运动训练对老年冠心病患者左室舒张功能的影响

目的探讨运动训练对老年冠心病患者左室舒张功能的影响。方法 64例老年冠心病患者随机分为运动训练组(n=32)和常规治疗组(n=32),均接受12 w相同的冠心病药物治疗,运动训练组同时给予运动训练。另选择30例健康老年人为正常对照组。超声心动图评估左室舒张功能和收缩功能,6分钟步行距离试验(6MWD)评估运动耐量。结果治疗前,与正常对照组相比,两组患者左室舒张参数A明显增高(P0.05),E、E/A比值明显降低(P0.05);两组患者的6MWD均显著短于正常对照组(P0.05);两组患者左室收缩功能均在正常范围。治疗后,常规治疗组和运动训练组患者E、A、E/A参数均有所改善,运动训练组参数E、A、E/A比值优于常规治疗组(P0.01);两组患者的步行距离均有增加,运动训练组较常规治疗组增加更显著(P0.01);两组患者左室收缩功能无明显改变(P0.05)。结论运动训练能改善老年冠心病患者的左室舒张功能和运动耐量。     

步行试验对老年慢性心力衰竭患者运动耐量的评估

目的探讨6 min步行试验(6MWT)对老年慢性心力衰竭(CHF)患者运动耐量的评价.方法将54例CHF患者随机分为常规治疗组(n=25)和卡维地洛组(n=29),治疗前后进行步行试验,监测肿瘤坏死因子(TNF-α)、白细胞介素6(IL-6)、去甲肾上腺素(NE)和左室射血分数(LVEF).结果心功能Ⅳ级患者较Ⅱ级患者步行距离明显下降(P<0.01),Ⅲ级与Ⅱ级、Ⅳ级与Ⅲ级患者之间步行距离的差异无显著性意义(P>0.05);卡维地洛组6 min步行距离治疗前后差异有显著性意义(P<0.01), 而常规治疗组差异无显著性意义(P>0.05),两组患者步行距离与TNF-α、IL-6、NE呈显著负相关(P<0.05),与LVEF呈正相关(P<0.05).结论6MWT具有简单、易行、安全、可靠的特点,可作为评估CHF患者运动耐量的临床工具,尤其适用于老年患者,同时可提供一定的判断CHF预后及治疗效果的信息.     

卡维地洛治疗老年心力衰竭的疗效观察及运动耐量评估

目的 探讨卡维地洛治疗老年心力衰竭患者的疗效和对其运动耐量的影响.方法 选择老年心力衰竭患者62例,随机分为常规治疗组31例和卡维地洛组31例,常规治疗组给予常规抗心力衰竭治疗,卡维地洛组在常规抗心力衰竭治疗基础上加用卡维地洛,于治疗前和治疗6个月后比较两组患者的每搏输出量(SV)、每分输出量(CO)及左室射血分数(LVEF),并观察6min步行距离和心率变化.结果 治疗后,常规治疗组与卡维地洛组的SV、CO、LVEF、步行距离和静息心率间差异具有统计学意义(P＜0.01).结论 在常规抗心力衰竭药物治疗基础上加用卡维地洛治疗老年心力衰竭,能够显著改善患者的心功能,增加运动耐量.     

辅酶Q10对稳定型心绞痛患者运动耐量的影响

目的 研究辅酶Q10对稳定型心绞痛患者临床疗效及运动耐量的影响.方法 将205例稳定型心绞痛患者随机分为常规治疗组、辅酶Q10组和曲美他嗪组,治疗8 周后,比较各组心绞痛发作次数、每周硝酸甘油消耗量、平板运动试验指标.结果辅酶Q10组及曲美他嗪组心绞痛发作次数、硝酸甘油消耗量明显减少,运动至出现ST段压低1 mm所需时间、运动至出现心绞痛所需时间显著延长,做功负荷量明显增加,明显优于常规治疗组(P<0.05或P<0.01),且两者比较无统计学意义.结论 辅酶Q10与曲美他嗪均能有效缓解稳定型心绞痛患者临床症状,改善运动诱发的心肌缺血,提高运动耐量,但比较而言,辅酶Q10更为廉价.     

