基于心肺运动试验客观定量评估的个体化运动在高血压患者中的应用

目的探讨基于心肺运动试验(CPET)客观定量评估的个体化运动在高血压患者中的应用及对血压、血压变异性、脂代谢和脉搏波波形特征的影响。方法选取2019年1月至2019年6月济宁医学院教职工中的40例高血压患者,男23例,女17例,年龄(48.5±4.6)岁,年龄范围为40~58岁。采用随机数表法将患者随机分为常规组和CPET组,每组20例。常规组给予常规生活方式干预,CPET组在常规组的基础上给予基于CPET客观定量评估的个体化运动。观察两组患者干预前后静息血压、血清低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、总胆固醇、甘油三酯、24 h收缩压标准差(24 hSSD)、24 h舒张压标准差(24 hDSD)、日间收缩压标准差(dSSD)、日间舒张压标准差(dDSD)、夜间收缩压标准差(nSSD)、夜间舒张压标准差(nDSD)和桡动脉脉搏波切迹幅度。结果 CPET组干预后收缩压(126.8±8.2)mmHg(1 mmHg=0.133 kPa)]和舒张压(75.3±6.1)mmHg]水平均低于常规组(132.1±6.2)mmHg、(79.7±6.4)mmHg],差异有统计学意义(P<0.05)。CPET组患者干预后LDL-C(2.2±0.5)mmol/L]、总胆固醇(4.8±0.6)mmol/L]、甘油三酯(1.2±0.4)mmol/L]水平均显著低于常规组(3.4±0.4)mmol/L、(5.3±0.7)mmol/L、(1.8±0.3)mmol/L],HDL-C(1.5±0.2)mmol/L]高于常规组(1.1±0.1)mmol/L],差异均有统计学意义(P<0.05)。CPET组干预后24 hSSD(10.3±4.3)mmHg]、dSSD(11.6±3.8)mmHg]、nSSD(9.5±4.1)mmHg]、24 hDSD(9.7±2.8)mmHg]、dDSD(11.2±3.3)mmHg]、nDSD(8.2±2.8)mmHg]水平低于常规组(13.4±5.4)mmHg、(14.3±4.8)mmHg、(12.1±3.4)mmHg、(12.4±3.4)mmHg、(13.0±4.2)mmHg、(10.1±3.8)mmHg],差异有统计学意义(P<0.05)。CPET组干预后脉搏波切迹幅度高于常规组,差异有统计学意义(P<0.05)。结论基于CPET客观定量评估的个体化运动用于高血压干预可改善患者的血压控制效果,降低血压变异性,改善脂代谢,增加脉搏波切迹幅度,改善血管弹性水平,具有临床推广价值。

Evaluation of cardiopulmonary exercise test in patients with hypertension

Objective To investigate the application of individualized exercise based on objective and quantitative evaluation of cardiopulmonary exercise test(CPET)in patients with hypertension and its influence on blood pressure,blood pressure variability,lipid metabolism and pulse wave characteristics.Methods From January 2019 to June 2019,40 patients with hypertension who were admitted in the Jining Medical University,23 males and 17 females,aged(48.5±4.6)years old,ranging from 40 to 58 years old.The patients were randomly divided into the routine group and the CEPT group with 20 cases in each group.The routine group of patients were given routine lifestyle intervention,and the CEPT group of patients were given individualized exercise based on objective quantitative evaluation of CPET on the basis of the routine group.The resting blood pressure,serum low density lipoprotein(LDL-C),high density lipoprotein(HDL-C),total cholesterol(TC),triglyceride(TG),24 h systolic standard deviation(24 hSDD),24 h diastolic standard deviation(24 hDSD),day systolic standard deviation(dSSD),daytime diastolic standard deviation(dDSD),night systolic standard deviation(nSSD),night diastolic standard deviation(nDSD)were observed before and after intervention the standard deviation of nDSD and the notch amplitude of radial pulse wave were measured.Results After intervention,the systolic blood pressure(126.8±8.2)mmHg,1 mmHg=0.133 kPa]and diastolic blood pressure(75.3±6.1)mmHg]levels in the CEPT group were lower than those in the routine group(132.1±6.2)mmHg and(79.7±6.4)mmHg],with statistically significant differences(P<0.05).After intervention,the levels of LDL-C(2.2±0.5)mmol/L],TC(4.8±0.6)mmol/L],TG(1.2±0.4)mmol/L]in the CEPT group were significantly lower than those in the routine group(3.4±0.4)mmol/L,(5.3±0.7)mmol/L,(1.8±0.3)mmol/L],and HDL-C(1.5±0.2)mmol/L]was higher than that in the routine group(1.1±0.1)mmol/L],with statistically significant differences(P<0.05).The levels of 24 h SSD(10.3±4.3)mmHg],dSSD(11.6±3.8)mmHg],nSSD(9.5±4.1)mmHg],24 h DSD(9.7±2.8)mmHg],dDSD(11.2±3.3)mmHg]and nDSD(8.2±2.8)mmHg]in the CEPT group were lower than those of the routine group(13.4±5.4)mmHg,(14.3±4.8)mmHg,(12.1±3.4)mmHg,(12.4±3.4)mmHg,(13.0±4.2)mmHg and(10.1±3.8)mmHg],with statistically significant differences(P<0.05).After intervention,the amplitude of pulse wave notch in the CEPT group was higher than that in the routine group,with statistically significant differences(P<0.05).Conclusion Individualized exercise based on objective and quantitative evaluation of CPET can improve the effect of blood pressure control,reduce blood pressure variability,improve lipid metabolism,increase the amplitude of pulse wave notch,and improve the level of vascular elasticity in patients with hypertension,which is worth of clinical promotion.