心肺运动试验指导肺康复运动处方的设计

正以运动为核心的肺康复不仅是慢性阻塞性肺疾病(COPD),同时也是其他慢性心肺疾病患者的综合治疗的重要组成部分之一。大量研究证明,肺康复能减轻患者呼吸困难的症状,提高运动能力和生活质量[1-2]。研究显示,运动锻炼的效果与运动强度成正比[3]。但高强度运动也增加了运动相关的风险。因此,临床上需要在控制运动风险的前提下,提高运动强度,以达到肺康复效益的最大化。     

心肺运动试验简介

<正>心肺运动试验(Cardiopulmonary exercise testing)是通过监测机体在运动状态下的摄氧量(VO2)、二氧化碳排出量(VCO2)、心率(HR)、分钟通气量(VE)等来评价心肺等脏器对运动的反应。由于运动需要肺、心脏和肌肉等脏器密切协     

心脏运动康复对PCI术后冠心病患者心肺功能及生活质量的影响

目的评价心脏运动康复对冠心病经皮冠状动脉介入治疗(PCI)术后患者心肺功能及生活质量的影响。方法入选确诊并已行PCI出院的冠心病患者110例,按个人意愿分为康复组和对照组各55例,收集患者的一般资料、入选时和运动治疗6月后心肺运动试验、心脏超声的相关指标及西雅图心绞痛量表(SAQ)等数据,并进行统计学分析,评估心脏运动康复对冠心病PCI术后患者心肺功能及生活质量的影响。结果 6个月运动康复治疗后,康复组患者无氧阈(AT)、最大摄氧量(VO2max)、氧脉搏(O2pulse)、最大运动时间、左心室射血分数(LVEF)、SAQ评分均优于干预前与对照组,差异有统计学意义(P0. 05)。结论心脏运动康复治疗可以改善冠心病PCI术后患者的心肺功能,提高患者的运动耐力及生活质量,是冠心病PCI术后患者二级预防的重要组成部分。     

心肺运动试验动态指导下的家庭运动康复对心力衰竭患者的疗效观察

目的探讨心肺运动试验动态指导下的家庭运动康复对心力衰竭患者的疗效。方法将84例心力衰竭好转出院的患者分为观察组(n=42)和对照组(n=42),观察组患者在常规药物治疗基础上,行心肺运动试验,根据试验的结果指导运动方案,定期随访,每隔3个月复查心肺运动试验,根据检查结果重新调整运动方案。对照组予常规药物治疗,行心肺运动试验,根据试验的结果指导运动方案,定期随访。所有运动均由患者家庭中自行完成。12个月后收集各组患者住院次数、住院天数、住院费用指标,统计12个月后能坚持运动的人数。实验前及12个月后行六分钟步行试验测量步行距离,通过明尼苏达心力衰竭生活质量问卷表(MLWHFQ)评估生活质量,超声心动图检查左心室、左心房大小及左心室射血分数,心肺运动试验测量最大摄氧量、无氧阈,统计两组患者的死亡人数、死亡原因、死亡率。结果人均住院次数、人均住院天数、人均住院费用观察组与对照组比较差异均有统计学意义(t=3.924、4.582、3.885,均P <0.01),观察组较之前最终六分钟步行距离明显增大(t=8.506,P <0.05)、生活质量改善(t=4.217,P <0.05)、左心室射血分数改善(t=2.475,P <0.05),最大摄氧量(t=7.468,P <0.05)、无氧阈(t=3.884,P <0.05)明显增加,与对照组比较差异均有统计学意义(P <0.05)。结论心肺运动试验动态指导下的运动康复对心力衰竭患者能有效减少住院次数、住院天数,降低住院费用,改善左心室射血分数,提高生活质量。     

老年心血管疾病运动康复研究进展

正我国社会经济的高速发展,人民健康水平大幅提高,全国人口老龄化比例已达8.87%,医疗水平的快速提升,挽救了老年心血管疾病患者,已造成带病人数剧增,改善其预后和生存质量,已成为重要的公共卫生问题。而心脏运动康复是以改善心脏储备功能、提高生活质量,最终改善患者预后为目的,因此本文着重探讨老年心血管疾病运动康复的进展。1运动改善心血管功能的生理机制     

不同性别、年龄及体力活动心脏康复患者心肺运动试验指标分析

背景 心脏康复是采用多学科方法实施心血管疾病综合二级预防的医学专业手段,分析心脏康复患者心肺运动试验(CPET)指标对了解心脏康复患者心肺功能和运动耐量、进行危险分层、评估心脏康复疗效及判断预后具有重要指导意义及参考价值.目的 分析不同性别、年龄、体力活动心脏康复患者CPET指标.方法 选取2015年11月至2020年...     

