个体化适度运动改善肺动脉高压患者心肺功能的效果

doi:10.3969/j.issn.1006-9771.2020.04.017

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (4): 479-486.doi: 10.3969/j.issn.1006-9771.2020.04.017

个体化适度运动改善肺动脉高压患者心肺功能的效果

朱世立¹,谢友红¹(),黄玮²,孙兴国³,王张敏¹,王晓东⁴,邓维⁴,王若兰¹

1.重庆医科大学附属康复医院,重庆市康复医院,重庆市 400050
2.重庆医科大学附属第一医院,重庆市 400016
3.国家心血管病中心,中国医学科学院阜外医院,北京市 100037
4.重庆医科大学附属大学城医院,重庆市 401331

收稿日期:2019-11-11 修回日期:2019-12-17 出版日期:2020-04-25 发布日期:2020-04-27
通讯作者: 谢友红 E-mail:172763320@qq.com
作者简介:朱世立(1981-),男,汉族,安徽太湖县人,硕士研究生,主治医师,主要研究方向：心肺康复。
基金资助:
重庆市卫生和计划生育委员会科研重点项目(2016ZDXM022)

Effect of Individualized Moderate-intensity Exercise Prescription on Cardiopulmonary Function for Patients with Pulmonary Arterial Hypertension

ZHU Shi-li¹,XIE You-hong¹(),HUANG Wei²,SUN Xing-guo³,WANG Zhang-min¹,WANG Xiao-dong⁴,DENG Wei⁴,WANG Ruo-lan¹

1. The Affiliated Rehabilitation Hospital of Chongqing Medical University, Rehabilitation Hospital of Chongqing, Chongqing 400050, China
2. The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
3. National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China
4. University-town Hospital of Chongqing Medical University, Chongqing 401331, China

Received:2019-11-11 Revised:2019-12-17 Published:2020-04-25 Online:2020-04-27
Contact: XIE You-hong E-mail:172763320@qq.com
Supported by:
Key Research Project of Chongqing Municipal Health and Family Planning Commission(2016ZDXM022)

摘要/Abstract

摘要：

目的分析病情稳定的肺动脉高压(PAH)患者心肺功能状况,探讨运用心肺运动试验(CEPT)精准制定个体化适度运动处方对PAH患者心肺功能储备及运动耐量的影响。方法 2018年4月至2019年7月,纳入病情稳定的PAH患者(PAH组,n= 31)和体检正常的健康人(正常组n = 32),入组前均进行CPET。PAH组行6分钟步行试验(6MWT)后,随机分为运动康复组(n = 16)和对照组(n = 15),运动康复组在规范靶向药物治疗的基础上进行个体化适度运动训练,每周5 d,共8周。对照组仅进行常规靶向药物治疗。治疗后两组再次行CPET和6MWT。结果治疗前,与正常组相比,PAH组体质量、体质量指数(BMI)、用力肺活量(FVC)、第一秒用力呼气容积(FEV₁)、最大通气量(MVV)、无氧阈(AT)、峰值心率(HRpeak)、峰值收缩压(SBPpeak)、峰值负荷功率(WRpeak)、峰值摄氧量(VO₂peak)、峰值氧脉搏(VO₂/HRpeak)、峰值心排量(COpeak)、峰值分钟通气量(VEpeak)、峰值潮气末二氧化碳分压(P_ETCO₂peak)、峰值脉氧饱和度(SpO₂peak)、摄氧通气效率峰值平台(OUEP)均降低(t > 2.419, P < 0.05);静息心率(HRrest)、峰值生理无效腔与潮气量比值(V _D/V_Tpeak)、二氧化碳排出通气效率最低值(Lowest VE/VCO₂)、二氧化碳排出通气斜率(VE/VCO₂slope)均升高(|t| > 2.615, P< 0.05)。治疗后,对照组FEV₁、MVV、峰值千克摄氧量[VO₂peak (ml/min/kg)]、VO₂/HRpeak降低(t > 2.272, P < 0.05);运动康复组FVC、FEV ₁、MVV、AT、SBPpeak、WRpeak、VO₂peak、VO₂/HRpeak、COpeak、VEpeak、P_ETCO₂peak、SpO₂peak和6分钟步行距离(6MWD)升高(|t| >2.167,P < 0.05),Lowest VE/VCO ₂、VE/VCO₂slope降低(t > 2.264, P < 0.05)。与对照组相比,运动康复组FEV ₁/FVC、AT、WRpeak、VO₂peak、VO₂/HRpeak、COpeak、6MWD升高(|t| >2.168, P < 0.05)。结论病情稳定的PAH患者整体心肺功能较正常人仍有降低。CPET精准指导的个体化适度运动处方可以有效改善PAH患者的心肺功能储备,提高PAH患者的运动耐量。