个体化有氧运动对老年冠心病患者心率恢复的影响

目的评价个体化有氧运动对老年冠心病患者心率恢复的影响。方法将60例老年冠心病患者随机分为康复运动组30例和对照组30例。康复运动组进行有氧运动训练3个月,对照组进行日常活动。采用6min步行试验检测2组运动治疗前后的静息心率、峰值心率、心率恢复值、收缩压、舒张压和6min步行距离。结果与治疗前比较,康复运动组治疗3个月峰值心率及心率恢复值明显提高,6min步行距离较运动前明显延长,差异有统计学意义(P<0.05,P<0.01),而血压、静息心率和LVEF比较,差异无统计学意义(P>0.05)。6min步行距离与心率恢复值呈正相关(r=0.48,P<0.01)。结论个体化有氧运动有助于改善老年冠心病患者的心率恢复能力和运动耐量。     

稳定型心绞痛病人社区综合运动康复治疗的疗效及安全性评价

目的观察稳定型心绞痛病人社区综合运动康复治疗的疗效及安全性。方法选择2013年10月—2014年10月本院收治的稳定型心绞痛病人120例,按随机数字表法分为观察组和对照组,每组60例。对照组病人给予常规药物治疗,观察组病人在此基础上进行踏车运动训练和平路步行锻炼,以6个月为1个疗程,治疗过程中监测病人的心率、血压变化,治疗结束后比较两组病人的生活质量评分(Qol),治疗结束1个月内心绞痛发生频率,使用6 min步行试验评价病人的运动耐量。结果与治疗前相比,病人的生活质量评分有所提高,观察组治疗后生活质量评分高于对照组,心绞痛发生率低于对照组,6 min步行距离长于对照组,差异有统计学意义(P0.05)。结论稳定型心绞痛病人社区综合运动康复治疗的疗效良好,能提高病人的生活质量和运动耐量,降低心绞痛发生频率。     

康复训练对糖尿病合并心衰患者血清乳酸及心功能的影响

共选取30例心功能稳定的糖尿病合并慢性心力衰竭患者,将其随机分为2组:训练组(n=15)及常规治疗组(n=15),2组患者均给予内科常规治疗,训练组患者在此基础上同时进行运动训练;并分别在治疗前及治疗8周后对2组患者进行血乳酸、心脏超声及6min步行试验等检查。结果运动训练可以显著降低训练组患者血乳酸水平(P0.05),增加6min步行距离(P0.05)。结论运动训练可以显著降低糖尿病并慢性心力衰竭患者血乳酸水平,可能对微循环具有改善作用,并改善其运动功能。     

运动康复改善老年慢性心衰患者心功能和生活质量的研究

目的:观察老年慢性心衰患者运动康复后心功能和生活质量的改变.方法:对60例老年慢性心衰病人在常规药物治疗的基础上,实施运动康复疗法,并与58例非康复组进行对照比较;观察出院时病人 6 min步行距离、运动耐量、平均住院日和心功能变化,同时测定血浆脑钠肽(BNP)含量,对其生活质量进行评定;观察随访一年时病人的心功能、再住院率和死亡率.结果:出院时康复组运动贮量、生活质量明显提高,NYHA心功能级别显著改善(P＜0.05或＜0.01),BNP水平和心室重量指数(LVMI)则显著降低(P＜0.05);较之对照组除上述指标显著改善(P＜0.05～＜0.01)外,6 min步行距离增加非常显著(P＜0.01)平均住院日显著减少(P＜0.05);随访一年时康复组病人的心功能、6 min步行距离、运动贮量、生活质量、左室射血分数(LVEF)和E/A比值均明显增加,NYHA心功能级别显著改善(P＜0.01),左房内径(LAd)、LVMI以及再入院率和死亡率明显低于对照组(P＜0.01或P＜0.05).结论:运动康复可以改善心功能,提高运动耐量和生活质量,缩短住院时间,降低再入院率和死亡率;长期运动康复可能有改善心肌的重构的作用.     

