不同运动方式对慢性肾脏病患者肾功能及心血管疾病相关危险因素的影响

目的:探究有氧运动和有氧运动联合抗阻训练对慢性肾脏病(CKD)患者肾功能及心血管疾病相关危险因素的影响。方法:87例CKD患者随机分为对照组(n=29)、有氧运动组(n=29)和有氧联合抗阻训练组(n=29)。有氧运动组以50%峰值摄氧量(VO2peak)踏功率自行车,每次30min。有氧联合抗阻训练组先以50%VO2peak踏功率自行车30min,再进行弹力带抗阻训练。两组运动周期均为每周3次,共12周。比较三组间运动前后肾小球滤过率(e GFR)、血肌酐(SCr)、血尿素氮(SBUN)、24h尿蛋白定量(24UP)、收缩压(SBP)、舒张压(DBP)、静息心率(RHR)、甘油三酯(TG)、总胆固醇(TC)和低密度脂蛋白(LDL-C)的差异。结果:运动前三组间各指标均无显著差异(P0.05);运动后,与对照组相比运动组在e GFR、SCr、SBUN、24UP、SBP、DBP、RHR、TG、TC和LDL-C均有显著改善(P0.05);且运动后,与有氧运动组相比有氧联合抗阻训练组在TG、TC、和LDL-C改善更明显(P0.05)。结论:单纯有氧运动和有氧运动联合抗阻训练对CKD患者肾功能及心血管疾病相关危险因素均有改善作用,且与单纯有氧运动相比有氧运动联合抗阻训练对CKD患者的血脂改善效果更好。     

有氧运动联合低水平抗阻训练对老年慢性阻塞性肺病患者肺功能与运动能力影响的观察

目的:探索个体化有氧联合低水平抗阻运动较单纯有氧运动对老年慢性阻塞性肺病(COPD)患者相关运动能力以及肺功能的影响,并分析其可能机制。方法:招募老年COPD患者40例(男性26例,女性14例),按照随机数表法分为有氧运动组20例,联合运动组20例。两组患者均保持常规药物治疗,给予健康宣教。有氧运动组根据心肺运动试验(CPET)测试评估结果,进行强度为60%—85%目标心率的个体化有氧训练;联合运动组在此基础上增加强度为60%—80%10RM的渐进式抗阻训练,包括腹肌力量训练,下肢弹力带训练,以及根据Breath-link呼吸功能评估与训练系统确定的吸气抗阻训练。训练共12周,每周3—5次,每次30—60min。运动训练前后评测所有患者的肺功能,包括1秒用力呼气量(FEV1),FEV1占预计值百分比(%),用力呼气量占用力肺活量比值(FEV1/FVC%);相关运动能力,包括最大摄氧量(VO_(2max)),无氧阈(AT),6分钟步行能力(6MWT)。结果:两组患者治疗前一般资料及各项指标无明显差异(P0.05),治疗后有氧运动组患者FEV1、FEV1%、FEV1/FVC%、VO_(2max)、AT、6MWT均有所改善(P0.05),联合运动组在VO_(2max)、AT、6MWT均有增强(P0.05),肺功能FEV1、FEV1%、FEV1/FVC%显著改善(P0.01)。同时,联合运动组各项结果优于有氧训练组(P0.05)。结论:个体化有氧联合抗阻运动相较于单一有氧训练能够更好地改善老年COPD患者的肺功能和运动能力。     

