水中平板运动对外周动脉疾病患者下肢经皮氧分压及运动能力影响的研究

目的:观察水中平板运动训练(UWTT)和普通平板运动训练(LTT)对外周动脉疾病(PAD)患者下肢经皮氧分压及运动能力的影响。方法:将58例轻、中度外周动脉疾病患者随机分为对照组(18例)、普通平板运动组(20例)及水中平板运动组(20例)。对照组只接受常规药物治疗,普通平板运动组和水中平板运动组,在常规药物治疗的基础上,分别给予普通平板运动训练和水中平板运动训练。训练频率均为每天1次,每周5天,持续12周。观察以下指数在治疗前后的评估结果:踝肱指数(ABI);PAD运动能力相关指标:运动平板测试、小腿经皮氧分压(TcPO_2)、6分钟步行距离测试(6MWDT)及行走受损问卷(WIQ);骨骼肌力量及平衡能力相关指标:肌肉力量测试、富尔顿高级平衡量表平衡评分(FAB-scale)。结果:所有测试指标,对照组治疗前后都无显著性差异(P0.05);普通平板运动及水中平板运动与本组治疗前相比,ABI、诱发跛行疼痛时间及达到跛行严重疼痛时间、TcPO_2、6MWDT、WIQ、肌肉力量、FAB量表评分值均明显提高(P0.05或P0.01);与对照组治疗后相比,普通平板运动及水中平板运动诱发跛行疼痛时间及达到跛行严重疼痛时间均明显延长(P0.001),TcPO_2、6MWDT、WIQ、肌肉力量、FAB量表评分均显著提高(P0.05或P0.01);水中平板运动与普通平板运动相比,诱发跛行疼痛时间及达到跛行严重疼痛时间、6MWDT、肌肉力量、FAB量表评分均显著升高(P0.05或P0.01)。结论:普通平板运动组与水中平板运动组均可以改善外周动脉疾病患者下肢经皮氧分压及运动能力,且水中平板运动效果优于普通平板运动。     

艾灸联合平板运动治疗外周动脉疾病患者下肢运动功能的疗效观察

目的:观察艾灸联合平板运动治疗外周动脉疾病患者下肢运动功能的临床疗效。方法:将58例轻、中度外周动脉疾病患者随机分为对照组(18例),平板运动组(20例)及艾灸联合平板运动组(20例)。在患者均接受常规药物治疗的基础上,分别进行平板运动及艾灸联合平板运动干预。干预前后分别行小腿经皮氧分压、运动平板测试、6min步行试验及行走受损问卷评估。结果:干预12周后,平板运动组和艾灸联合平板运动组患者经皮氧分压基线、平板测试诱发跛行疼痛发作及最大跛行疼痛的时间,6min步行距离及行走受损问卷评估均比对照组明显提高(P0.01);且艾灸联合平板运动组的患者在改善下肢运动功能方面均优于平板运动组(P0.01)。结论:平板运动及艾灸联合平板运动均可以明显改善外周动脉疾病患者下肢运动功能,且艾灸联合平板运动对患者下肢运动功能的改善更为显著。     

回旋灸中医护理干预对外周动脉疾病病人下肢运动功能的影响

[目的]探讨对外周动脉疾病(PAD)病人实施回旋灸中医护理干预对其下肢运动功能的影响。[方法]将80例PAD病人采用随机分组信件法分为观察组和对照组,每组40例。对照组采用平板上步行训练,观察组采用回旋灸中医护理干预,疗程均为12周,比较两组病人干预前后经皮氧分压(TcPO_2)值、6 min步行试验(6区MWT)、行走受损问卷(WIQ)测定值及血清血管内皮生长因子(VEGF)、内皮素-1(ET-1)、白介素-6(IL-6)、一氧化氮(NO)、高敏C反应蛋白(hs-CRP)的表达水平。[结果]干预后观察组病人TcPO_2、6 MWT及WIQ测定值均明显高于对照组(P0.05);观察组病人VEGF、NO水平均明显高于对照组(P0.05),ET-1、IL-6、hs-CRP水平均明显低于对照组(P0.05)。[结论]回旋灸中医护理干预可明显改善PAD病人下肢运动功能,可能的作用机制包括平衡炎症反应和改善微循环。     