体外反搏对平板运动试验阳性的稳定型心绞痛患者运动耐量和心功能的影响

目的观察体外反搏对平板运动试验阳性的稳定型心绞痛患者运动耐量和心功能的影响。方法将2011年3月~2013年9月就诊于武汉大学中南医院心内科的68例冠状动脉粥样硬化性心脏病(冠心病)稳定型心绞痛患者随机分为两组,常规治疗组(常规药物治疗,n=34)和体外反搏组(在常规药物基础上加用体外反搏治疗,n=34);治疗前后进行平板运动试验和超声心动图检测,对两组患者的运动耐量和心功能相关指标对比观察。结果治疗6周后,两组患者ST段最大下移幅度均减小,运动总时间延长,做工量增加,射血分数(EF)升高,左室舒张末期内径(LVDD)减小,与治疗前比差异有统计学意义(P0.05);两组相比,体外反搏组治疗前后射血分数、左室舒张末期内径的变化更为明显(P0.05),舒张功能指标(舒张早期运动速度Ea、舒张晚期运动速度Aa、Ea/Aa)在体外反搏组得到明显改善,而在常规治疗组变化则不明显(P0.05)。结论联合体外反搏治疗稳定型心绞痛优于单纯药物治疗,尤其是能改善冠心病患者心脏舒张功能,提高运动耐量,从而改善患者的生活质量。     

运动疗法对冠心病慢性心力衰竭患者近期疗效观察

目的观察运动治疗对冠心病慢性心力衰竭患者心功能和运动耐量的影响。方法将64例冠心病慢性心力衰竭患者分成运动组32例和对照组32例,两组均常规进行内科治疗,运动组加以运动疗法。分别于入组时和治疗12周后对两组患者临床心功能、左室射血分数(LVEF)、运动耐量及6min步行距离进行测定与比较。结果治疗12周后,与对照组比较,运动组患者心功能改善,LVEF明显升高,运动耐量显著提高,6min步行距离显著增加,差异有统计学意义(P<0.05、<0.01)。结论运动疗法可以减轻冠心病心力衰竭患者症状,改善心功能,提高运动耐量。     

肺康复对稳定期慢性阻塞性肺疾病的疗效分析

目的探讨肺康复锻炼对稳定期慢性阻塞性肺疾病患者的临床疗效及意义。方法 300例稳定期慢阻肺患者,采用前瞻性随机对照法分为两组:康复组(n=149)给予门诊慢阻肺健康宣教,包括饮食干预,戒烟教育,用药指导;肺康复锻炼(呼吸运动训练联合步行运动训练)。对照组(n=151)仅给予门诊慢阻肺健康宣教。比较6个月后两组患者的血气分析、肺功能、6MWD(6分钟步行距离)及慢阻肺急性加重期住院的次数等。结果 6个月后共234例完成试验,康复组(n=121)较对照组(n=113)的6MWD,血气分析等指标有明显改善,具有统计学意义(P0.05),而两组间肺功能FEV_1/FVC、FEV_1%和慢阻肺急性加重期住院的次数无统计差异(P0.05)。结论肺康复锻炼(呼吸运动训练联合步行运动训练)能有效提高PaO_2及降低PaCO_2,提高6MWD,适度改善运动耐力,是一种简便易行的康复锻炼方法,值得临床应用及推广。     

噻托溴胺联合呼吸操训练治疗稳定期慢性阻塞性肺病患者的临床研究

目的探讨噻托溴胺联合呼吸操训练对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,慢阻肺)稳定期患者的肺通气功能、生活质量以及运动耐力的影响。方法选择2014年10月至12月稳定期慢阻肺患者共73例,随机分为常规药物治疗组(A组,n=37)和呼吸操训练组(B组,n=36)。对A组患者常规吸入噻托溴胺,有氧疗指征者给予长期家庭氧疗。B组患者除应用噻托溴胺和(或)氧疗外,指导呼吸操训练,方法包括腹式呼吸、缩唇呼气及全身性呼吸体操。记录每例患者入组时及12周后的FEV1占预计值的百分比(FEV1%Pred)、圣乔治呼吸疾病问卷(SGRQ)评分及6 min步行距离(6MWD)。结果入组时两组患者的性别、平均年龄、肺功能分级、FEV1%Pred、SGRQ评分及6MWD均无显著差异(P0.05)。干预12周后两组患者FEV1%Pred、SGRQ评分及6MWD均较治疗前有显著变化。其中B组患者的SGRQ评分显著低于A组,B组患者的6MWD显著长于A组(P0.05)。结论在常规吸入长效抗胆碱能药物治疗外,配合呼吸操训练可更好的改善稳定期慢阻肺患者的生活质量及运动耐力。     

Home-based exercise is capable of preserving hospital-based improvements in severe chronic obstructive pulmonary disease