心肺运动测试指导心脏康复对慢性心力衰竭患者心肺功能、生命质量影响

目的探讨心肺运动测试(CPET)指导心脏康复对慢性心力衰竭(CHF)患者心肺功能、生命质量的影响。方法选取在我院接受治疗的86例CHF患者,采用随机数字表法分为对照组43例和观察组43例。对照组予以常规抗心力衰竭治疗,包括:吸氧、休息,给予强心苷、利尿药、血管紧张素Ⅱ受体拮抗剂、血管紧张素转化酶抑制剂、钙通道阻滞剂、β受体阻断剂等治疗。在此基础上,观察组依据CPET客观定量评估,精确定制个体化运动处方进行治疗。比较两组患者心肺功能、生命质量、心功能分级、6分钟步行距离(6WMD)、血浆N末端B型脑钠肽原(NT-pro BNP)水平变化。结果观察组患者心肺功能指标峰值氧耗量(peak VO2)和无氧阈氧耗量(VO2AT)均明显增加,而二氧化碳通气当量斜率(VE/VCO2slop)显著下降,且观察组上述指标均明显优于对照组(P 0. 05);两组患者生活质量各项指标评分均显著高于治疗前(P 0. 05);且观察组患者生活质量各项指标评分增幅显著高于对照组(P 0. 05);两组患者6MWD水平均显著上升,且观察组明显大于对照组(P 0. 05);两组患者NT-pro BNP水平均明显降低,且观察组明显低于对照组(P 0. 05);治疗后,观察组心功能分级优于同期对照组(z=2. 95,P 0. 05)。结论 CHF患者通过CPET指导心脏康复治疗不仅可以改善患者心肺功能,还可提高生活质量。     

Diagnostic value of the cardiopulmonary exercise test in coronary artery disease

BackgroundCoronary angiography (CAG) is “gold standard” for the diagnosis of coronary heart disease (CHD). This study aimed to explore the diagnostic value of cardiopulmonary exercise testing (CPET) and the oxygen uptake kinetics indexes of CPET.MethodsOne hundred thirty-one patients with chest pain who underwent coronary angiography in the Department of Cardiology of our hospital from April to September 2021 were selected. According to the results of angiography, the patients were divided into an observation group (patients with coronary heart disease, n=80) and a control group (patients without coronary heart disease, n=75). Both groups underwent CPET before angiography. The differences of peak oxygen uptake, anaerobic threshold, peak kilogram oxygen uptake, peak oxygen pulse, maximum exercise load, maximum metabolic equivalent, and exercise time between the two groups were compared. Also, the correlation between the above indexes and the degree of coronary artery stenosis was analyzed, and the clinical value of the CPET in the diagnosis of CHD was evaluated.ResultsThe peak oxygen uptake, anaerobic threshold, peak kilogram oxygen uptake, peak oxygen pulse, maximum exercise load, maximum metabolic equivalent, and exercise time in the observation group were lower than those in the control group (P<0.01), and were negatively correlated with the Gensini score (P<0.01). The area under the receiver operating characteristic (ROC) curve of the above seven indexes in the combined diagnosis of CHD was 0.974, the sensitivity was 86.40%, and the specificity was 98.50%, which was better than the clinical value of any of the above indexes alone.ConclusionsCPET is an effective non-invasive examination in the diagnosis of CHD, and has a certain clinical value in the evaluation of the severity of coronary artery stenosis.     

心肺运动试验在心血管疾病中的诊疗和预后价值探讨

心血管疾病发病率和病死率持续增高,心肌缺血和心肌梗死是主要病因。心肺耐力反应了个体的心肺功能契合度以及对最大运动强度的耐受程度。心肺耐力为人体五大生命体征之一,可用于评价心血管疾病患病风险。心肺运动试验(CPET)作为新兴的心肺一体化客观无创检测技术,可以较早的推测出患者潜在的病理生理改变。CPET的数据解读相对复杂及未得到广泛普及,其在临床的应用潜力巨大。目前CPET应用领域包括疾病的诊断、病情及预后风险评估、运动处方制定等。用CPET对心血管疾病的早期风险予以评估和诊断,实现早干预、早治疗,符合心脏康复的主流。     

