心肺运动试验联合无创心排量指导心脏康复对慢性心力衰竭的改善作用

Improvement effect of cardiopulmonary exercise testing combined with impedance cardiography in guiding cardiac rehabilitation in patients with chronic heart failure

目的探讨心肺运动试验(CPET)联合阻抗心电图(ICG)指导心脏康复(CR)对慢性心力衰竭(CHF)患者的心功能、心肺反应及运动耐量的改善作用。方法选择2021年5月至2023年8月期间纳入180例病情稳定的成年CHF患者,随机分为研究组和对照组(每组各90例)。研究组采用药物治疗和“CPET+ICG”指导下进行运动心脏康复治疗,对照组采用药物治疗。在基线和采取干预措施12周后测量两组患者的心功能、心肺反应及运动耐量指标。结果与治疗前比较,治疗后研究组静息心率(HR)、无氧阈值(AT)-HR、峰值HR显著降低(P<0.05),而AT-运动时长、AT-最大摄氧量(VO2)/HR、AT-每分钟递增工作速率(WR)、峰值运动时间、峰值VO2/HR、峰值负荷、VO2/WR、△VO2/△WR、每15 s平均每分钟通气(VE)/二氧化碳排出量(VCO_(2))、6 min步行试验(6MWT)、静息代谢当量(METS)、峰值METS显著升高(P<0.05);与治疗前比较,治疗后对照组AT-HR、峰值-HR显著降低(P<0.05);AT-VO2/HR显著升高(P<0.05)。治疗后研究组AT-运动时长、ATWR、峰值运动时间、VO2/HR、峰值负荷、VO2/WR、△VO2/△WR、静息METS、峰值METS显著高于治疗后对照组(P<0.05)。与治疗前比较,研究组治疗后心输出量(CO)、心脏指数(CI)、左室射血分数(LVEF)均显著升高(P<0.05),左房内径(LAD)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)均显著降低(P<0.05);治疗后对照组的CI升高,而LAD有所降低(P<0.05)。与研究组比较,治疗后对照组LVEDD显著升高(P<0.05)。LVEF与△VO2/△WR,CI与AT-负荷、VO2/HR、峰值负荷均呈显著正相关(P<0.05)。LAD与AT-负荷、静息METS、AT-VO2/WR、△VO2/△WR,LVEDD与静息METS,LVESD与静息METS均呈显著负相关(P<0.05)。结论“ICG+CPET”评估有助于制定CHF稳定期的运动方案,并改善患者的心功能和运动耐力。

Objective To discuss the improvement effect of cardiopulmonary exercise testing(CPET)combined with impedance cardiography(ICG)on heart function,cardiopulmonary response and exercisetolerance in guiding cardiac rehabilitation(CR)in patients with chronic heart failure(CHF).Methods The patients(n=180)with stable CHF were chosen and divided randomly into study group and control group(each n=90)from May 2021 to Aug.2023.The study group was given medication and exercise CR guided by CPET+ICG,and control group was given medication.The indexes of heart function,cardiopulmonary responses and exercise tolerance were detected at baseline and after intervention for 12 weeks.Results The indexes of resting heart rate(HR),anaerobic threshold(AT)-HR and peak HR decreased significantly(P<0.05),AT-exercise duration,AT-maximal oxygen uptake(VO2max)/HR,increasingworking rate(WR)per minute,peak exercise time,peak VO2max/HR,peak load,VO2max/WR,△VO2max/△WR,average minute ventilation volume(VE)per 15 s/carbon dioxide output(VCO2),6-minute walk test(6MWT),restingmetabolic equivalents(METS)and peak METS increased significantly in study group after the intervention(P<0.05).The indexes of AT-HR,peak HR decreased significantly(P<0.05),and AT-VO2/HR increased significantly(P<0.05)in control group after the intervention.The indexes of AT-exercise duration,AT-WR,peak exercise time,VO2max/HR,peak load,VO2max/WR,△VO2max/△WR,resting METS and peak METS were significantly higher in study group than those in control group after the intervention(P<0.05).The indexes of cardiac output(CO),cardiac index(CI)and left ventricular ejection fraction(LVEF)increased significantly,and left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)decreased significantly in study group(P<0.05),and CI increased and LAD decreased in control group(P<0.05)after the intervention.LVEDD increased significantly in control group compared with study group after the intervention(P<0.05).LVEF was positively correlated to△VO2max/△WR,and CI was positively correlated to AT-load,VO2max/HR and peak load(P<0.05).LAD was negatively correlated to AT-load,resting METS,AT-VO2max/WR and△VO2max/△WR,LVDD was negatively correlated to resting METS and LVESD was negatively correlated to resting METS(P<0.05).Conclusion ICG+CPET is conducive for developing the exercise scheme in CHF stable stage,and improving heart function and exercisetolerancein CHF patients.