轻度慢性阻塞性肺疾病患者运动肺功能的研究

目的　探讨轻度慢性阻塞性肺疾病 (COPD)患者运动时通气功能的状况 ,及其与静息肺功能的相关性 ,为临床上COPD患者运动肺功能评价和早期进行康复训练提供参考。方法　收集 13例正常对照和 14例轻度稳定期COPD患者 ,分别行静息肺功能测定和症状自限最大运动负荷递增试验 ,记录用力肺活量 (FVC)、第 1秒用力肺活量 (FEV1.0 )、无氧阈 (AT)、最大运动负荷 (Wmax)、最大耗氧量 (VO2 max)、分钟通气量 (VEmax)、通气储备 (BR)等各项参数。结果　 (1)最大运动负荷时 ,COPD患者Wmax、VO2 、VE、AT及BR等参数均明显低于对照组 (P <0 .0 5 ) ,而VD/VT 却有所增加(P <0 .0 5 )。 (2 )对照组与COPD组运动后FEV1.0 均有所增加 ,但两组增加值比较差异无显著性(P >0 .0 5 )。 (3)COPD患者FVC、FEV1.0 、FEV1.0 占预计值 %、最大通气量 (MVV)与最大运动时WR、VO2 、VE 等指标均呈正相关 (P <0 .0 5 )。结论　COPD患者运动耐力及通气功能减退 ,并与静息肺功能 ,尤其是FEV1.0 和MVV有一定的相关性。     

胸式呼吸训练与腹式呼吸训练对早期脑卒中患者肺功能的影响

目的:探讨胸式呼吸训练与腹式呼吸训练对早期脑卒中患者肺功能的影响。方法:选取2012年11月～2013年2月于本院进行治疗的84例早期脑卒中患者为研究对象,将其随机分为A组(常规康复组)28例、B组(胸式呼吸训练组)28例和C组(腹式呼吸训练组)28例,后将3组患者训练前及训练后12周的肺功能指标、血氧饱和度、动脉血氧分压、运动中最大摄氧量、运动中最大心率、无氧阈值及呼吸力学指标进行比较。结果:C组训练后12周的肺功能指标、血氧饱和度、动脉血氧分压、运动中最大摄氧量、运动中最大心率、无氧阈值及呼吸力学指标均明显优于A组及B组,而B组则优于A组,P均<0.05,均有显著性差异。结论:呼吸训练可有效改善早期脑卒中患者肺功能状态及相关指标,且腹式呼吸训练对患者的作用更佳。     

无氧阈强度运动治疗对慢性缺血性心脏病患者运动耐力的影响

目的 探讨无氧阈强度运动治疗对血管重建后的慢性缺血性心脏病患者运动耐力的影响.方法 43例完全血管重建后的慢性缺血性心脏病患者(3例冠脉搭桥,22例陈旧性心肌梗死及18例不稳定性心绞痛),实施了心肺运动负荷试验(CPET)和3个月的无氧阈强度的运动治疗,其中32例患者完成了运动治疗; 3个月后复查CPET,比较患者运动耐力的前后变化.结果 无氧阈运动强度心率[(97±9)次/min]显著小于传统运动康复的最小运动强度心率[(112±7)次/min],小于运动试验的最初缺血强度心率[(115±11)次/min];3个月后运动处方执行组无氧阈氧耗量从(10.7±2.4 ) ml·min-1·kg-1到(12.6±2.9) ml·min-1·kg-1(P=0.04),有氧运动负荷能力从(37±18) J/s到(47±13) J/s(P=0.04),峰值氧耗量从(15.3±3.1) ml·min-1·kg-1到(20.6±4.2) ml·min-1·kg-1(P=0.02)及峰值运动负荷能力(68±12) J/s到(87±14) J/s(P=0.01),均明显增加;运动处方未执行组的无氧阈氧耗量从(11.0±2.7) ml·min-1·kg-1到(11.3±2.8) ml·min-1·kg-1,有氧运动负荷能力从(38±11) J/s到(37±9) J/s,峰值氧耗量从(15.3±2.9) ml·min-1·kg-1到(16.2±3.1) ml·min-1·kg-1] 和峰值运动负荷能力从(65±13) J/s到(73±16) J/s增加,差异均无统计学意义.结论 无氧阈强度显著小于慢性缺血性心脏病患者运动最初出现缺血时的强度;无氧阈强度运动治疗能有效地提高慢性缺血性心脏病患者的氧代谢水平和运动耐受力.

