中重度慢性阻塞性肺疾病患者无氧阈和高强度肺康复运动方案的比较

目的 比较无氧阈和高强度肺康复运动方案在中重度COPD患者中的效果.方法 2006年3月至12月在广州呼吸疾病研究所门诊就诊的中重度COPD患者54例入组,13例脱落.随机分为无氧阈组(15例)、高强度组(17例),另设对照组(9例).无氧阈组以无氧阈为运动强度,高强度组以最大可耐受的运动强度,进行12周(每周2次)的康复计划.康复前后分别测静态肺功能、心肺运动试验,记录心肺运动试验中每分钟呼吸困难(Borg)指数.采用SPSS 12.0软件进行统计学处理,受试者一般情况以x±s表示,均数两两比较采用独立样本t检验,试验前后总体均数比较采用配对t检验,两组以上均数比较采用单因素方差分析,率的比较采用Fisher精确概率法,非参数指标(如Borg指数)采用非参数Wilcoxon或Mann-Whitney u检验.结果 无氧阈组和高强度组康复后的峰值摄氧量占预计值%分别为(69±14)%和(79±13)%,明显高于康复前的(61±11)%和(72±12)%;康复后无氧阈组的峰值摄氧量占预计值%提高(14±17)%,高强度组提高(12±13)%,两组的改善程度无明显差别.高强度组康复后的无氧阈占预计值%为(42±9)%,明显高于康复前的(38±8)%.在56 W运动强度时,高强度组康复后的分钟通气量为(33±5)L/min,比康复前的(36±4)L/min明显下降(t=6.167,P<0.01);康复后的呼吸频率为(31±3)次/min,比康复前的(32±1)次/min明显下降(t=2.876,P<0.05);康复后的潮气量为(1.3±0.3)L,比康复前的(1.2±0.3)L明显升高(t=2.587,P<0.05).无氧阈组和高强度组康复后的心率分别为(109±39)次/min和(110±25)次/min,比康复前的(116±39)次/min和(114±42)次/min明显下降;康复后的氧脉分别为(10.4±4.0)ml/次和(9.0±3.2)ml/次,比康复前的(9.6±3.7)ml/次和(8.5±4.3)ml/次明显升高.无氧阈组和高强度组康复后的单位摄氧量下Borg指数分别由8.6±3.2和6.5±2.6下降到7.4±2.5和5.6±2.4,均得到明显改善,但改善程度无明显差别.结论 无氧阈和高强度的肺康复方案均可改善运动能力和呼吸困难症状,且改善程度相似,但高强度方案可额外改善无氧阈和通气形式.     

高血压及左心室肥厚患者的心肺运动功能

目的 评估高血压及伴左心室肥厚(LVH)患者心肺运动功能改变并探讨LVH对心脏贮备功能的影响.方法 对70例原发性高血压(EH)患者根据超声心动图测定的左心室质量指数(LVMI)分为LVH组和非LVH组,选健康体检者为对照组.应用内置同步12导联心电图的运动心肺功能仪测定和比较各组在分级递增运动后达无氧阈(AT)和最大摄氧量(VO2max)时的代谢当量(METs),摄氧量(VO2),公斤体重摄氧量(VO2/kg),和每搏摄氧量(VO2/HR).结果 (1)在达AT值时,EH并LVH组和非LVH组METs和VO2/kg均低于对照组[METs:3.57±0.8和4.34±1.47比5.21±1.45,P<0.01;VO2/kg:(12.38±2.85)ml·min-1·kg-1和(14.42±4.33)ml·min-1·kg-1比(18.48±4.52)ml·min-1·kg-1,P<0.01],EH并LVH组的降低较非LVH组差异也有统计学意义(P<0.05).(2)在VO2max时,EH并LVH组和非LVH组METs和VO2/kg均低于对照组[METs:4.94±1.24和5.90±1.51比6.96±1.85;VO2/kg:(17.20±4.34)ml·min-1·kg-1和(20.41±4.59)ml·min-1·kg-1比(24.04±5.21)ml·min-1·kg-1,P均<0.01],EH并LVH组的降低较非LVH组差异也有统计学意义(P<0.05).(3)经相关分析显示,EH并LVH组LVMI与VO2/kg呈显著负相关(在AT值R=-0.40,在VO2max值R=-0.31,P<0.01).结论 EH患者心肺运动指标METs和VO2/kg降低,运动耐量受损,并与LVMI增高相关.提示EH患者心脏贮备功能下降.     