外周动脉疾病患者运动训练的最佳证据总结

目的 检索、汇总外周动脉疾病（peripheral arterial disease,PAD）患者运动训练的最佳证据,为临床外周动脉疾病患者运动训练干预提供循证依据。 方法 检索UpToDate、美国血管外科学会网站、欧洲血管外科学会网站、Cochrane Library、PubMed、Springer Link、Embase、CINAHL、医脉通、中华医学会血管外科分会网站、超星期刊数据库、中国知网、万方数据库、中文科技期刊数据库针对PAD患者进行运动训练的证据。证据来源包括临床指南、证据总结、专家共识、系统评价及荟萃分析等。文献检索时限为建库至2021年7月1日。此外,由2名研究者对所纳入的文献质量进行评价和提取所需资料。 结果 共纳入14篇文献。从运动安全、运动时机、运动方式、运动强度、运动时间、效果评价、注意事项7个方面,共提取20条最佳证据。 结论 运动训练可以提高PAD患者的步行能力,改善生活质量,建议在保证安全的前提下应进行运动训练干预。该研究证据总结过程严谨、内容全面。在实际临床工作中,医护人员在应用证据时需考虑到实际的应用环境和患者的个体情况。     

踏车运动对恢复期脑卒中患者步行能力的影响

目的：探讨踏车运动对恢复期脑卒中患者步行能力的影响。方法：将具有一定行走能力的61例恢复期脑卒中患者随机分为观察组（31例）和对照组（30例），对照组患者采用常规康复训练方法，观察组患者在常规康复训练的基础上．增加踏车运动，8周后评定疗效。结果：经过8周的康复训练后，两组的步行能力明显提高，但是观察组提高的程度高于对照组，观察组独立和监视步行患者达87．1％，对照组60％，两组间差异有显著性意义（P〈0．05）。结论：踏车运动对提高恢复期脑卒中患者的步行能力有积极作用。     

行走受损问卷在外周动脉疾病临床研究中的应用

外周动脉疾病（Peripheral arterial disease,PAD）指上肢或下肢动脉疾病,临床多指下肢动脉疾病。PAD可表现为小腿疼痛、间歇性跛行（Intermittent claudication,IC）、静息痛、溃疡及坏疽,是下肢截肢的主要原因,严重损害了患者的日常活动,特别是行走能力。     

踏车运动对恢复期脑卒中患者ADL的影响

目的：探讨踏车运动对恢复期脑卒中患者日常生活活动能力（ADL）的影响。方法：61例有一定行走能力的恢复期脑卒中患者随机分为观察组31例和对照组30例,均采用常规康复训练方法配合治疗,观察组并增加踏车运动,每天1次,30min。结果：经过8周的训练后,与治疗前比较,2组患者的ADL明显提高（P〈0.05）,观察组提高的程度优于对照组（P〈0.05）。结论：踏车运动对提高恢复期脑卒中患者的ADL有积极作用。     

