长期慢病患者单次精准功率运动前后脉搏波波形特征个体化分析研究

Individualized analysis of pulse wave shape before and after a single accurate power exercise in patients with long-term chronic diseases

目的:观察研究长期慢病患者的静息桡动脉脉搏波及单次个体化运动后脉搏波的变化情况。方法:选取被明确诊断为高血压和(或)糖尿病和(或)高脂血症的长期(病程≥5年)慢病患者16例,完成症状限制性极限心肺运动试验(CPET),计算Δ50%功率为个体化精准运动强度,完成持续30 min的单次个体化运动。于运动前和运动后10 min、20 min、30 min分别测量50 s桡动脉脉搏波,得到每个脉搏波特征点:起始点(B)、主波波峰点(P1)、重搏波波谷点(PL)、重搏波波峰点(P2)、结束点(E),从仪器中导出各点对应的横坐标(时间T)和纵坐标(幅值Y)的原始数据,将上一个脉搏波的结束点E视为下一个波的起始点B,TB归零,得到主要观察指标:YB、YP1、YPL、YP2及TP1、TPL、TP2、TE,并计算出ΔYP1、ΔYPL、ΔYP2,TE-TPL、(TE-TPL)/TPL、脉率,S1、S2,ΔYP2-ΔYPL、TP2-TPL作为次要观察指标;计算波峰明显的重搏波出现率;对每位患者运动前后的50 s脉搏波数据个体化分析,再将所有数据求均值进行整体分析。结果:(1)16例长期慢病患者(男14女2),年龄(53.7±12.6,28~80)岁,身高(171.7±6.6,155~183)cm,体质量(80.0±13.5,54~98)kg。(2)静息时YB(91.5±10.8,71.1~108.6)、YP1(203.6±24.7,162.7~236.3)、YPL(127.1±6.2,118.2~140.3)、YP2(125.9±6.2,115.7~137.7)、TP1(137.2±22.3,103.0~197.1)、TPL(368.7±29.5,316.3~434.0)、TP2(422.7±32.8,376.9~494.7)、TE(883.4±95.0,672.2~1003.3),ΔYP1(112.1±33.8,60.3~157.5)、ΔYPL(35.5±14.2,17.5~66.2)、ΔYP2(34.4±13.3,20.0~62.9)、TE-TPL(514.6±85.4,341.4~621.9)、(TE-TPL)/TPL(1.4±0.2,1.0~1.7)、脉率(68.8±8.4,59.8~89.3)、S1(0.9±0.3,0.4~1.4)、S2(0.0±0.0,-0.1~0.0)、ΔYP2-ΔYPL(-1.2±2.6,-6.5~2.5)、TP2-TPL(54.0±10.8,33.6~81.1)。(3)运动后10 min,YB、YPL、YP2、TPL、TE减小,YP1增大;ΔYPL、TE-TPL、(TE-TPL)/TPL减小,而ΔYP1、脉率、S1、ΔYP2-ΔYPL、TP2-TPL增大(P均<0.05)。运动后20 min和30 min的脉搏波变化趋势与运动后10 min保持一致,但从10 min后大部分指标逐渐向静息水平恢复。(4)静息时16例长期慢病患者波峰明显的重搏波出现率为28.6%,运动后10 min(65.7%)、20 min(77.1%)、30min(73.7%)的出现率明显提高(P均<0.01)。其中6例患者运动后波峰明显的重搏波出现率显著升高,且能持续到30 min;3例患者运动后10 min出现率上升明显,20 min时开始下降;1例患者运动后20 min出现率才开始升高;2例患者运动后10 min出现率升高后随即下降;1例患者运动后20 min出现率短暂升高后下降;1例患者运动后出现率下降,20 min时开始回升;2例患者运动后出现率不升,30 min时稍有升高。结论:长期慢病患者的桡动脉脉搏波波形矮小,重搏波不明显甚至消失,单次精准功率运动后,主波增高,重搏波位置降低、幅度增大;具体反应情况应个体化分析。

