心肺联合运动测试指导下不同强度四肢联动训练对慢性阻塞性肺疾病稳定期患者个体化心肺功能的影响

Effects of different intensity limb linkage training under the guidance of cardio-pulmonary exercise test on individualized cardiopulmonary function in patients with stable chronic obstructive pulmonary disease

目的:观察心肺联合运动测试(cardio-pulmonary exercise test,CPET)指导下不同强度四肢联动训练对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)稳定期患者个体化心肺功能的影响。方法:2020年7月—2021年7月,本院80例COPD稳定期患者采用随机数字表法分为对照组(n=20)、低强度组(n=20)、中等强度组(n=20)、高强度组(n=20),对照组给予常规治疗,低强度组、中等强度组和高强度组在常规治疗基础上分别给予40%WRpeak(峰值功率)、60%WRpeak和80%WRpeak不同强度的四肢联动训练共12周,每周5天,每次时间40min。所有患者治疗前后均通过CPET检测患者峰值摄氧量(VO2peak)、无氧阈(AT)、WRpeak、峰值分钟通气量(VEpeak)、呼吸储备(BR)、峰值氧脉搏(VO2/HRpeak)指标变化,同时采用mMRC、BODE、COPD-QOL量表对各组患者疗效进行评定。结果:治疗后,对照组VO2peak、AT、WRpeak、VEpeak、BR、VO2/HRpeak指标值较治疗前无明显变化(P>0.05),低强度组、中等强度组、高强度组与对照组相比VO2peak、AT、WRpeak、VEpeak、BR、VO2/HRpeak均较治疗前增加(P<0.05),且效果逐步明显,组间有显著性差异(P<0.05)。对照组mMRC、BODE、COPD-QOL评分较治疗前无明显变化(P>0.05);低强度组、中等强度组、高强度组与对照组相比mMRC、BODE评分均较治疗前减少,且降低逐步显著,组间有显著性差异(P<0.05),而三组COPD-QOL评分与对照组相比均较治疗前增加(P<0.05),且升高逐渐明显,组间有显著性差异(P<0.05)。结论:CPET指导下对COPD稳定期患者进行四肢联动训练效果明显,其中中等强度及高强度四肢联动训练在提高有氧运动能力,改善肺通气,增强呼吸储备,减轻呼吸困难,降低疾病严重程度,改善生存质量等方面疗效更显著。

Objective:To observe the effect of different intensity limb linkage training under the guidance of cardio-pulmonary exercise test(CPET)on individualized cardiopulmonary function in patients with stable chronic obstructive pulmonary disease(COPD).Method:From July 2020 to July 2021,80 patients with stable COPD in our hospital were randomly divided into control group(n=20),low intensity group(n=20),medium intensity group(n=20)and high intensity group(n=20).The control group was given routine treatment.The low intensity group,medium intensity group or high intensity group was given limb linkage training with 40%WRpeak,60%WRpeak or 80%WRpeak,respectively,for 12 weeks,5 times a week,40 minutes each time.Before and after treatment,the changes of peak oxygen uptake(VO2peak),anaerobic threshold(AT),peak power(WRpeak),peak minute ventilation(VEpeak),respiratory reserve(BR)and peak oxygen pulse(VO2/HRpeak)were detected by CPET.At the same time,the curative effect was evaluated by mMRC,BODE and COPD-QOL.Result:After treatment,the indexes of VO2peak,AT,WRpeak,VEpeak,BR and VO2/HRpeak in the control group had no significant change compared with those before treatment(P>0.05).Compared with the control group,the VO2peak,AT,WRpeak,VEpeak,BR and VO2/HRpeak in the low-intensity group,medium-intensity group and high-intensity group were increased(P<0.05),and the effects were gradually obvious.There was significant difference between the groups(P<0.05).The scores of mMRC,BODE and COPD-QOL in the control group had no significant change compared with those before treatment(P>0.05);Compared with the control group,the scores of mMRC and BODE in the low-intensity group,medium-intensity group and high-intensity group were significantly lower than those before treatment(P<0.05).The COPD-QOL scores of the three groups were higher than those before treatment(P<0.05),and the increase was gradually obvious.There was significant difference between the groups(P<0.05).Conclusion:Under the guidance of CPET,the limb linkage training for patients with stable COPD has obvious effect.Among them,the moderate and high-intensity limb linkage training is more effective in improving cardiopulmonary function,enhancing aerobic exercise ability,improving ventilation function,reducing dyspnea,reducing disease severity and improving quality of life.