不同强度有氧运动对经皮冠状动脉介入治疗术后患者心功能及运动耐力的影响

目的:探讨不同强度有氧运动对经皮冠状动脉介入治疗(PCI)术后患者心功能及运动耐力的影响。方法:将65例PCI术后患者随机分为高强度(峰值功率的80%)间歇有氧运动组(22例)、中等强度(峰值功率的60%)有氧运动组(21例)、对照组(22例)。高强度运动组以3min训练、1min休息的间歇训练模式进行,每次训练10组,共40min。中等强度运动组每次持续训练40min,两组患者均训练12周,每周3次,所有患者训练前后均行超声心动图及心肺运动试验(CPET)评估患者心功能及运动耐力。结果:训练前3组患者的左室射血分数(LVEF)、峰值功率(PP)、运动持续时间(ED)、峰值摄氧量(VO2peak)、无氧阈(AT)均无显著差异(P0.05);训练后高强度运动组及中等强度运动组PP、ED、VO2peak比较差异具有显著性(P0.05),且均优于对照组(P0.05);中等强度运动组与对照组LVEF差异并无显著性(P0.05),但均与高强度运动组有显著差异(P0.05);AT仅高强度运动组比对照组明显增高(P0.05)。结论:与中等强度持续有氧运动相比,高强度间歇有氧运动可以更好地改善PCI术后患者的左室收缩功能及有氧代谢能力,提高患者的运动耐力。     

不同运动方式训练对慢性肾脏病患者运动功能的影响

目的探究有氧运动和有氧运动联合抗阻训练对慢性肾脏病(CKD)患者肌力、心肺耐力等运动功能的影响。方法 2015年7月至2016年8月,CKD患者60例随机分为对照组(n=20)、有氧运动组(n=20)和有氧联合抗阻训练组(n=20)。有氧运动组以50%峰值摄氧量(VO2peak)踏功率自行车,每次30 min。有氧运动联合抗阻训练组在有氧运动组基础上,进行弹力带抗阻训练。每周3次,共12周。比较三组间训练前后上下肢一次最大重复负荷(1 RM)、心肺运动试验(CPET)、手臂弯曲试验(ACT)、30秒坐站试验(CS-30)和6分钟步行试验(6MWT)的差异,并监测训练前后患者血肌酐(sCr)和肾小球滤过率(e GFR)的变化。结果训练前三组间各指标均无显著性差异(F1.841,P0.05)。训练后,有氧运动组和有氧联合抗阻训练组在各指标方面均改善(t2.162,P0.05),且优于对照组(t2.132,P0.05);有氧联合抗阻训练组在上肢1 RM、下肢1 RM、VO_(2peak)、ACT、CS-30和6MWT方面均优于有氧运动组(t2.081,P0.05)。结论有氧运动可改善CKD患者运动功能,联合抗阻训练效果更好。     

不同强度有氧训练对轻中度慢性阻塞性肺疾病的作用

目的:比较不同强度有氧训练对轻中度稳定期慢性阻塞性肺疾病(COPD)患者肺的通气功能和运动耐力的影响。方法:将60例轻中度稳定期COPD患者随机分为高强度(峰值功率的70%)有氧训练组20例、低强度(峰值功率的50%)有氧训练组20例、对照组20例,所有患者训练前后均进行心肺运动试验(CPET)评估,高强度与低强度有氧训练组均进行8周训练,每周3次,高强度训练组每次训练4组,每组以5min训练、5min休息的间歇训练模式进行,共40min。低强度训练组每次持续训练20min。结果:训练前3组间的测试持续时间、峰值功率、峰值通气量、峰值摄氧量及无氧阈均无差异(P>0.05)。训练后各指标差值(训练后-训练前)比较,3组间测试持续时间、峰值功率、峰值摄氧量的差值(训练后—训练前)两两比较均有差异(P<0.05),高强度组明显增加;对照组与低强度组间的峰值通气量(VE)差异无显著性意义(P>0.05),但均与高强度组有差异(P<0.05);无氧阈值(AT)仅高强度组比对照组明显增高(P<0.05)。结论:与低强度持续有氧训练相比,高强度间歇有氧训练可以明显提高轻中度稳定期COPD患者肺的通气功能及运动耐力。     

高强度间歇与中强度持续有氧训练对经皮冠状动脉介入术后运动康复分层低危患者的影响

目的:探讨高强度间歇与中强度持续有氧训练对经皮冠状动脉介入术(PCI)后运动康复分层低危患者的影响。方法:选取PCI术后运动康复分层低危患者43例,按照随机数字表法将其分为高强度间歇有氧训练组(高强度间歇组,22例)和中强度持续有氧训练组(中强度持续组,21例)。2组患者均采用功率自行车进行训练,高强度间歇组采用高强度...     