多通道FES踏车训练对脑卒中患者下肢感觉-运动能力的临床影响

目的：观察多通道功能性电刺激踏车训练对脑卒中患者下肢本体感觉、平衡及步态的影响。方法：选取44例脑卒中患者随机分为对照组和观察组，每组22例。对照组给予常规康复训练和普通主被动踏车训练，观察组进行常规康复训练和多通道功能性电刺激踏车训练。治疗前、治疗8周后采用平衡仪评估患者的本体感觉；采用Berg平衡量表(BBS)评估患者的平衡功能；采用三维步态评估患者的步行功能。结果：治疗8周后，2组患者ATE、Time以及步宽的数值均较治疗前降低（P<0.05），且观察组的数值更低于对照组（P<0.05)；2组患者BBS评分、步长、步速、健侧时间摆动占比以及下肢各关节最大活动角度的数值均较治疗前提高（P<0.05），且观察组的数值更高于对照组（P<0.05)；患者患侧下肢ATE差值与步宽差值呈正相关（P＜0.05），与步长差值、步速差值、健侧摆动时间占比差值、患侧髋关节/膝关节/踝关节屈伸角度差值均呈负相关（P＜0.05）；患者Time差值与步宽差值呈正相关（P＜0.05），与步长差值、步速差值、健侧摆动时间占比差值、患侧髋关节/踝关节屈伸角度差值均呈低度负相关（P＜0.05）。结论：在常规康复治疗基础上联合使用多通道功能性电刺激踏车训练可以有效提高脑卒中患者的本体感觉，进一步改善平衡功能以及步态。     

踏车训练中应用循环性功能性电刺激对脑卒中患者下肢运动功能恢复的影响

目的:观察踏车训练中联合应用循环性功能性电刺激对脑卒中患者下肢运动功能恢复的影响。方法:40例脑卒中患者随机数字表法分为观察组和对照组各20例。2组均采用常规康复训练,其中对照组增加下肢踏车训练(RT300踏车训练系统),观察组在踏车训练的基础上增加循环性功能性电刺激(FES)训练。治疗前后分别采用简式Fugl-Meyer评定法(FMA),Berg评定法(BBS),功能性步行分级量表(FAC)进行下肢运动功能评定。结果:治疗8周后,2组FMA、BBS评分及FAC分级均较治疗前明显提高(均P0.05),且观察组高于对照组(P0.05)。结论:在踏车训练中联合应用循环性功能性电刺激能够更好地改善脑卒中患者的下肢运动功能。     

平衡训练对脑卒中偏瘫患者下肢运动能力的影响

目的:探讨平衡训练对脑卒中偏瘫患者下肢运动能力的影响.方法:脑卒中偏瘫患者61例,将其随机分为观察组31例和对照组30例.2组均给予常规康复训练,观察组在此基础上加用Biodex平衡功能分析训练仪进行训练;训练前后进行功能性步行量表(FAC)、下肢运动功能评定量表(FMA)、日常生活活动能力Barthel指数(BI)及Berg平衡量表(BBS)评定.结果:治疗5周后,2组FMA、BI、BBS及FAC评分均较治疗前明显提高(P＜0.01,0.05),且观察组更高于对照组(P＜0.05).结论:平衡训练结合常规康复治疗对脑卒中偏瘫患者下肢运动能力的恢复较常规康复治疗效果更好.     

Effects of ambulation on foot oxygen tension in limbs with peripheral atherosclerosis

Summary. As walking a few steps increases the arteriovenous pressure difference for blood flow through the feet, we studied the effect of a brief period of walking on transcutaneous oxygen tension (tcPO₂). Foot tcPO₂ was measured using Clarke type electrodes before, during and after a brief period of repetitive walking on the treadmill in 15 patients with various degrees of arterial obstruction. TCPO₂ was significantly higher during walking, than while standing on the treadmill, in limbs with severe disease manifested by toe systolic pressure < 30 mmHg (mean change 0.7 kPa or 5 mmHg, P= 0.001). Also, supine tcPO₂ was significantly higher following periods of walking than before in limbs with toe pressure both below and above 30 mmHg (mean change 1.5 kPa or 11 mmHg, P < 0.001). The results indicate that a brief period of walking increases skin oxygenation. Regimens of such exercise may promote healing in some limbs with arterial disease.     