关键词: 肺动脉高压, 心肺运动试验, 心肺功能, 个体化, 运动康复

Abstract:

Objective To analyze the cardiopulmonary function of stable patients with pulmonary arterial hypertension (PAH), and to explore effects of the cardiopulmonary exercise testing (CPET)-based individualized moderate-intensity exercise prescription on cardiopulmonary functional reserve and exercise capacity in patients with PAH.Methods From April, 2018 to July, 2019, 31 stable patients with PAH (PAH group) and 32 healthy counterparts (normal group) were enrolled. All subjects underwent CPET. PAH group was assessed with 6-Minute Walking Test (6MWT), and then was divided into exercise group (n= 16) and control group (n = 15). Both groups were treated with ordinary targeted drugs, while the exercise group was additionally provided with an individualized moderate-intensity exercise prescription of △50% power treadmill training, five days a week for eight weeks. CPET and 6MWT were conducted again after intervention. Results Before intervention, body mass, body mass index (BMI), force vital capacity (FVC), forced expiratory volume in one second (FEV₁), maximum voluntary ventilation (MVV), anaerobic threshold (AT), peak heart rate (HRpeak), peak systolic blood pressure (SBPpeak), peak load power (WRpeak), peak oxygen uptake (VO₂peak), peak oxygen pulse (VO₂/HRpeak), peak cardiac output (COpeak), peak minute ventilation (VEpeak), peak end-tidal carbon dioxide (P_ETCO₂peak), peak pulse oxygen saturation (SpO₂peak) and oxygen uptake efficiency plateau (OUEP) were significantly lower (t > 2.419, P < 0.05), and the rest heart rate (HRrest), peak dead space to tidal volume ratio (V _D/V_Tpeak), minimum ventilatory equivalent for carbon dioxide (Lowest VE/VCO₂) and slope of ventilatory equivalent for carbon dioxide (VE/VCO₂slope) were higher (|t| > 2.615, P< 0.05) in PAH group than in the normal group. After intervention, FEV₁, MVV, VO₂peak (ml/min/kg) and VO₂/HRpeak decreased in the control group (t > 2.272, P < 0.05); FVC, FEV ₁, MVV, AT, SBPpeak, WRpeak, VO₂peak, VO₂/HRpeak, COpeak, VEpeak, P_ETCO₂peak, SpO₂peak and 6-Minute Walking Distance (6MWD) increased (|t| >2.167,P < 0.05), while the average Lowest VE/VCO ₂ and VE/VCO₂slope decreased (t > 2.264, P < 0.05) in the exercise group. Compared with the control group, the FEV ₁/FVC, AT, WRpeak, VO₂peak, VO₂/HRpeak, COpeak and 6MWD increased in the exercise group (|t| >2.168, P < 0.05). Conclusion The holistic cardiopulmonary function of stable patients with PAH decreases. CPET-based individualized moderate-intensity exercise could enhance the cardiopulmonary functional reserve and exercise capacity of patients with PAH.

Key words: pulmonary arterial hypertension, cardiopulmonary exercise testing, cardiopulmonary function, individualization, exercise rehabilitation

中图分类号:

R544.1

朱世立,谢友红,黄玮,孙兴国,王张敏,王晓东,邓维,王若兰. 个体化适度运动改善肺动脉高压患者心肺功能的效果[J]. 《中国康复理论与实践》, 2020, 26(4): 479-486.