高强度有氧训练对冠心病患者运动耐力的影响

目的探讨高强度与低强度有氧训练对稳定期冠心病患者运动耐力的影响。方法将60例稳定期冠心病患者随机分为高强度有氧训练组20例、低强度有氧训练组20例、对照组20例。所有患者训练前后均进行心脏超声和心肺运动试验评估,有氧训练每周3次,共进行8周。结果有氧训练后,与对照组相比,心脏射血分数有所提高,但无统计学意义;但3组间有氧运动持续时间、峰值功率、氧脉搏及无氧阈值两两比较均有差异,高强度运动组明显增加。结论与低强度持续性有氧训练和对照组相比,高强度间歇有氧训练可以明显提高稳定期冠心病患者的运动耐力。     

抗阻联合有氧训练对冠心病患者支架植入术后心功能、运动耐力和生活质量的影响效果

目的:探讨抗阻联合有氧运动能否改善经皮冠脉介入治疗(percutaneous coronary intervention,PCI)术后患者心功能、运动耐力、生活质量。方法:选择符合入选标准的PCI术后患者60例,采用随机数表法将受试者随机分为混合训练组(抗阻与有氧训练相结合)、有氧训练组和对照组。三组均接受常规药物的治疗,在这基础上,混合训练组进行抗阻训练以及有氧耐力训练12月,有氧训练组进行有氧耐力训练12月,对照组进行日常生活活动。干预前和干预12月后对三组受试者进行左室射血分数(left ventricular ejection fraction,LVEF)、峰值功率(peak power,PP)、最大摄氧量(maximal oxygen consumption,VO2max)、运动持续时间(exercise duration,ED)、6分钟步行距离测试(6 minute’s walk test,6MWT)和SF-36生活质量量表得分进行评估和比较。结果:治疗前,3组间LVEF、PP、VO2max、ED、6MWT和SF-36生活质量量表得分各项指标比较,差异均无统计学意义(P0.05);治疗后,3组的LVEF、PP、6MWT和SF-36生活质量量表得分比较,差异均有统计学意义(P0.05)组间两两比较显示:有氧训练组、混合训练组与对照组比较,LVEF、PP、6MWT和SF-36评估得分间差异均具有统计学意义(P0.05)混合训练组与有氧训练组比较,LVEF和PP间差异均有统计学意义(P0.05),6MWT和SF-36生活质量量表得分间差异均无统计学意义。结论:对于PCI术后的冠心病患者,抗阻训练和有氧训练具有协同作用,联合治疗比单一有氧运动治疗更能改善其心功能和运动耐力,可以更好地提高患者的生活质量。     

弹力带渐进抗阻训练对膝关节置换术后患者下肢运动功能的影响

目的:探讨弹力带渐进抗阻训练对单膝关节全膝关节置换术后患者下肢运动功能的影响。方法:选取27例全膝关节置换术后患者,分为渐进抗阻训练组(A组)和等张肌力训练组(B组),分别于研究开始(T0)、6周后(T1)、12周后(T2)采集患者单足支撑相患肢股外侧肌和股二头肌表面肌电信号(拮抗收缩指数,CCI),VAS,6MWT。对上述数据进行组间及组内比较。结果:经过6周的渐进抗阻训练,A组患者VAS、CCI明显降低(P0.05),6MWT明显增加(P0.05);在随后的6周训练后,A组患者VAS、CCI持续降低(P0.05),6MWT继续增加(P0.05)。经过6周的等张肌力训练,B组患者6MWT、VAS、CCI均无明显变化;经过12周的等张肌力训练,B组患者VAS、CCI明显降低(P0.05),6MWT明显增加(P0.05)等张肌力训练组;但上述指标在T1与T2间无明显差异。经过12周的肌力训练,渐进抗阻训练组CCI、VAS明显低于(P0.05),6MWT明显大于(P0.05)等张肌力训练组。结论:抗阻肌力训练能有效改善TKA患者下肢肌肉协同收缩模式,缓解疼痛,提高功能活动能力。与等张抗阻训练相比,弹力带渐进抗阻训练在改善TKA术后下肢运动控制,缓解疼痛,提高活动能力方面更具优势。     