Evaluation of the one-minute exercise test to detect peripheral arterial disease

Background Asymptomatic peripheral arterial disease (PAD) is common amongst the elderly and is a risk factor for cardiovascular morbidity and mortality. PAD can be assessed by non‐invasive tests such as the ankle/brachial pressure index (ABPI) at rest and Doppler flow velocity (DFV) scanning, but these tests may underestimate the prevalence of PAD. The aim of this study was to estimate the added value, for the detection of PAD, of the one‐minute exercise test, defined as positive if the drop of the ankle systolic pressure was more than 30 mmHg. We also investigated whether the combination of the ABPI at rest and the one‐minute exercise test could replace DFV scanning. Materials and methods We studied this in a random sample (n = 631) of a 50‐ to 75‐year‐old population. Results Of these subjects 11% (66/631) had an abnormal ABPI (< 0·9) and 16% (102/631) had an abnormal DFV curve. Of this sample 72% of the subjects performed a one‐minute exercise test. Of all subjects 6% (27/451) had an abnormal ABPI (< 0·9) and 12% (54/451) had an abnormal DFV curve. The one‐minute exercise test revealed seven cases of PAD (beyond the 67 already identified) which were not detected by an abnormal ABPI at rest and/or DFV scanning. As a result the prevalence of PAD increased by 2%. All patients with an aortoiliac or femoropopliteal obstruction had an ABPI at rest < 0·9. The sensitivity of the combination of the ABPI at rest and the one‐minute exercise test to detect abnormal DFV curves was low for crural obstructions. Conclusion The one‐minute exercise test slightly improves the detection of peripheral arterial disease in the general population.     

One-year effect of a supervised exercise programme on functional capacity and quality of life in peripheral arterial disease

Purpose: Peripheral arterial disease (PAD) is a chronic, progressive disease with a significant cardiovascular and cerebrovascular risk burden and a considerable impact on functional capacity and quality of life (QoL). Exercise programmes result in significant improvements in walking distances but long-term effects are uncertain. The aim of this study was to assess the one-year effects of participation in a 12-week supervised exercise programme on functional capacity and QoL for PAD patients. Methods: Patients were randomly allocated to a control (n = 16) or an exercise (n = 28) group. Data regarding functional capacity (Walking Impairment Questionnaire WIQ), disease-specific QoL (Intermittent Claudication Questionnaire ICQ) and generic QoL (SF-36) were collected at baseline, 12 weeks and 1 year. Results: At 12 weeks, there was a trend towards improved QoL in both groups, with a tendency for greater improvement in the exercise group (p = 0.066) and a trend towards improved functional capacity (WIQ Stair-climbing p = 0.093) in the exercise group. At 1 year, ICQ scores in the exercise group were considerably better than those in the control group (p = 0.058), reflecting improved QoL and maintenance of benefits. Conclusions: Participation in a supervised exercise programme results in improvements in functional capacity and QoL at 1 year post-participation.

Implications for Rehabilitation

• Peripheral arterial disease has a considerable impact on functional capacity and quality of life

• Functional capacity and quality of life are improved in patients with peripheral arterial disease up to 1 year post-participation in supervised exercise

• Improvements at 1 year are reduced from those noted immediately following an exercise programme

     

Relationship between arterial baroreflex sensitivity and exercise capacity in patients with acute myocardial infarction

To investigate the relationship between arterial baroreflex sensitivity (BRS) and exercise capacity, we examined arterial BRS and its relation to exercise capacity during upright bicycle exercise in 40 uncomplicated patients with acute myocardial infarction. Arterial BRS was measured 3 weeks (20 ± 5 days) after acute myocardial infarction and assessed by calculating the regression line relating phenylephrine‐induced increases in systolic blood pressure to the attendant changes in the R–R interval. All patients underwent graded symptom‐limited bicycle exercise with direct measurements of hemodynamic and metabolic measurements. In all patients, the average arterial BRS was 5·6 ± 2·6 ms mmHg^?1. There were no significant correlations between arterial BRS and hemodynamic measurements at rest. However, arterial BRS was negatively related to systemic vascular resistance at peak exercise (r = ?0·60, P = 0·0001) and percent change increase in systemic vascular resistance from rest to peak exercise (r = ?0·45, P = 0·003), whereas arterial BRS was positively related to cardiac output (r = ?0·48, P = 0·002) and stroke volume at peak exercise (r = 0·42, P = 0·007), and percent change increase in cardiac output (r = ?0·55, P = 0·0002) and stroke volume from rest to peak exercise (r = 0·41, P = 0·008). Furthermore, arterial BRS had modest but significant correlations with peak oxygen consumption (r = ?0·48, P = 0·002) and exercise duration (r = 0·35, P = 0·029), indicating that patients with better arterial BRS have better exercise capacity in patients with acute myocardial infarction. These results suggest that arterial BRS was linked to central and peripheral hemodynamic responses to exercise and hence, contributed to exercise capacity after acute myocardial infraction.     