Work-rate affects cardiopulmonary exercise test results in heart failure

AIMS: Cardiopulmonary exercise test (CPET) is used to evaluate patients with chronic heart failure (HF) usually by means of a personalized ramp exercise protocol. Our aim was to evaluate if exercise duration or ramp rate influences the results. METHODS AND RESULTS: Ninety HF patients were studied (peak V (O(2)): >20 ml/min/kg, n=28, 15-20 ml/min/kg, n=39 and <15 ml/min/kg, n=23). Each patient did four CPET studies. The initial study was used to separate the subjects into three groups, according to their exercise capacity. In the remaining studies, work-rate was increased at three different rates designed to have the subjects reach peak exercise in 5, 10 and 15 min from the start of the ramp increase in work-rate, respectively. The order was randomized. The work-rate applied for the total population averaged 22.7+/-8.0, 11.6+/-3.7, 7.5+/-2.9 W/min with effective loaded exercise duration of 5 min and 16 s+/-29 s, 9 min and 43 s+/-49 s and 14 min and 32 s+/-1 min and 12 s for the 5-, 10- and 15-min tests, respectively. Peak V (O(2)) averaged 16.9+/-4.3*, 18.0+/-4.4 and 18.0+/-5.4 ml/min/kg for the 5-, 10- and 15-min tests, (*=p<0.001 vs. 10 min). The shortest test had the lowest peak heart rate and ventilation and highest peak work-rate. Peak V (O(2)) and heart rate were lowest in 5-min tests regardless of HF severity. The DeltaV (O(2))/Deltawork-rate was lowest in 5-min tests and highest in 15-min tests. At all ramp rates, DeltaV (O(2))/Deltawork-rate was lower for the subjects with the lower peak V (O(2)). The V (e)/V (CO(2)) slope and V (O(2)) at anaerobic threshold were not affected by the protocol for any grade of HF. CONCLUSIONS: In chronic HF, exercise protocol has a small effect on peak V (O(2)) and DeltaV (O(2))/Deltawork but does not affect V (O(2)) at anaerobic threshold and V (e)/V (CO(2)) slope.     

原发性醛固酮增多症患者心肺运动试验中运动血压的特点

目的 探讨原发性醛固酮增多症(PA)患者在心肺运动试验(CPET)中,随着运动强度增加,血压的经时变化。方法 连续纳入2017年5月—2019年12月就诊于阜外深圳医院心脏康复科的PA患者50例及原发性高血压(EH)患者60例。通过CPET获取运动中血压参数,比较两组CPET中随着运动强度增加血压的变化。结果两组患者的静息血压,运动3 min、6 min、峰值血压差异无统计学意义(均P>0.05)。PA患者恢复期1 min收缩压[(185.2±25.4)比(172.4±25.8)mm Hg,t=2.516,P=0.011]、恢复期6 min收缩压[(152.3±17.7)比(142.8±23.9)mm Hg,t=2.356,P=0.020]较EH患者增高。性别分层后,男性PA患者恢复期1 min收缩压[(190.6±24.4)比(174.5±27.6)mm Hg,t=2.421,P=0.018]、恢复期6 min收缩压[(157.2±18.8)比(144.4±25.4)mm Hg,t=2.205,P=0.031]较男性EH患者增高。多元线性回归分析显示,恢复期1 min收缩压与2...     

The role of exercise in cardiovascular rehabilitation: a review

The epidemiological literature supports an inverse association and a dose-response gradient between exercise training and both cardiovascular disease in general and coronary artery disease in particular. An overwhelming number of studies has supported similar findings for hypertension, dyslipidaemia, obesity, diabetes, inflammatory and coagulation markers related to cardiovascular disease and cardiac heart failure. Findings are highly suggestive that endurance type exercise training, of moderate intensity most days of the week can lower blood pressure in patients with hypertension, can decrease triglyceride levels and increase HDL cholesterol levels in patients with dyslipidaemia, reduces body weight when combined with diet, improves insulin sensitivity, modifies the inflammatory process and finally can improve stroke volume and reduce cardiomegaly in patients with cardiac heart failure.     

Early exercise test after revascularization and rehabilitation

Ergospirometry was performed on 51 patients before their discharge from hospital, that is between the seventh and tenth days after myocardial revascularization by cardiac bypass surgery. The aim of our study is to show that this type of measurement can be performed with reasonable safety and that it gives an accurate assessment of the patient's ability to withstand exercise. It employs a metabolic approach: study of oxygen consumption (V'O2), carbon dioxide release (V'CO2), the respiratory quotient (RQ), the minute ventilation (V'E) and the respiratory equivalent for oxygen (REO2). The patients withstood a mean load of 82 +/- 17.7 watts for a mean V'O2 of 1.186 +/- 0.258 l/min STPD and a mean V'E of 46.5 +/- 10 l/min BTPS. Changes in respiratory and metabolic parameters as a function of load are discussed, as is the advice that can be given to the patient regarding physical rehabilitation.     

运动心肺功能试验对特发性肺纤维化早期诊断价值探讨

目的　探讨运动心肺功能试验对特发性肺间质纤维化 (IPF)早期的诊断价值。方法　收集 2 0 0 0 - 0 6～ 2 0 0 3- 0 2甘肃省人民医院门诊及住院IPF患者 32例 ,分成早期组 (19例 )和非早期组 (13例 ) ,二组IPF患者和 2 2名正常人进行运动心肺功能试验。结果　运动心肺功能试验各项指标IPF早期组与正常组比较 ,差异有显著性 (P <0 0 5 ) ;非早期组与正常组比较 ,差异有非常显著性 (P <0 0 1) ;非早期组与早期组比较 ,差异有显著性 (P <0 0 5 )。结论　运动心肺功能试验检查能显著提高IPF的早期诊断水平