有氧运动和抗阻运动对原发性高血压患者自主神经功能干预效果对比研究

目的:比较有氧运动和抗阻运动对原发性高血压患者自主神经功能的干预效果。方法:选取原发性高血压患者60例,分为有氧运动组、抗阻运动组和有氧抗阻运动组各20例,分别给予有氧运动、抗阻运动和有氧抗阻运动。比较3组干预前后血压的变化及心率变异性(HRV)和血压变异性(BPV)。结果:干预后,有氧抗阻运动组的收缩压和舒张压均低于另2组,降压幅度均高于另2组(均P<0.05)。有氧运动组和有氧抗阻运动组HRV-HF较干预前均升高(P<0.05),HRV-LF、HRV-LF/HF及BPV-LF较干预前均降低(P<0.05),抗阻运动组的结果与另2组相反。干预后HRV-HF值由高到低依次为有氧抗阻运动组、有氧运动组和抗阻运动组(均P<0.05),HRV-LF、HRV-LF/HF及BPV-LF值3组排序相反(均P<0.05)。结论:有氧抗阻运动可明显降低原发性高血压患者的血压,并且降压效果优于有氧运动和抗阻运动,可能与改善患者的心血管自主神经功能有关。     

Liver hemostasis using high-intensity focused ultrasound

Liver hemorrhage, the major cause of death in hepatic trauma, is notoriously difficult to control. We report on the use of high-intensity focused ultrasound (HIFU) to arrest the bleeding from incisions made in rabbit livers. A HIFU transducer, with a spherically curved aperture of 6.34 cm² area, a focal length of 4 cm and a frequency of 3.3 MHz was used. In approximately 94% of the incisions, the hemorrhage was reduced to a slow oozing of blood in less than 2 min. The maximum temperature of liver tissue around the incision area, during HIFU application, was measured to be 86°C. The mechanism of hemostasis, confirmed by histological examination, appears to be coagulative necrosis of a volume of liver tissue around the incision. We believe that acoustic hemostasis, with the unique characteristic of “volume cauterization”, offers a novel method for the management of liver hemorrhage and, thus, has major clinical implications.     

Improved visualization of high-intensity focused ultrasound lesions

Spectral parameter imaging in both the fundamental and harmonic of backscattered radio-frequency (RF) data were used for immediate visualization of high-intensity focused ultrasound (HIFU) lesion sites. A focused 5-MHz HIFU transducer with a coaxial 9-MHz focused single-element diagnostic transducer was used to create and scan lesions in chicken breast and freshly excised rabbit liver. B-mode images derived from the backscattered RF signal envelope were compared with midband fit (MBF) spectral parameter images in the fundamental (9-MHz) and harmonic (18-MHz) bands of the diagnostic probe. Images of HIFU-induced lesions derived from the MBF to the calibrated spectrum showed improved contrast (approximately 3 dB) of tumor margins versus surround compared with images produced from the conventional signal envelope. MBF parameter images produced from the harmonic band showed higher contrast in attenuated structures (core, shadow) compared with either the conventional envelope (3.3 dB core; 11.6 dB shadow) or MBF images of the fundamental band (4.4 dB core; 7.4 dB shadow). The gradient between the lesion and surround was 3.4 dB/mm, 6.9 dB/mm and 17.2 dB/mm for B-mode, MBF-fundamental mode and MBF-harmonic mode, respectively. Images of threshold and "popcorn" lesions produced in freshly excised rabbit liver were most easily visualized and boundaries best-defined using MBF-harmonic mode.     