Abstract：

Objective To investigate the effects of exercise therapy at the intensity of anaerobic threshold (AT) for exercise tolerance in patients with chronic stable coronary artery disease. Methods Forty-three patients with chronic stable coronary artery disease (3 patients after coronary arterial bypass graft (CABG) surgery, 22 patients with old myocardial infarction and 18 unstable angina pectoris undergoing successful percutaneous coronary intervention (PCI) finished twice cardiopulmonary exercise test (CPET) and followed their rehabilitation program for 3 months. Thirty-two patients finished their aerobic exercise therapy based on their individual anaerobic thresholds while 11 patients had no exercise therapy. Results The heart rate at AT intensity (97±9 /min) was lower than their traditional minimal target heart rate (112±7 /min) and lower than heart rate (115±11 /min) at ischemic threshold post-CPET. The O2 consumption (10.7±2.4 to 12.6±2.9 ml·min-1·kg-1) （P=0.04） and workload (37±18 to 47±13 J/s) （P=0.04）at AT level and the O2 consumption (15.3±3.1 to 20.6±4.2 ml·min-1·kg-1,P=0.02) and workload（68±12 and 87±14 J/s, P=0.01）at peak levelmarkedly increased after 3 months in the exercise group. And the O2 consumption（15.3±2.9 to 16.2±3.1 ml·min-1·kg-1）and workload（65±13 to 73±16 J/s）at peak level mild increased after 3 months in the non-exercise group, but their O2 consumption （11.0±2.7 to 11.3±2.8 ml·min-1·kg-1）and workload （38±11 to 37±9 J/s）at AT level had no obvious change. Conclusion AT exercise intensity was lower than ischemic threshold post-CPET. Exercise therapy at the intensity of anaerobic threshold can improve oxygen capacity and exercise tolerance.     

猕猴桃中药复方制剂服用前后人体左心功能的研究

应用超声心动图对40例健康老年人及青年人进行了服用猕猴桃中药复方制剂(大自然健身滋)前后的左心功能测定,根据其测定的各项参数的变化进行分析,证实了猕猴桃中药复方制剂对正常心脏起着保健、扶助作用,可提高左心室的收缩功能,增加心脏输出量,同时可减慢心率,减少心肌耗氧量。     

曲美他嗪对高血压合并糖尿病患者心功能及运动耐量的影响

目的: 观察曲美他嗪治疗对高血压合并2型糖尿病患者心功能及运动耐量的影响。方法: 采用随机、双盲、安慰剂对照的前瞻性研究方法。选择高血压合并2型糖尿病患者60例，随机分成曲美他嗪治疗组和对照组各30例。两组均给予规范降压、降糖、抗血小板及他汀类药物降脂治疗，治疗组在此基础上口服盐酸曲美他嗪治疗，对照组使用安慰剂治疗，疗程为1年。两组治疗前后均行心脏超声心动图检查、运动心肺功能测定、血浆氨基端脑钠肽前体（NT-ProBNP）浓度测定，并测定其超敏C反应蛋白、TNF-α、血管紧张素Ⅱ、血浆内皮素等血浆细胞因子水平。结果: 曲美他嗪治疗组治疗后，左心室质量指数、二尖瓣血流频谱E峰与A峰比值、二尖瓣环运动舒张早期峰速度与舒张晚期峰速度比值及收缩期峰值速度均明显改善，与治疗前及对照组治疗后差异均具有统计学意义（均P < 0.05）；NT-ProBNP下降，与治疗前及对照组治疗后差异均具有统计学意义（均P < 0.05）；运动耐量改善，表现为运动时间延长，运动当量、最大摄氧量、无氧阈增大，各指标与治疗前及对照组治疗后差异均有统计学意义（均P < 0.05）；治疗组超敏C反应蛋白、血浆内皮素、TNF-α、血管紧张素Ⅱ下降，相比治疗前及对照组治疗后差异均有统计学意义（均P < 0.05）。对照组未见上述指标在治疗前后有明显差异（均P>0.05）。两组均未发生严重不良反应。结论: 曲美他嗪能有效改善高血压合并糖尿病患者的心功能，提高运动耐量。     

常规剂量氨茶碱对中老年人运动能力和氧耗量的影响

探讨静脉注射常规剂量氨茶碱对正常中老年人运动肺功能的影响。方法１４例正常中老年人分别于静脉注射０．２５ｇ氨茶碱前后，作症状限制性运动肺功能检查。结果氨茶碱能显著增加静息时分时通气量，呼吸频率及心率，但对运动能力和最大运动负荷时的分时通气量、氧耗量和通气方式等均不产生明显的影响。     

Cigarette smoking decreases dynamic inspiratory capacity during maximal exercise in patients with type 2 diabetes

To investigate the influence of cigarette smoking on exercise capacity, respiratory responses and dynamic changes in lung volume during exercise in patients with type 2 diabetes. Forty-one men with type, 2 diabetes without cardiopulmonary disease were recruited and divided into 28 non-current smokers and 13 current smokers. All subjects received lung function tests and cardiopulmonary exercise testing using tracings of the flow-volume loop. Exercise capacity was compared using the percentage of predicted oxygen uptake at maximal workload (%VO2max). Respiratory variables and inspiratory capacity (IC) were compared between the two groups at rest and at 20%, 40%, 60%, 80% and 100% of maximum workload. Although there was no significant difference in lung function tests between the two groups, venous carboxyhemoglobin (CO-Hb) levels were significantly higher in current smokers. %VO2max was inversely correlated with CO-Hb levels. Changing patterns in respiratory rate, respiratory equivalent and IC were significantly different between the two groups. Current smokers had rapid breathing, a greater respiratory equivalent and a limited increase in IC during exercise. Cigarette smoking diminishes the increase in dynamic IC in patients with type 2 diabetes. As this effect of smoking on dynamic changes in lung volume will exacerbate dynamic hyperinflation in cases complicated by chronic obstructive pulmonary disease, physicians should consider smoking habits and lung function when evaluating exercise capacity in patients with type 2 diabetes.     