ZHU Shi-li,XIE You-hong,HUANG Wei,SUN Xing-guo,WANG Zhang-min,WANG Xiao-dong,DENG Wei,WANG Ruo-lan. Effect of Individualized Moderate-intensity Exercise Prescription on Cardiopulmonary Function for Patients with Pulmonary Arterial Hypertension[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(4): 479-486.

图/表 3

表1

表2

表3

治疗前后运动康复组与对照组的心肺运动试验参数及6MWD比较"

项目	对照组(n = 15)		运动康复组(n= 16)		t值^a	P值^a	t值^b	P值^b	t值^c	P值^c
项目	治疗前	治疗后	治疗前	治疗后	t值^a	P值^a	t值^b	P值^b	t值^c	P值^c
FVC(L)	2.66±0.89	2.54±0.88	2.55±0.78	2.66±0.78	1.987	0.067	-2.428	0.028	-0.402	0.690
FEV₁(L)	2.09±0.67	1.95±0.69	2.06±0.61	2.20±0.58	3.272	0.006	-2.579	0.021	-1.095	0.283
FEV₁/FVC(%)	78.93±7.93	77.07±8.76	80.94±6.72	83.56±5.45	0.793	0.441	-1.962	0.069	-2.494	0.019
MVV(L/min)	80.53±24.68	75.20±23.99	83.00±23.52	90.25±23.05	2.460	0.028	-3.859	0.002	-1.781	0.085
HRrest(/min)	80.07±13.42	84.33±10.67	82.44±13.62	80.75±10.85	-2.051	0.059	0.820	0.425	0.925	0.362
AT(L/min)	0.52±0.08	0.49±0.10	0.49±0.08	0.59±0.15	1.795	0.094	-3.294	0.005	-2.168	0.038
HRpeak(/min)	137.47±20.46	142.93±16.51	132.75±16.88	139.25±20.97	-2.179	0.047	-2.518	0.024	0.540	0.593
SBPpeak(mmHg)	147.93±24.99	149.47±22.31	144.13±26.45	155.88±18.82	-0.514	0.615	-2.914	0.011	-0.867	0.393
WRpeak (W)	57.40±16.40	58.47±15.58	57.31±18.00	78.38±23.80	-0.679	0.508	-8.115	< 0.001	-2.735	0.011
VO₂peak (L/min)	0.75±0.18	0.71±0.1	0.70±0.15	0.91±0.28	2.082	0.056	-5.203	< 0.001	-2.348	0.026
VO₂peak (ml/min/kg)	13.69±3.73	12.99±3.88	14.09±2.86	18.20±5.23	2.581	0.022	-5.231	< 0.001	-3.133	0.004
VO₂/HRpeak (ml/次)	5.48±1.25	5.00±1.12	5.34±1.31	6.62±2.06	2.272	0.039	-3.794	0.002	-2.694	0.012
COpeak (L/min)	4.97±1.19	4.76±1.17	4.68±1.03	6.10±1.90	2.023	0.063	-5.199	< 0.001	-2.345	0.026
VEpeak (L/min)	35.43±7.60	35.01±8.61	31.51±11.38	43.21±13.51	0.315	0.757	-6.351	< 0.001	-2.000	0.055
V_D/V_Tpeak	0.25±0.05	0.25±0.06	0.24±0.05	0.22±0.06	-1.245	0.234	1.948	0.070	1.391	0.175
P_ETCO₂peak (mmHg)	27.00±5.03	26.93±5.19	28.31±4.67	29.44±4.10	0.126	0.902	-2.167	0.038	-1.499	0.145
SpO₂peak (%)	87.93±10.05	87.73±11.00	90.00±6.92	91.75±6.57	0.212	0.835	-2.445	0.027	-1.245	0.223
OUEP	26.33±4.62	25.97±4.39	28.63±5.20	28.68±5.93	-0.416	0.684	-0.063	0.951	-1.438	0.161
Lowest VE/VCO₂	42.24±8.35	41.98±8.63	39.66±6.72	37.15±5.07	0.305	0.765	3.184	0.006	1.915	0.065
VE/VCO₂slope	39.78±10.37	40.18±10.67	37.55±10.28	34.07±5.65	-0.614	0.549	2.264	0.039	2.011	0.054
6MWD (m)	499.73±60.88	495.47±68.98	499.31±50.69	556.56±51.34	0.791	0.442	-6.707	< 0.001	-2.810	0.009