慢性阻塞性肺疾病患者运动高峰时肺内气体交换对运动能力的影响

目的 探讨COPD患者在运动高峰时肺内气体交换对最大运动能力的影响.方法 对42例男性稳定期COPD患者及26例健康男性进行功率递增至症状自限的踏车运动,同步实时测定摄氧量和二氧化碳产生量,在运动高峰时抽取桡动脉血,测定并计算PaO2、PaCO2、死腔容积与潮气容积比值(VD/VT)和P(A-a)O2.分别对两组资料进行正态性检验,符合正态分布的资料以x-±s表示,两组间比较采用独立样本t检验,最大摄氧量与运动高峰时的血气参数进行相关因素分析.结果 COPD组的最大摄氧量[(16±4)ml·kg-1·min-1]明显低于对照组[(19±6)ml·kg-1·min-1];PaCO2[(43±3)mm Hg,1 mm Hg=0.133 kPa]、VD/VT(0.35±0.11)和P(A-a)O2[(33±11)mm Hg]均明显高于对照组[(40±5)mm Hg、0.27±0.08和(15±7)mm Hg];最大摄氧量与VD/VT呈显著负相关(r=-0.734,P＜0.01).结论 VD/VT增加导致通气效率降低,这是引起COPD患者运动能力减低的一个重要原因.     

终末期慢性心力衰竭患者运动中摄氧通气效率指标的临床应用

目的 评估心肺运动试验(CPET)摄氧通气效率指标摄氧效率平台(OUEP)、摄氧效率斜率(OUES)、通气量((V) E)/二氧化碳排出量((V)CO2)最低值和(V)E/(V)CO2斜率在监测终末期慢性心力衰竭(CHF)患者心功能和血液动力学状态中的意义.方法 入选2012年10月至2013年9月阜外心血管病医院住院行心脏移植的CHF患者26例.收集临床资料和CPET参数.在行CPET的2周内,进行超声心动图和Swan-Ganz导管检查监测血液动力学参数,并对CPET中摄氧通气效率指标与超声心动图参数和血液动力学参数进行相关性分析.结果 CPET摄氧效率指标OUEP、OUES与传统指标峰值氧耗量(峰值(V)O2)之间相关性好(r=0.535、P＜0.01;r=0.840、P＜0.001).在终末期CHF患者中OUEP相对峰值(V)O2的变化斜率约为32,而OUES相对峰值(V)O2的变化斜率仅约为2,两者相差约16倍,OUEP改变比OUES、峰值(V)O2更加敏感和显著(P＜0.05).OUEP、峰值(V)O2测定值占预测值百分比(％ pred)、(V)E/(V)CO2斜率和(V)E/(V)CO2最低值与无创血液动力学参数峰值心输出量(r =0.535,P＜0.01; r=0.652,P＜0.001; r=-0.640,P＜0.001; r=-0.606,P=0.001)和峰值心脏指数(r=0.556,P＜0.01;r=0.772,P＜0.001; r=-0.641,P＜0.001;r=-0.620,P＜0.001)均显著相关,但与静息状态下有创血液动力学参数心输出量和心脏指数不相关(P＞0.05).峰值(V)O2(％pred)和(V)E/(V)CO2斜率与肺动脉收缩压(r=-0.424,P＜0.05; r=0.509,P＜0.01)和平均肺动脉压力(r=-0.479,P＜0.05;r=0.405,P＜0.05)均显著相关,峰值(V)O2(％pred)还与肺毛细血管楔压显著相关(r=-0.415,P＜0.05),(V)E/(V)CO2斜率与肺血管阻力亦呈显著相关(r=0.429,P＜0.05).结论 CPET摄氧通气效率指标OUEP,可配合传统指标峰值(V)O2、(V)E/(V)CO2最低值、(V)E/(V)CO2斜率等,对CHF患者心功能和血液动力学状态的变化进行更好地监测和评估,以指导终末期CHF患者的临床管理.     