Magnetic resonance-guided high-intensity ultrasound ablation of the prostate

OBJECTIVES: This paper describes our work in developing techniques and devices for magnetic resonance (MR)-guided high-intensity ultrasound ablation of the prostate and includes review of relevant literature. METHODS: Catheter-based high-intensity ultrasound applicators, in interstitial and transurethral configurations, were developed to be used under MR guidance. Magnetic resonance thermometry and the relevant characteristics and artifacts were evaluated during in vivo thermal ablation of the prostate in 10 animals. Contrast-enhanced MR imaging (MRI) and diffusion-weighted MRI were used to assess tissue damage and compared with histology. RESULTS: During evaluation of these applicators, MR thermometry was used to monitor the temperature distributions in the prostate in real time. Magnetic resonance-derived maximum temperature thresholds of 52 degrees C and thermal dose thresholds of 240 minutes were used to control the extent of treatment and qualitatively correlated well with posttreatment imaging studies and histology. The directional transurethral devices are selective in their ability to target well-defined regions of the prostate gland and can be rotated in discrete steps to conform treatment to prescribed boundaries. The curvilinear applicator is the most precise of these directional techniques. Multisectored transurethral applicators, with dynamic angular control of heating and no rotation requirements, offer a fast and less complex means of treatment with less selective contouring. CONCLUSIONS: The catheter-based ultrasound devices can produce spatially selective regions of thermal destruction in prostate. The MR thermal imaging and thermal dose maps, obtained in multiple slices through the target volume, are useful for controlling therapy delivery (rotation, power levels, duration). Contrast-enhanced T1-weighted MRI and diffusion-weighted imaging are useful tools for assessing treatment.     

Production of harmonics in vitro by high-intensity focused ultrasound

Experiments were performed to investigate the production of harmonics by high-intensity focused ultrasound (HIFU) produced by a spherical bowl; spherical radius 15 cm, frequency 1.7 MHz, as a function of beam power in excised bovine liver. The intensity of the nth harmonic, in both water and the tissue sample, varied approximately as the nth power of the incident intensity up to the point at which irreversible changes were produced in the sample. The greatest observed axial power absorption enhancement factor was approximately 6.3, and the greatest observed total absorbed power enhancement was approximately 2.3. These enhancements may have some effect on the onset of lesioning, but not much effect on its subsequent development. In water, at an intensity of about 120 W/cm² at the focus, the −3-dB beam diameters of harmonic components were observed to vary approximately as the inverse square root of the harmonic number.     

Feasibility study of ultrasonic computed tomography-guided high-intensity focused ultrasound

The aim of this study was to establish a proof of concept for an ultrasonic image-guided high-intensity focused ultrasound (HIFU) breast treatment system. An ultrasonic computed tomography (UCT) scanner served as a platform for image acquisition and thermal mapping. With this system, images depicting the speed of sound (SOS) can be obtained. After HIFU activation, the resulting changes in SOS can be mapped. For the temperature range T ≤ 45°C, the temperature elevation is obtained directly from the change in SOS. For thermal ablation, monitoring is obtained by studying the temporal derivative of the SOS while continuous HIFU heating is applied. The method was implemented to in vitro tissue specimens and the ability for thermal monitoring was demonstrated. The results indicate that the suggested concept is indeed feasible.     

Resection of abdominal solid organs using high-intensity focused ultrasound

Our objective was to evaluate high-intensity focused ultrasound (HIFU) for minimizing blood loss during surgery by hemodynamically isolating large portions of solid organs before their resection. A high-power HIFU device (in situ intensity of 9000 W/cm(2), frequency of 3.3 MHz) was used to produce a wall of cautery for sealing of blood vessels along the resection line in surgically exposed solid organs (liver lobes, spleen and kidneys) of eight adult pigs. Following HIFU application, the distal portion of the organ was excised using a scalpel. If any blood vessels were still bleeding, additional HIFU application was used to stop the bleeding. The resection was achieved in 6.0 +/- 1.5 min (liver), 3.6 +/- 1.1 min (spleen) and 2.8 +/- 0.6 min (kidneys) of HIFU treatment time, with no occurrence of bleeding for up to 4 h (until sacrifice). The coagulated region at the resection line had average width of 3 cm and extended through the whole thickness of the organ (up to 4 cm). Blood vessels of up to 1 cm in size were occluded. This method holds promise for future clinical applications in resection of solid tumors and hemorrhage control from high-grade organ injuries.     