We examined the feasibility of home-based walking training to maintain the benefits of a short-term exercise training in patients with severe chronic obstructive pulmonary disease (COPD). After initial recovery from an exacerbation, 46 patients were randomized into a training and a control group, and 30 patients completed the programme (mean +/- SD FEV1, 36 +/- 7% predicted). The training group performed a 10-day walking training programme in the hospital, followed by a 6-month programme of supervised walking training at home, integrated into daily activities. The control group did not have exercise training in the hospital or at home. Until 6 months after discharge, lung function, exercise performance and symptom scores were assessed. Six-minute walking distance in the training group improved from day 1 to day 10 (P<0.001) and this effect was maintained over 6 months (P<0.001). On average, daily walking distance at home was 2308 m and walking was reported on 157 days. Quality of life (QoL) scores changed significantly over 6 months (P<0.001). The control group showed no significant changes in exercise performance or QoL scores throughout the whole study period. Therefore, (i) significant improvements in exercise performance and Chronic Respiratory Disease Questionnaire (CRQ) scores could be achieved after recovery from an exacerbation and (ii) these improvements were maintained after discharge, when supported by a home-based walking training.     

Effects of high-intensity exercise training in a pulmonary rehabilitation programme for patients with chronic obstructive pulmonary disease

BACKGROUND AND OBJECTIVES: The benefits of pulmonary rehabilitation for patients with COPD depend on the intensity of training. Traditional pulmonary rehabilitation programmes (PRPs) do not consistently achieve high-intensity training and have variable training effects. This study examined the effects of high-intensity exercise training on cardiac and pulmonary function in COPD patients. METHODS: Patients with COPD participated in a 6-week, cardiopulmonary exercise test-based PRP. Spirometry, 6-min walking distance and cardiopulmonary exercise test were used to evaluate cardiopulmonary function, respiratory muscle strength and endurance at rest, during exercise and before and after the programme. Patients were encouraged to complete high-intensity exercise with a targeted training intensity of at least 75% maximum oxygen uptake (VO(2)). RESULTS: Thirty-four COPD patients were enrolled into the study; 16 completed the high-intensity training, 18 did not. At the end of the 12-session PRP, submaximal exercise capacity (6-min walking distance, 461.8 +/- 77.2-502.7 +/- 66.9 m, P < 0.001) improved in both the patients who completed high-intensity training and those who did not. Only the patients who completed high-intensity training had significant improvements in FVC (2.47 +/- 0.70-2.70 +/- 0.62 L, P = 0.024) at rest, maximal exercise capacity (peak VO(2), 1001.6 +/- 286.4-1116.1 +/- 320.4 mL/min, P = 0.020) and work efficiency (7.3 +/- 1.4-8.4 +/- 1.8 mL/min/watt, P = 0.026). There was no statistically significant difference between the two groups in the change in the physiological parameters before and after exercise. CONCLUSIONS: Exercise training in a PRP improved submaximal exercise capacity. Only patients who completed high-intensity exercise training showed improvements in maximal exercise capacity, FVC and work efficiency.     

运动训练联合居家运动在老年肺康复病人中的应用

目的探讨运动训练联合居家运动在老年肺康复病人中的应用效果及对圣乔治呼吸问卷(SGRQ)、呼吸困难指数(mMRC)评分的影响。方法选择2017年6月至2019年6月进行肺康复锻炼的60例老年病人,按随机数字表法分为2组,每组30例。对照组给予常规康复模式,观察组采用运动训练方案联合居家运动,2组均完成4周干预。比较2组肺功能及血气指标、mMRC评分、6 min步行距离(6MWD)、SGRQ评分及BODE指数的差异。结果观察组干预后肺功能改善情况好于对照组,PaO2高于对照组,PaCO2低于对照组(P<0.05);观察组干预后mMRC评分低于对照组,6MWD远于对照组(P<0.05);观察组干预后SGRQ评分及BODE指数均低于对照组(P<0.05)。结论运动训练方案联合居家运动在老年肺康复病人中的应用效果显著,能够明显改善病人的肺功能,提高病人的生活能力及运动耐力,减轻不适症状,降低复发率的同时减轻家庭及社会的经济负担,值得推广应用。     

运动训练对心衰患者的影响

目的探讨运动训练对慢性心力衰竭患者运动耐苗的影响。方法将60例NYHA心功能Ⅱ-Ⅲ级心哀患者随机分为训练组和对照组,两组均予以常规抗心哀治疗,训练组予以有氧操训练1次,d,疗程10周。两组均分别在入院后24h内（治疗前）及治疗10周后分别进行6分钟步行试验及行超声心动图检查,测定左室射血分数（LVEF）,并比较两组前后的结果。结果治疗10周后,两组6分钟步行的行止距离及LVEF均有所增加,且训练组增加更明显。结论适量运动训练与其他常规药物联用可显著增强心哀患者的运动耐量,可作为该病治疗的辅助方法。     