气道正压通气治疗对CHF合并睡眠呼吸暂停患者最大摄氧量等的影响

目的:探讨经鼻持续气道正压通气治疗(nCPAP)对慢性充血性心力衰竭(CHF)合并中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者最大摄氧量(V·O2max)的影响,探讨其意义。方法:选择CHF合并中重度OSAHS患者83例,随机分为常规治疗组(40例)及nCPAP治疗组(43例),治疗6个月,测定治疗前后左室射血分数、呼吸暂停低通气指数(AHI)及V·O2max值,比较两组差异。结果:治疗6月后,与常规治疗组比较,nCPAP治疗组AHI[(27.5±6.2)比(6.8±1.2)]显著降低,LVEF[(0.45±0.07)比(0.48±0.05)]及V·O2max值[(16.5±3.5)ml·kg-1·min-1比(19.2±3.4)ml·kg-1·min-1]显著升高(P均0.05)。结论:经鼻持续气道正压通气治疗可以改善已接受基础药物治疗的CHF合并中重度OSAHS患者通气功能、心功能和最大摄氧量。     

老年原发性高血压患者红细胞分布宽度与早期肾功能损害的相关性分析

目的探讨老年原发性高血压患者红细胞分布宽度(RDW)与早期肾功能损害的关系。方法入选2014年7~12月首都医科大学宣武医院高血压门诊364例老年原发性高血压患者作为观察组,另连续选取100名同期年龄匹配的体检健康者作为对照组,记录两组年龄、性别、收缩压、舒张压、体质指数(BMI)、空腹血糖(FPG)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、尿酸、肌酐、尿素氮、尿蛋白定性及血常规等。采用肾脏病饮食改良(MDRD)简化公式计算估算肾小球滤过率(eGFR),根据eGFR水平将高血压组患者分为两组:eGFR下降组(eGFR<90 ml·min-1·1.73 m-2)102例与e GFR正常组(eGFR≥90 ml·min-1·1.73 m-2)262例。并比较RDW、eGFR、BMI和生化指标等参数在各组间的变化差异,分析RDW与eGFR的相关性。结果 (1)与对照组比较,高血压组患者BMI[(25.84±2.95)kg/m2比(23.79±3.12)kg/m2]、TG[(1.96±1.34)mmol/L比(1.58±0.69)mmol/L]、血尿酸[(325.37±88.97)mmol/L比(296.63±80.11)mmol/L]和RDW(13.05%±0.87%比12.59%±0.61%)水平升高,HDL-C[(1.43±0.38)mmol/L比(1.61±0.33)mmol/L]和e GFR[(104.63±28.47)ml·min-1·1.73 m-2比(124.49±25.96)ml·min-1·1.73 m-2]水平下降,差异均有统计学意义(均为P<0.05);(2)在高血压患者中,与e GFR正常组比较,e GFR下降组的年龄[(62.6±9.3)岁比(59.9±8.8)岁]、BMI[(26.99±3.05)kg/m2比(25.39±2.78)kg/m2]、收缩压[(163.44±15.18)mm Hg比(154.42±12.27)mm Hg]、高血压病程[(12.4±3.7)年比(9.8±3.6)年]、血尿酸[(358.84±97.93)mmol/L比(312.34±81.79)mmol/L]、肌酐[(87.56±21.16)μmol/L比(58.60±11.01)μmol/L]、尿蛋白阳性率(46.10%比21.00%)及RDW(13.45%±0.94%比12.90%±0.79%)均升高,而eGFR[(73.85±12.32)ml·min-1·1.73 m-2比(116.61±23.54)ml·min-1·1.73 m-2]下降,差异均有统计学意义(均为P<0.05);经Pearson相关分析显示,高血压组患者RDW与eGFR水平呈负相关(r=-0.237,P=0.000);(3)Logistic多元回归分析显示,RDW是eGFR的危险因素(OR=1.485,P=0.015)。结论老年原发性高血压患者的RDW与eGFR呈负相关,RDW可作为评估老年原发性高血压患者早期肾功能损害的预测因素。     