Hemostasis of punctured vessels using Doppler-guided high-intensity ultrasound.

The use of Doppler ultrasound was investigated to determine if it would aid in guiding the application of high-intensity focused ultrasound (HIFU) to stop bleeding from punctured vessels. Major vessels (abdominal aorta, illiac, carotid, common femoral and superficial femoral arteries and the jugular vein) were surgically exposed, punctured and treated in anesthetized pigs. Treatment was applied when the Doppler sounds indicated the focus coincided with the bleeding site. In 89 treatment trials, the average time to achieve major hemostasis (a point where bleeding was reduced to a level of only oozing) was 8 s, and for complete hemostasis was 13 s. These times were significantly shorter than those of an identical former study in which only visual guidance was used. In that study, the average times for major and complete hemostasis were 40 and 62 s, respectively. The advantage of Doppler guidance in applying HIFU in treating bleeding vessels was demonstrated.     

脉冲高强度聚焦超声在治疗中的应用

脉冲高强度聚集超声不像传统的高强度聚焦超声发射连续波消融组织,而是脉冲超声辐照局部组织机械能量的不连续积累。脉冲高强度聚焦超声辐照局部组织可以促进基因的转染和表达、靶向传输药物治疗肿瘤以及增强超声微泡造影剂的溶栓作用。本文综述了其在肿瘤、溶栓等方面的应用研究进展。     

高能聚焦超声治疗良性前列腺增生的临床应用

目的探讨Sonablate500高能聚焦超声治疗仪在良性前列腺增生治疗中的临床应用。方法自2002年12月~2003年12月使用Sonablate500高能聚焦超声治疗仪对113例良性前列腺增生患者进行经直肠超声消融。结果术后使用国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率以及经直肠B超检测前列腺体积作为评价指标随访12个月。IPSS评分由术前21.6分降至8.8分(P<0.001)。QOL评分由术前4.9降至2.2(P<0.001)。最大尿流率由(5.3±3.5)ml/s增加至(12.3±5.2)ml/s(P<0.01)。前列腺体积由48.9ml降至36.5ml(P<0.01)。术后患者均有轻微的血尿,3例出现附睾炎(占2.7%),35例出现短期血精(占31%),15例出现逆向射精(占13%)。结论高能聚焦超声在良性前列腺增生治疗中具有微创、安全、术中无出血、疗效确切、痛苦少、恢复快、并发症少等优点,特别对一些高危的老年患者尤为适合,值得推广应用。     

Effect of vitamin C on neutrophil function after high-intensity exercise

High-intensity exercise leads to an increased risk of upper respiratory tract infections in athletes, which had been related to an exercise-induced impairment of neutrophil function. In this study, several indices of neutrophil function were analysed before and after a biathlon and the effect of oral vitamin C on neutrophil function was determined. Six athletes took 2 g vitamin C daily for 1 week prior to a biathlon and four athletes did not take any supplementation. Neutrophil phagocytosis was analysed by fluorescence microscopy and flow cytometry. Cytosolic calcium kinetics were assessed fluorometrically and neutrophil bactericidal ability was assessed by fluorescence microscopy. Reactive oxygen production was analysed by flow cytometry. Catecholamines were analysed by high-performance liquid chromatography. After high-intensity exercise there were significant reductions in the number of phagocytosed Escherichia coli per neutrophil and in neutrophil bactericidal ability. There was a significant exercise-dependent increase of catecholamines. There was no difference between the two groups of athletes. These results do not support the concept that vitamin C supplementation corrects neutrophil dysfunction after strenuous exercise.