基础上进行个体化适度运动训练,每周5 d,共8周。对照组仅进行常规靶向药物治疗。治疗后两组再次行CPET和6MWT。结果治疗前,与正常组相比,PAH组体质量、体质量指数(BMI)、用力肺活量(FVC)、第一秒用力呼气容积(FEV1)、最大通气量(MVV)、无氧阈(AT)、峰值心率(HRpeak)、峰值收缩压(SBPpeak)、峰值负荷功率(WRpeak)、峰值摄氧量(VO_2peak)、峰值氧脉搏(VO_2/HRpeak)、峰值心排量(COpeak)、峰值分钟通气量(VEpeak)、峰值潮气末二氧化碳分压(PETCO_2peak)、峰值脉氧饱和度(Sp O_2peak)、摄氧通气效率峰值平台(OUEP)均降低(t> 2.419, P <0.05);静息心率(HRrest)、峰值生理无效腔与潮气量比值(VD/VTpeak)、二氧化碳排出通气效率最低值(Lowest VE/VCO_2)、二氧化碳排出通气斜率(VE/VCO_2slope)均升高(|t|> 2.615,P <0.05)。治疗后,对照组FEV1、MVV、峰值千克摄氧量[VO_2peak (ml/min/kg)]、VO_2/HRpeak降低(t>2.272, P <0.05);运动康复组FVC、 FEV1、MVV、AT、SBPpeak、WRpeak、VO_2peak、 VO_2/HRpeak、COpeak、VEpeak、PETCO_2peak、Sp O_2peak和6分钟步行距离(6MWD)升高(|t|> 2.167, P <0.05),Lowest VE/VCO_2、 VE/VCO_2slope降低(t> 2.264, P <0.05)。与对照组相比,运动康复组FEV1/FVC、 AT、WRpeak、VO_2peak、VO_2/HRpeak、COpeak、6MWD升高(|t|> 2.168, P <0.05)。结论病情稳定的PAH患者整体心肺功能较正常人仍有降低。CPET精准指导的个体化适度运动处方可以有效改善PAH患者的心肺功能储备,提高PAH患者的运动耐量。

Objective To analyze the cardiopulmonary function of stable patients with pulmonary arterial hypertension(PAH),and to explore effects of the cardiopulmonary exercise testing(CPET)-based individualized moderate-intensity exercise prescription on cardiopulmonary functional reserve and exercise capacity in patients with PAH.Methods From April,2018 to July,2019,31 stable patients with PAH(PAH group)and 32 healthy counterparts(normal group)were enrolled.All subjects underwent CPET.PAH group was assessed with 6-Minute Walking Test(6MWT),and then was divided into exercise group(n=16)and control group(n=15).Both groups were treated with ordinary targeted drugs,while the exercise group was additionally provided with an individualized moderate-intensity exercise prescription of△50%power treadmill training,five days a week for eight weeks.CPET and 6MWT were conducted again after intervention.Results Before intervention,body mass,body mass index(BMI),force vital capacity(FVC),forced expiratory volume in one second(FEV1),maximum voluntary ventilation(MVV),anaerobic threshold(AT),peak heart rate(HRpeak),peak systolic blood pressure(SBPpeak),peak load power(WRpeak),peak oxygen uptake(VO2peak),peak oxygen pulse(VO2/HRpeak),peak cardiac output(COpeak),peak minute ventilation(VEpeak),peak end-tidal carbon dioxide(PETCO2peak),peak pulse oxygen saturation(SpO2peak)and oxygen uptake efficiency plateau(OUEP)were significantly lower(t>2.419,P<0.05),and the rest heart rate(HRrest),peak dead space to tidal volume ratio(VD/VTpeak),minimum ventilatory equivalent for carbon dioxide(Lowest VE/VCO2)and slope of ventilatory equivalent for carbon dioxide(VE/VCO2 slope)were higher(|t|>2.615,P<0.05)in PAH group than in the normal group.After intervention,FEV1,MVV,VO2peak(ml/min/kg)and VO2/HRpeak decreased in the control group(t>2.272,P<0.05);FVC,FEV1,MVV,AT,SBPpeak,WRpeak,VO2peak,VO2/HRpeak,COpeak,VEpeak,PETCO2peak,SpO2peak and 6-Minute Walking Distance(6MWD)increased(|t|>2.167,P<0.05),while the average Lowest VE/VCO2 and VE/VCO2 slope decreased(t>2.264,P<0.05)in the exercise group.Compared with the control group,the FEV1/FVC,AT,WRpeak,VO2peak,VO2/HRpeak,COpeak and 6MWD increased in the exercise group(|t|>2.168,P<0.05).Conclusion The holistic cardiopulmonary function of stable patients with PAH decreases.CPET-based individualized moderate-intensity exercise could enhance the cardiopulmonary functional reserve and exercise capacity of patients with PAH.