有氧运动对急性心肌梗死患者预后的改善研究

目的探讨12周及24周的有氧运动对急性心肌梗死患者心功能及氧代谢功能的影响。方法选取50例急性ST段抬高型心肌梗死并行急诊PCI的患者,随机分为有氧运动治疗(运动组)及非运动治疗(对照组)各25例,2组患者给予相同药物治疗,于入院后第8天、第12周及24周检查无氧阈值、峰值氧耗量、以及LVEF、N末端B型钠尿肽前体(NT-proBNP)水平。结果与对照组比较,运动组第12周及24周后无氧阈值[(15.05±5.80)ml/(kg·min)vs(14.78±1.50)ml/(kg·min),(15.94±0.86)ml/(kg·min)vs(14.43±1.82)ml/(kg·min),峰值耗氧量[(22.31±2.50)ml/(kg·min)vs(19.50±2.52)ml/(kg·min),(23.06±2.13)ml/(kg·min)vs(19.79±2.89)ml/(kg·min)],LVEF[(55.8±2.8)%vs(53.3±5.1)%,(56.5±2.9)%vs(53.7±5.2)%]明显升高,而NT-proBNP[(2171.4±1014.0)ng/L vs(2922.8±1342.6)ng/L,(1628.2±740.1)ng/L vs(2476.7±964.8)ng/L]明显降低(P<0.05,P<0.01)。与同组第8天比较,2组12、24周后无氧阈值、峰值氧耗量、LVEF明显升高,而NT-proBNP明显降低(P<0.05,P<0.01),运动组24周较12周时NT-proBNP明显降低(P<0.05)结论有氧运动治疗可以明显改善急性心肌梗死患者的心功能及氧代谢指标。     

雷米普利与硝苯地平对老年高血压性心脏病患者心功能、炎性因子的影响

目的:探讨雷米普利片与硝苯地平控释片对老年高血压性心脏病患者心功能、炎性因子的影响及其疗效。方法:选择186例老年高血压性心脏病患者,随机均分为雷米普利组、硝苯地平组、联合治疗组(雷米普利+硝苯地平),各62例,观察各组治疗8周后的疗效。结果:与治疗前比较,三组治疗后LVEF、心脏指数(CI)、左室舒张早期/晚期峰值流速(E/A)、6min步行距离(6MWD)均显著增加,BNP、CRP、白细胞介素(IL)-1、IL-6水平均显著下降(P均0.01);且与雷米普利、硝苯地平组比较,联合治疗组治疗后LVEF [(43.44±5.75)%、(43.41±5.73)%比(49.89±5.84)%]、CI [(2.23±0.64)L·min-1·m-2、(2.28±0.69)L·min-1·m-2比(2.87±0.71)L·min-1·m-2]、E/A [(0.87±0.31)、(0.90±0.32)比(1.21±0.39)]、6MWD [(233.44±38.95)m、(236.45±39.13)m比(299.77±45.77)m]显著增加,血浆BNP [(199.67±27.86)ng/L、(194.55±25.46)ng/L比(124.67±29.45)ng/L]、CRP [(10.32±3.18)mg/L、(10.21±2.89)mg/L比(8.35±2.12)mg/L]、肿瘤坏死因子(TNF)-α[(45.52±14.56)pg/ml、(45.45±13.78)pg/ml比(37.86±10.35)pg/ml]、IL-1 [(6.34±2.54)pg/ml、(6.31±2.31)pg/ml比(3.42±1.89)pg/ml]、IL-6 [(6.71±2.23)pg/ml、(6.68±2.11)pg/ml比(4.11±1.75)pg/ml]水平均显著降低(P均=0.001)。临床治疗整体疗效显著优于雷米普利组(Z=3.747,P=0.001)和硝苯地平组(Z=3.838,P=0.001)。结论:雷米普利与硝苯地平联合应用能提高对老年高血压性心脏病患者疗效,改善心功能,降低炎性因子水平。     

