中低危冠心病患者有氧康复运动靶心率不同评价方法的临床价值比较研究

Different Evaluation Methods for Target Heart Rate for Aerobic Exercise-based Rehabilitation in Patients with Lowto-intermediate Risk of Coronary Heart Disease

背景有氧康复运动作为冠心病患者运动康复基础,需要在干预过程中准确客观地设定安全运动强度,但因疾病复杂性和患者耐受运动强度不确定性,不同评价靶心率的方法难以对有氧运动强度进行准确评价。目的比较中低危冠心病患者有氧康复运动靶心率不同评价方法的临床价值。方法回顾性分析2018年1月—2019年3月于郴州市第一人民医院就诊的52例中低危冠心病患者的临床资料,患者均行心肺运动试验。采用无氧阈法、峰值摄氧量法、心率储备法、年龄预计法、安静心率+20法计算靶心率,分析峰值摄氧量法和心率储备法与无氧阈法评价一致性。结果峰值摄氧量法、心率储备法、安静心率+20法分别与无氧阈法计算的靶心率比较,差异均无统计学意义(P>0.05);年龄预计法与无氧阈法计算的靶心率比较,差异有统计学意义(P<0.05)。峰值摄氧量法、心率储备法与无氧阈法计算的靶心率均呈正相关(r=0.89、0.83,P<0.05);年龄预计法、安静心率+20法与无氧阈法计算的靶心率无直线相关关系(r=-0.15,P=0.57;r=0.41,P=0.19)。Bland-Altman法一致性分析显示,峰值摄氧量法、心率储备法无氧阈法与计算的靶心率平均差值分别为1.07、0.99,均与0线接近,且95%一致性界限内最大差值点均在±5%内,提示峰值摄氧量法和心率储备法与无氧阈法具有较高评价一致性(P<0.05)。结论中低危冠心病患者有氧康复运动靶心率采用峰值摄氧量法和心率储备法评价结果与无氧阈法接近,具有临床推广使用价值。

Backgroud For safety's sake,exercise intensity should be set accurately and objectively for coronary heart disease(CHD)patients receiving aerobic exercise-based rehabilitation,a basis for cardiac rehabilitation.However,due to the complexity of the disease and variability in patients'tolerance to exercise intensity,it is difficult to accurately evaluate aerobic exercise intensity by different methods for determining the target heart rate.Objective To perform a comparative analysis of different methods for determining the target heart rate for aerobic exercise-based rehabilitation in patients with low-tointermediate risk of CHD.Methods A retrospective analysis was conducted.52 patients with low-to-intermediate risk of CHD were chosen from Chenzhou First People's Hospital from January 2018 to March 2019.All of them performed cardiopulmonary exercise tests,and target heart rates for which determined based on anaerobic threshold,peak oxygen uptake,heart rate reserve,age,and resting heart rate plus 20 method were compared.The agreement between peak oxygen uptake and heart rate reserve and anaerobic threshold was analyzed,respectively.Results The target heart rate determined by anaerobic threshold showed a substantial difference from that determined by age(P<0.05),but did not differ significantly from that determined by peak oxygen uptake,heart rate reserve,or resting heart rate plus 20 method(P>0.05).The target heart rate determined by anaerobic threshold was positively correlated with that determined by peak oxygen uptake or heart rate reserve(r=0.89,0.83,P<0.05),but showed no linear correlation with that determined by age or resting heart rate plus 20 method(r=-0.15,P=0.57;r=0.41,P=0.19).Bland-Altman plot for agreement analysis revealed that the average difference of target heart rate measured between anaerobic threshold and peak oxygen uptake,and between anaerobic threshold and heart rate reserve were 1.07,and 0.99,respectively,which were close to zero,with the maximum difference of 95%limits of agreement ranging from-5%to 5%,indicating that there was relatively good agreement between anaerobic threshold and peak oxygen uptake,and between anaerobic threshold and heart rate reserve(P<0.05).Conclusion Both heart rate reserve and peak oxygen uptake showed good agreement with anaerobic threshold in determining the target heart rate for aerobic exercise-based rehabilitation in patients with low-tointermediate risk of CHD,which possess clinical application value.