个体化有氧运动对冠心病患者心率恢复及运动能力的影响

目的:探讨个体化有氧运动对心率恢复异常冠心病患者心率恢复情况及运动能力的影响,并分析两者间的相关性。方法:招募经冠状动脉造影确诊的冠心病患者行心肺运动试验(CPET),将75例心率恢复异常(试验终止1min时的心率恢复值(HRR1)≤12次/min)的患者纳入研究,并随机分为康复组(38例)和对照组(37例)。对照组进行常规药物治疗;康复组在对照组基础上加以强度为60%—85%目标心率的个体化有氧运动训练,每次40min,每周3次,共12周。所有患者研究结束后再次进行CPET评估心率恢复及运动能力情况。结果:训练前,两组患者HRR1、峰值功率(PP)、峰值摄氧量(VO2peak)、无氧阈(AT)均无显著差异(P>0.05);训练后,康复组的PP、VO2peak、AT与训练前相比,差异具有显著性(P<0.01,P<0.01,P<0.05),且优于对照组(P<0.05);在HRR1方面,康复组与训练前比较,差异具有显著性(P<0.05);但与对照组相比,差异并不显著(P>0.05),训练后,康复组有16例患者HRR1>12次/min,且PP、VO2peak与HRR1≤12次/min的患者相比,差异具有显著性(P<0.05);康复组HRR1的提高值(△HRR1)与运动能力提高水平(△VO2peak、△PP)呈显著相关性(r=0.347,P<0.05;r=0.419,P<0.01)。结论:虽然有氧运动在改善心率恢复方面并不像提高运动能力那样显著,但是有氧运动可以改善心率恢复并与运动能力的提高密切相关。     

Influence of external pressure on transcutaneous oxygen tension and laser Doppler flowmetry on sacral skin

Summary. The effects of external pressure upon transcutaneous oxygen tension (tcpO₂) and skin blood flow (SKBF) over the sacral area were studied in 16 healthy volunteers. Pressure was applied on the sacral area using a special device which included tcpO₂ and laser-Doppler flowmetry probes. The mean values of tcpO₂, SKBF and wave occurrence of the flow were analysed for 18 increasing pressure levels. A significant decrease of tcpO₂ was observed from 40 mmHg (5.3 Kpa) of applied pressure, while we obtained a significant decrease of SKBF when the external pressure was at 20 mmHg (2.7 Kpa). Using a non-linear regression model, we have found a fourth degree polynomial to describe the relationship between tcpO₂ and SKBF according to increasing pressure. SKBF slow wave occurrence decreased when external pressure was at 10 mmHg (1.3 Kpa), while rapid wave occurrence significantly decreased only at 120 mmHg (16.1 kPa) pressure.     