运动康复治疗对慢性稳定性心力衰竭患者运动耐力、心肺功能及生活质量的影响

目的:探讨运动康复治疗对慢性稳定性心力衰竭(心衰)患者运动耐力、心肺功能和生活质量的影响。方法:入选的96例纽约心脏协会(NYHA)心功能Ⅱ~Ⅲ级、左心室射血分数(LVEF)40%的慢性稳定性心衰患者在药物治疗基础上,随机分为运动康复组(n=46)和对照组(n=50)。运动康复组采用踏车运动康复,训练强度为基线水平症状限制性心肺运动试验测得的峰值氧耗量(peak VO2)50%~80%;每周运动3次,每次25~40 min。在基线及12周随访结束时通过心肺运动试验测peak VO2、二氧化碳通气当量斜率(VE/VCO2 slop)、无氧阈氧耗量(VO2 AT)、最大运动功率和最大运动时间;超声心动图检查左心房内径(LAD)、左心室舒张末期内径(LVEDD)、心脏指数(CI)、LVEF;测6 min步行距离;检测血浆N末端B型利钠肽原(NT-pro BNP);通过明尼苏达心衰生活质量问卷表(MLWHFQ)评估生活质量。对上述指标进行组内及组间比较。结果:运动康复组患者通过12周的规律有氧运动训练,与基线水平比较,peak VO2[(19.8±2.7)ml/(min·kg)vs(17.4±2.1)ml/(min·kg)]、VO2 AT[(11.6±2.5)ml/(min·kg)vs(9.5±1.8)ml/(min·kg)]、最大运动功率[(120±20)W vs(102±21)W]、最大运动时间[(8.2±1.7)min vs(6.4±1.5)min]、CI[(2.2±0.5)L/(min·m2)vs(1.9±0.4)L/(min·m2)]、LVEF[(42±5)%vs(35±4)%]和6 min步行距离[(406±58)m vs(345±79)m]均增加(P均0.05),VE/VCO2 slop[(31.7±4.6)vs(34.2±5.8)]、LAD[(38.6±5.5)mm vs(41.5±3.6)mm]、LVEDD[(58.4±6.3)mm vs(62.9±5.4)mm]、NT-pro BNP[(235±69)ng/ml vs(387±57)ng/ml]和MLWHFQ总评分[(30.8±12.0)分vs(42.3±8.5)分]下降(P均0.05);运动康复组与对照组比较,上述指标之间的差异也均有统计学意义(P均0.05)。而对照组随访12周后,上述指标与基线水平比较,差异无统计学意义(P均0.05)。结论:运动康复治疗能安全、有效地改善慢性稳定性心衰患者的运动耐力、心肺功能和生活质量。     