Effects of physical exercise versus rosiglitazone on endothelial function in coronary artery disease patients with prediabetes

We conducted a three‐arm, parallel‐group, randomized, controlled trial to compare the effects of rosiglitazone and physical exercise on endothelial function in patients with coronary artery disease and impaired fasting glucose or impaired glucose tolerance over a 6‐month period. Group A received rosiglitazone tablets 8 mg daily (n = 16), group B underwent a structured physical exercise programme (n = 15) and group C served as a control group (n = 12). At baseline and after 6 months, brachial artery ultrasound imaging was performed to assess reactive flow‐mediated dilation (FMD). Rosiglitazone treatment and exercise both led to significant improvements in insulin resistance at 6 months, whereas no change was observed in control patients. FMD improved significantly in physical exercise patients, whereas no change could be observed in patients receiving rosiglitazone or in the control group. Between‐group comparisons also showed a significant relative improvement in FMD in exercise patients compared with rosiglitazone.     

脑心通对急性心肌梗死病人运动耐量及血管内皮功能的影响

目的研究脑心通胶囊对急性心肌梗死病人的运动耐量及血管内皮功能的影响.方法将63例急性心肌梗死病人随机分为两组,对照组(30例)予西医常规治疗;治疗组(33例)在西医常规治疗的基础上加用脑心通胶囊治疗,疗程皆为30 d,分别观察两组疗效,并用心电图平板运动试验和二维超声分别测定两组病人运动耐量及肱动脉血管内皮功能.结果经30 d治疗后,治疗组总有效率(93.9%)优于对照组(83.3%,P＜0.05);两组运动耐量均较治疗前明显提高(P＜0.05),肱动脉血管内皮功能均较治疗前明显改善(P＜0.05).结论脑心通胶囊治疗急性心肌梗死不仅可以提高疗效,而且可显著提高病人的运动耐量及改善血管内皮功能.     

前庭旋转训练对脑卒中偏瘫患者平衡功能的影响

目的探讨前庭旋转训练对脑卒中患者平衡功能的影响。方法46例脑卒中偏瘫患者随机分成两组:治疗组23例,采用前庭旋转训练,配合常规康复训练;对照组23例,仅进行常规康复训练。每天1次,每周训练6次,共4周。评价指标采用Berg平衡量表、Fugl-Meyer运动评分和Barthel指数法。每位患者均在治疗开始前和全部治疗结束后进行评定。结果两组对象在试验开始前评价指标比较差异无统计学意义,训练4周后治疗组的平衡、运动功能和生活活动能力均有明显改善,与对照组比较差异有统计学意义(P<0.05)。结论前庭旋转训练对脑卒中患者的平衡功能恢复比单纯常规康复训练具有更佳的疗效,且平衡能力的改善有助于脑卒中患者下肢运动功能及日常生活活动能力的提高。     

Effects of exercise training after open heart surgery on quality of life and exercise tolerance in patients with mitral regurgitation or aortic regurgitation

We conducted a questionnaire survey regarding quality of life (QOL) to evaluate the effects of exercise training on the QOL in patients with valvular heart disease after surgery. This study included 64 consecutive patients who underwent heart surgery. They were divided into two groups: exercise training could (EX(+) group, n = 31) and could not be performed (EX(-) group, n = 33) until 6 months after surgery. To evaluate the QOL and exercise tolerance, we employed "a questionnaire regarding disease and quality of life" developed for Japanese people and cardiopulmonary exercise testing. In our questionnaire survey, the improvement rating (Delta subjective/social index), which was calculated from the difference between the pre-and postoperative values, was greater in the EX(+) group than that in the EX(-) group (4.9 +/- 3.1 versus 1.1 +/- 4.0, P < 0.05). In the changes in exercise tolerance, Delta anaerobic threshold was greater in the EX(+) group (0.79 +/- 0.17 versus -0.02 +/- 0.28, P < 0.01). Moreover, there was a positive correlation between Delta subjective/social index and Delta peak VO(2) (r = 0.62, P < 0.05). We concluded that exercise training for patients after cardiac surgery improves the QOL and exercise tolerance. It is suggested that changes in subjective and social parameters contribute to an exercise training-related improvement in the QOL.