运动康复对维持性血液透析患者透析后疲劳感和左心室结构功能的影响

Effect of exercise-based rehabilitation on postdialysis fatigue and left ventricular structure-function in maintenance hemodialysis patients

目的探讨透析期间运动康复干预对维持性血液透析(Maintenance hemodialysis,MHD)患者透析后疲劳感(Postdialysis fatigue,PDF)及左心室结构功能和炎症指标的影响。方法根据Chalder疲劳量表评分(Chalder fatigue questionnaire,CFQ)选择MHD伴有PDF患者76例,在常规管理模式基础上进行为期6个月的透析期间运动康复锻炼干预,并测定干预前、干预后6min步行试验(6MWT),记录6min步行距离(6MWDs);采用超声测定左心室结构和功能。比较运动康复干预前后患者临床指标和PDF情况。结果MHD伴PDF患者运动康复前和运动康复干预后CFQ分别为(19.71±6.04)分、(15.09±5.76)分,差异有统计学意义(t=4.826,P=0.000)。运动康复前尿素清除指数(Kt/V)、透析前收缩压(SBP)、舒张压(DBP)、白蛋白(AIB)、总胆固醇(TC)、血钙、血钠、血钾及甲状旁腺激素(PTH)和运动康复后比较,差异无统计学意义(P>0.05);运动康复后患者透析后的SBP、DBP、Hb较干预前均升高,而血磷、C反应蛋白(CRP)、甘油三酯(TG)、脑钠肽(BNP)均下降(P<0.05);运动康复后左心室舒张末期内径(LVEDd)和左心室收缩末期内径(LVEDs)降低,左室射血分数(LVEF)及6MWDs升高(P<0.05)。结论透析期间运动康复可以改善MHD患者PDF状况和炎症状态,同时能够改善患者贫血、左心室结构和功能,值得临床推广。

Objective To investigate the effect of exercise-based rehabilitation on postdialysis fatigue(PDF)and left ventricular structure and function,inflammation factors in maintenance hemodialysis(MHD)patients.Methods 76 MHD patients with PDF were selected according to the Chalder fatigue questionnaire(CFQ).On the basis of conventional management mode,exercise-based rehabilitation was carried out in the interval of dialysis for 6 months.The 6-minute walk test(6 MWT)before and after the intervention was measured,and the 6-minute walk distances(6 MWDs)were recorded.Left ventricular structure and function were assessed by echocardiography.The clinical indexs and the occurrence of PDF were compared before and after the exercise-based intervention.Results The CFQ of MHD patients with PDF before and after the exercise-based rehabilitation were(19.71±6.04)and(15.09±5.76)respectively,and the difference was statistically significant(t=4.826,P=0.000).There was no significant difference in Kt/V,pre-dialysis systolic blood pressure(SBP),diastolic blood pressure(DBP),albumin,total cholesterol,calcium,sodium,potassium and parathyroid hormone before and after the exercise-based rehabilitation(P>0.05).After exercise-based rehabilitation,postdialysis SBP and DBP,hemoglobin level increased,while blood phosphorus,CRP,triglycerides and BNP decreased(P<0.05),left ventricular end diastolic diameter(LVEDd)and left ventricular end systolic diameter(LVEDs)decreased,left ventricular ejection fraction(LVEF)and 6 MWDs increased(P<0.05).Conclusion Exercise-based rehabilitation can improve the PDF and inflammation status of MHD patients,it can improve anemia and left ventricular structure and function,which is worthy of clinical promotion.