Objective:To observe and study the resting radial artery pulse wave and changes after a single individualized exercise in patients with long-term chronic diseases.Methods:We selected 16 patients with chronic disease(disease duration≥5 years)who have been clearly diagnosed as hypertension and/or diabetes and/or hyperlipemia,and first completed the symptomrestricted limit cardiopulmonary exercise testing(CPET).Then a single individualized exercise withΔ50%power as the exercise intensity was completed within one week after CPET.We measured and recorded 50 s pulse wave data before exercise and 10 min,20 min,30 min after exercise,then obtained each pulse wave characteristic point:starting point(B),main wave peak point(P1),trough of a repulse point(PL),crest of a repulse point(P2),and end point(E).The raw data of the abscissa(time T)and ordinate(amplitude Y)corresponding to each point were derived from the instrument.We treated the end point E of the previous pulse wave as the start point B of the next wave,returned TB to zero,and got the main observation indicators:YB,YP1,YPL,YP2 and TP1,TPL,TP2,TE,and calculated outΔYP1,ΔYPL,ΔYP2,TE-TPL,(TE-TPL)/TPL,pulse rate,S1,S2,ΔYP2-ΔYPL and TP2-TPL as secondary observation indicators.Then calculated the occurrence rate of dicrotic wave with obvious crest.Finally we analyzed individually the 50 s pulse wave data of each patient before and after exercise,and then averaged all the data for overall analysis.Results:(1)16 patients with long-term chronic diseases(males 14,females 2),ages(53.7±12.6,28~80)years old,height(171.7±6.6,155~183)cm,body weight(80.0±13.5,54~98)kg.(2)YB(91.5±10.8,71.1~108.6),YP1(203.6±24.7,162.7~236.3),YPL(127.1±6.2,118.2~140.3),YP2(125.9±6.2,115.7~137.7),TP1(137.2±22.3,103.0~197.1),TPL(368.7±29.5,316.3~434.0),TP2(422.7±32.8,376.9~494.7),TE(883.4±95.0,672.2~1003.3),ΔYP1(112.1±33.8,60.3~157.5),ΔYPL(35.5±14.2,17.5~66.2),ΔYP2(34.4±13.3,20.0~62.9),TE-TPL(514.6±85.4,341.4~621.9),(TE-TPL)/TPL(1.4±0.2,1.0~1.7),pulse rate(68.8±8.4,59.8~89.3),S1(0.9±0.3,0.4~1.4),S2(0.0±0.0,-0.1~0.0),ΔYP2-ΔYPL(-1.2±2.6,-6.5~2.5),TP2-TPL(54.0±10.8,33.6~81.1).(3)10 min after exercise,YB,YPL,YP2,TPL,TE decreased,YP1 increased.ΔYPL,TE-TPL,(TE-TPL)/TPL decreased,andΔYP1,pulse rate,S1,ΔYP2-ΔYPL,TP2-TPL increased(all P<0.05).The change trend of pulse wave at 20 min and 30 min after exercise was consistent with that at 10 min after exercise,but most indicators gradually recovered to the resting level before exercise from 10 min.(4)The appearance rate of dicrotic wave with obvious crest in 16 patients with long-term chronic disease at rest was 28.6%,and the appearance rate of 10 min(65.7%),20 min(77.1%),30 min(73.7%)after exercise was significantly increased(all P<0.01).In 6 patients,the incidence of dicrotic waves with obvious peaks after exercise was significantly increased,and it could continue until 30 minutes.In 3 patients,the incidence increased significantly 10 minutes after exercise,and began to decrease at 20 minutes.In 1 patient,the rate of appearance only started to increase 20 minutes after exercise.In 2 patients,the incidence increased 10 minutes after exercise and then decreased.In 1 patient,the rate of occurrence increased briefly 20 minutes after exercise and then decreased.The incidence of 1 patient dropped after exercise and began to rise at 20 minutes.In 2 cases,the incidence rate did not increase after exercise,and it increased slightly after 30 minutes.Conclusion:In patients with longterm chronic diseases,the radial artery pulse wave is short and the dicrotic wave is not obvious or even disappears.After a single precise power exercise,the main wave increases,the position of the dicrotic wave decreases,and the amplitude increases.The specific response should be analyzed individually.