Pharmacological prevention of atherothrombotic events in patients with peripheral arterial disease

Peripheral arterial disease (PAD) is strongly associated with atherosclerosis in the coronary and carotid arteries, leading to a highly increased incidence of myocardial infarction, ischaemic stroke and cardiovascular death. Fortunately, pharmacological interventions in large clinical trials have been as effective in subgroups of patients with PAD as in subjects with other atherosclerotic disease. Antiplatelet treatment is indicated in virtually all patients with PAD. Aspirin 75-325 mg day(-1) is considered as first-line treatment, and clopidogrel 75 mg day(-1) is an effective alternative. Statin therapy is indicated to achieve a target low-density lipoprotein cholesterol level of < or = 2.5 mmol L(-1) in patients with PAD and there is emerging evidence that even lower levels are beneficial. Lowering of plasma homocysteine by supplementing folic acid, vitamin B(12) and vitamin B(6) is not recommended in patients with mild to moderate hyperhomocysteinaemia in the 12-25 micromol L(-1) range, since it does not reduce the incidence of cardiovascular events. Antihypertensive treatment is indicated to achieve a goal blood pressure of < or = 140/90 mmHg or < or = 130/80 mmHg in the presence of diabetes or chronic kidney disease. All classes of antihypertensive drugs are acceptable for treatment of hypertension in patients with PAD, but angiotensin-converting enzyme inhibitors ramipril or perindopril are especially appropriate because they reduce the incidence of cardiovascular events beyond their blood pressure-lowering effects. Beta-blockers should not be used as first-line antihypertensive treatment. Diabetic patients with PAD should reduce their glycosylated haemoglobin to < or = 7%. In conclusion, pharmacological secondary prevention of cardiovascular morbidity and mortality in patients with PAD should be as comprehensive as that in patients with established coronary or cerebrovascular disease.     

Related factors associated with exercise behavior in patients with peripheral arterial disease

[Purpose] This study aimed to identify the factors associated with exercise behavior in patients with peripheral arterial disease. [Participants and Methods] The study included 43 patients with peripheral arterial disease (mean age, 75.2 ± 5.6 years) who were admitted for endovascular treatment from January 2020 to June 2021. Participants were surveyed through questionnaires to assess their physical function for determining their exercise behavior and the presence of physical, personal, and environmental factors that might have affected their stage of change regarding exercise behavior. [Results] A comparison of physical, personal, and environmental factors between the two groups classified by the presence or absence of exercise behavior showed that subjective health and exercise self-efficacy were significantly lower in the group without exercise. Furthermore, a difference was noted in the presence or absence of work. The adjusted binomial logistic regression analysis results using each of the factors differing between the groups, plus the walking impairment questionnaire total score as explanatory variables, showed a significant relationship with exercise self-efficacy only. [Conclusion] The results of this study showed that exercise self-efficacy presented a useful predictive relationship with the presence of exercise behavior in patients with peripheral arterial disease.     

Effects of anesthetic agents on the drift of a transcutaneous oxygen tension sensor

Both halothane and nitrous oxide can be reduced at the cathode of a polarographic oxygen electrode, causing the electrode current to drift upward and report falsely high oxygen tension. Because transcutaneous oxygen tension is measured by a heated oxygen electrode, there is a potential for significant upward drift of these values. To examine the clinical significance of this drift, the following study was performed. Transcutaneous oxygen tension sensors were calibrated at oxygen tensions of 0 mm Hg and 157 mm Hg (room air) just before clinical use during anesthesia. This calibration was rechecked immediately upon removal of the sensor from the patient at the end of the anesthesia. The predominant anesthetic agent used and the duration of monitoring were noted from the record. Data were collected from 208 patients representing a total of 463.6 hours of anesthesia. The patients were divided into five groups based on anesthetic administered: halothane, enflurane, isoflurane, nitrous oxide-narcotic, and local/regional. The mean zero point recalibration value was 0.4 mm Hg or less for all agents except halothane, for which it was 1.8 ± 3.2 mm Hg. This halothane drift was significantly greater than that for the other agents (P<0.01). Room air recalibration was not significantly different in any of the five groups, varying from 160 ± 4.9 mm Hg for halothane to 157 ± 4.9 mm Hg for enflurane. All these drift values are within the manufacturer’s specifications. We conclude that the drift of the transcutaneous oxygen tension sensor due to anesthetic agents is not clinically significant. However, caution should be exercised when halothane is used during an extremely long period of anesthesia.