踏车训练和呼吸训练对维持性血液透析患者运动耐力、肺功能及生存质量的影响

Effects of intradialytic cycling and respiratory training on exercise endurance,pulmonary function and quality of life in maintenance hemodialysis patients

目的:评估和比较踏车训练和呼吸训练对维持性血液透析(maintenance hemodialysis,MHD)患者运动耐力、肺功能及生存质量的影响。方法:2022年7月—2023年7月,本院60例MHD患者采用随机数字表法分为对照组(n=20)、踏车组(n=20)、呼吸组(n=20)。对照组给予常规血液透析治疗。踏车组在常规血液透析治疗基础上给予中等强度的透析中踏车训练共12周,每周3次,每次时间40min。呼吸组在常规血液透析治疗基础上给予呼吸训练(腹式呼吸训练、缩唇呼吸训练以及膈肌呼吸训练)共12周,每周3次,每次时间40min。分别于治疗前和治疗后对患者进行评估,采用峰值摄氧量(VO_(2peak))、无氧阈(AT)、峰值氧脉搏(VO_(2)/HR_(peak))评估患者的运动耐力,用力肺活量(FVC)、第一秒用力呼气量(FEV1)、每分钟最大通气量(MVV)评估患者的肺功能,肺功能指标以实测值占预计值的百分比表示,即FVC%、FEV1%、MVV%。采用健康调查简表(the MOS item short from health survey,SF-36)评估患者的生存质量,包括生理健康(PCS)、精神健康(MCS)、总分。结果:治疗前,3组患者的VO_(2peak)、AT、VO_(2)/HR_(peak)、FVC%、FEV1%、MVV%、PCS、MCS及总分均无明显差异(P>0.05);治疗12周后,踏车组VO_(2peak)、AT、VO_(2)/HR_(peak)、PCS、总分较本组治疗前增加且优于对照组(P<0.05);呼吸组FVC%、FEV1%、MCS、总分较本组治疗前增加且优于对照组(P<0.05)。结论:踏车训练和呼吸训练均能改善MHD患者的心肺功能及生存质量,其中踏车训练在提高运动耐力及生理健康方面疗效更显著,呼吸训练在提高肺功能及精神健康方面疗效更显著。

Objective:To evaluate and compare the effects of intradialytic cycling and respiratory training on exercise endurance,pulmonary function and quality of life of maintenance hemodialysis(MHD)patients.Method:From July 2022 to July 2023,60 MHD patients in our hospital were randomly divided into control group(n=20),cycling group(n=20),and respiratory group(n=20).The control group was given routine hemodialysis treatment.The cycling group was given moderate-intensity intradialytic cycling training on the basis of routine hemodialysis treatment,for 12 weeks,3 times a week,40 minutes each time.The respiratory group was given respiratory training(abdominal breathing exercise,pursed-lip breathing exercise and diaphrag matic breathing exercise)on the basis of routine hemodialysis treatment,for 12 weeks,3 times a week,40 minutes each time.VO_(2peak),AT and VO/HR_(peak) were used to evaluate the exercise endurance.FVC,FEV1 and MVV were used to evaluate the pulmonary function,which were expressed as a percentage of the predicted values,i.e.FVC%,FEV1%,MVV%.SF-36 was used to assess the quality of life,which includes PCS,MCS and total score.Result:There were no significant difference in VO_(2pea)k,AT,VO_(2)/HR_(peak),FVC%,FEV1%,MVV%,PCS,MCS and total score among the three groups before intervention(P>0.05);after 12 weeks of intervention,VO_(2peak),AT,VO_(2)/HR_(peak),PCS,and total score of the cycling group were increased compared with those before intervention and were better than that of the control group(P<0.05);FVC%,FEV1%,MCS,and total score of the respiratory group were increased compared with those before intervention and were better than that of the control group(P<0.05).Conclusion:Both intradialytic cycling and respiratory training can improve cardiorespiratory function and quality of life of MHD patients.The intradialytic cycling is more effective in improving exercise endurance and physical health,and respiratory training is more effective in improving lung function and mental health.