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

Abstract

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

CLC Number:

R544.1

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.

Figures/Tables 3

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

References 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

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

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