孟鲁司特钠对稳定期慢性阻塞性肺疾病患者肺功能及运动耐量的影响

目的观察孟鲁司特钠对稳定期慢性阻塞性肺疾病患者肺功能及运动耐量的影响。方法将入选的60例缓解期慢性阻塞性肺疾病患者随机将其分为对照组和治疗组,治疗组予10mg孟鲁司特钠口服,每天一次,连服6个月,对照组予安慰剂维生素B110mg,每天一次,连服6个月。观察两组治疗前后肺功能及运动肺功能的变化,并记录治疗期间两组发作的次数。其中运动肺功能采用台阶测试方法。结果治疗组肺功能及运动心肺功能均较治疗前改善（P〈0.05）;与对照组比较亦有改善（P〈0.05）;治疗组治疗期间发作次数较对照组明显减少（P〈0.05）。结论服用孟鲁司特钠能较明显地改善稳定期慢性阻塞性肺疾病患者肺功能,提高运动耐量,减少发作次数。     

阿托伐他汀对心脏舒张功能不全合并运动高血压患者运动耐量的影响

目的：观察阿托伐他汀治疗后心脏舒张功能不全合并运动高血压患者运动耐量的改变情况。 方法：采用随机、双盲、安慰剂对照的方法,前瞻性选择左心室舒张功能不全（彩色多普勒二尖瓣血流频谱的舒张早期血流峰速度/舒张晚期血流峰速度比值<1）合并运动高血压（运动最大收缩压>200 mm Hg）患者60例,随机分成阿托伐他汀（立普妥20 mg,每天1次）治疗组及安慰剂对照组各30例。所有入选者入组后原治疗方案继续,疗程1年。两组治疗前后均行运动心肺功能检查、运动血压测定、静息及运动后血浆脑利钠肽（BNP）浓度测定,并测定血浆炎症指标超敏C反应蛋白（hs CRP）及内皮功能指标内皮肽（ET）水平。结果：阿托伐他汀治疗组治疗后,静息收缩压和脉压差降低,运动最大收缩压降低,运动后血浆BNP浓度下降,运动耐量改善,表现为运动时间延长,运动当量、运动最大摄氧量、无氧阈值增大,各指标相比治疗前差异均有统计学意义（均P<005）;相比对照组治疗后静息脉压差、运动最大收缩压、运动后血浆BNP浓度、运动时间差异也有统计学意义（均P<005）。治疗组治疗后血浆hs CRP和ET浓度明显下降,与治疗前及对照组比较差异均有统计学意义（均P<005）。对照组各指标治疗前后差异均无统计学意义（P>005）。 结论：阿托伐他汀治疗能有效降低心脏舒张功能不全合并运动高血压患者血浆hs CRP和ET浓度,并降低运动最大收缩压,降低运动后血浆BNP浓度,改善运动耐量。     

The effects of Chinese Yam-Epimedium mixture on respiratory function and quality of life in patients with chronic obstructive pulmonary disease

OBJECTIVE:To examine the clinical effects of a mixture of Chinese Yam and Epimedium in patients with stable moderate or severe chronic obstructive pulmonary disease(COPD).METHODS:Forty-nine patients with COPD were randomly allocated to a group whose usual treatment was supplemented with oral Chinese Yam-Epimedium mixture,or a control group given placebo.For each patient,body mass index,airflow obstruction,dyspnea,and exercise capacity were measured and converted into the BODE index before treatment and at one and three months after initiation of treatment.Participants also completed the St George’s Respiratory Questionnaire(SGRQ) at the same intervals.RESULTS:After one month,improvements were seen in the BODE index and SGRQ of participants taking Chinese Yam-Epimedium mixture compared to controls.There were statistically significant differences in the SGRQ:three of its components and the total SGRQ scores were significantly decreased(P<0.05),respiratory symptom scores had improved(P<0.01),and the dyspnea component of the BODE index had significantly decreased(P<0.05).Similar improvements were observed after three months of treatment,but exercise tolerance had also improved:the six-minute walking distance had significantly increased(P<0.05) in the treatment group when compared with controls.CONCLUSION:Chinese Yam-Epimedium mixture can significantly improve dyspnea,exercise capacity,and the quality of life of patients with stable moderate or severe COPD.