表3

参考文献 29

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项目	运动康复组(n= 16)	对照组(n = 15)	t值	P值
年龄(岁)	41.75±18.53	43.60±15.21	-0.303	0.764
性别(女/男,n)	14/2	12/3		0.654
BMI (kg/m ²)	19.99±2.43	20.73±1.70	-0.974	0.338
WHO心功能分级(Ⅰ级/Ⅱ级,n)	7/9	7/8		1.000
6MWD (m)	499.31±50.69	499.73±60.88	-0.021	0.983
临床分类(n)
特发性肺动脉高压	6	5		1.000
结缔组织病	7	8		0.724
先天性心脏病	3	2		1.000
靶向药物治疗(n)
内皮素受体拮抗剂	14	12		0.654
5-型磷酸二酯酶抑制剂	12	13		0.654
前列环素类药物	2	2		1.000

项目	正常组(n = 32)	PAH组(n= 31)	t/χ²值	P值
年龄(岁)	43.53±14.01	42.65±16.75	0.228	0.820
性别(女/男,n)	26/6	26/5	0.075	0.784
身高(m)	1.63±0.06	1.61±0.06	1.074	0.287
体质量(kg)	61.23±6.98	52.84±7.65	4.533	< 0.001
BMI(kg/m²)	23.23±2.98	20.35±2.11	4.426	< 0.001
FVC(L)	3.33±0.50	2.61±0.82	4.221	< 0.001
FEV₁(L)	2.69±0.44	2.07±0.63	4.529	< 0.001
FEV₁/FVC(%)	81.06±5.94	79.97±7.00	0.668	0.507
MVV(L/min)	109.63±23.40	81.81±23.71	4.687	< 0.001
HRrest(/min)	73.72±9.33	81.29±13.36	-2.615	0.011
AT(L/min)	0.98±0.30	0.50±0.08	8.509	< 0.001
HRpeak(/min)	148.88±17.85	135.03±18.54	3.020	0.004
SBPpeak(mmHg)	161.19±24.53	145.97±25.40	2.419	0.019
WRpeak (W)	133.80±30.62	57.35±16.96	12.202	< 0.001
VO₂peak (L/min)	1.63±0.49	0.72±0.17	9.819	< 0.001
VO₂peak (ml/min/kg)	26.71±7.83	13.90±3.26	8.425	< 0.001
VO₂/HRpeak (ml/次)	10.91±2.77	5.41±1.26	10.102	< 0.001
COpeak (L/min)	10.84±3.24	4.82±1.11	9.815	< 0.001
VEpeak (L/min)	48.69±13.27	33.41±9.78	5.188	< 0.001
V_D/V_Tpeak	0.21±0.03	0.24±0.05	-3.249	0.001
P_ETCO₂peak (mmHg)	41.34±3.72	27.68±4.81	12.633	< 0.001
SpO₂peak (%)	96.25±2.21	89.00±8.49	4.669	< 0.001
OUEP	44.72±6.23	27.52±4.98	12.074	< 0.001
Lowest VE/VCO ₂	26.21±2.31	40.91±7.54	-10.534	< 0.001
VE/VCO₂slope	24.09±2.56	38.63±10.21	-7.807	< 0.001

个体化适度运动改善肺动脉高压患者心肺功能的效果

Effect of Individualized Moderate-intensity Exercise Prescription on Cardiopulmonary Function for Patients with Pulmonary Arterial Hypertension

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