稳定期重度慢性阻塞性肺疾病吸烟与不吸烟患者运动心肺功能的对比研究

目的 通过比较吸烟组、戒烟组及未吸烟组稳定期重度慢性阻塞性肺疾病(COPD)患者的相关肺功能指标及心肺运动试验结果,探讨吸烟对COPD患者运动心肺功能的影响.方法 将121例处于稳定期的重度COPD男性患者分为三组:吸烟组(n=47例),戒烟组(戒烟时间≥6月,n=46例)及未吸烟组(n =28例),并分别进行常规肺功能检测(pulmonary function test,PFT)及心肺运动试验(cardiopulmonary exercise testing,CPET),测定相关肺通气功能参数、心肺运动功能参数,并将三组间数据进行方差分析.结果 ①三组的PFT测定结果显示,FEV1、FEV1％ pred、FEV1/FVC、TLC、DLCO三组间比较差异无统计学意义(P＞0.05),而吸烟组的IC值[(1.43±0.5)L]显著低于戒烟组[(1.51±0.6)L]与未吸烟组[(1.64±0.6)L](P＜0.05),吸烟组的RV、RV/TLC[(4.43±1.5)L,(57.2±9.8)％]显著低于戒烟组[(4.1±1.3)L,(54.3±7.6)％]与未吸烟组[(3.4±1.2)L,(51.5±7.9)％](P＜0.05);②CPET测定结果显示,三组间peak Load差异无统计学意义(P＞0.05),吸烟组的(V)O2/kg、peak(V)E、dO2/dW1、peak O2 pulse、VD/VT[(15.4±4.6)ml·min-1·kg-1,(33.1±7.6) L/min,(8.1±0.8)ml· min-1·watt-1·(8.0±2.4)ml/beat,(39.4±7.0)％]与戒烟组[(17.2±4.8)ml·min-1·kg-1,(34.3±79.1)L/min,(8.7±0.7)ml·min-1·Watt-1,(9.8±2.7)ml/beat,(35.1±6.7)％]、未吸烟组[(18.7±4.0) ml· min-1 ·kg-1,(38.6±7.7)L/min,(9.1±1.5) ml·min-1·watt-1,(10.8±2.7)ml/beat,(32.4±6.1)％]比较,差异有统计学意义(P＜0.05);吸烟组的peak(V)O2、peak(V)O2％ pred、lowest(V)E/(V) CO2[(876.6±384.3)ml/min,(54.3±15.6)％,(32.5±3.2)]与戒烟组[(1 086.9±305.1) ml/min,(63.4±18.4)％.(30.3±3.4)]、未吸烟组[(1 299.5±284.8) ml/min,(71.1±17.6)％,(28.8±2.9)]间比较差异有统计学意义(P＜0.01);③吸烟指数与IC、TLC、peak(V)O2、peak(V)O2/Kg、peak(V)E呈负相关(P＜0.01);与peak(V)O2、peak (V)E、lowest(V)E/(V) CO2、VD/VT呈正相关(P＜0.01).结论 吸烟能明显影响COPD患者运动心肺功能,降低运动耐量,且其影响程度与吸烟量的多少相关.戒烟对于COPD患者仍有较大意义.     

Risk stratification by treadmill exercise echocardiography in patients with excellent exercise capacity

BACKGROUND: The incremental value of exercise echocardiography (EE) has been demonstrated to be maximal in patients with moderate pretest probability for coronary artery disease, but there is a lack of data in patients with low pretest probability or patients with good functional capacity. METHODS: To investigate whether such incremental value is maintained in patients with excellent exercise capacity, we studied 1,433 patients who had excellent exercise capacity (>or=8 METs for women, >or=10 METs for men). RESULTS: During a follow-up of 2.3 +/- 1.5 years, 42 hard events occurred (cardiac death or nonfatal myocardial infarction). Variables independently associated to hard events were male gender (P = 0.04), % of the age-predicted maximum heart rate (P = 0.02), chronotropic reserve (P = 0.002), and abnormal EE (P = 0.03; incremental P value of EE = 0.03). CONCLUSIONS: EE has incremental value over clinical variables, resting echocardiography, and exercise testing variables in patients with excellent exercise capacity. EE may be preferable to ECG exercise testing even in patients expected to have good exercise capacity.     

急性心肌梗死早期院内康复结合院外康复的治疗

目的：探讨AMI早期院内康复锻炼与门诊康复结合的安全可行性及对复工的影响。方法：39例AMI患早期康复治疗2－3周后出院，尔后门诊指导继续3－4个月的康复运动治疗。结果：全部病例安全出院，其后3－4个月79％复工。余21％可参与家务、生活自理。结论：AMI早期短程康复治疗结合出院后门诊3－4个月康复运动，是安全、可行的。     

Cerebral oxygenation during exercise and exercise recovery in patients with idiopathic dilated cardiomyopathy

We compared cerebral oxygenation during exercise and during exercise recovery between 22 healthy subjects and 35 patients with idiopathic dilated cardiomyopathy (IDC). Although cerebral oxyhemoglobin increased during exercise in most of the healthy subjects, oxyhemoglobin decreased during exercise in 15 of 35 patients with IDC. Cerebral oxygenation during exercise and exercise recovery was related to left ventricular function in the patients with IDC.     

Maintenance of exercise in women with fibromyalgia

OBJECTIVE: To identify predictors of maintenance of exercise for women with fibromyalgia (FM). METHODS: Women with FM who had been randomized to the exercise arm of a clinical trial were studied prospectively during and 3 months following treatment. Subjects completed exercise logs weekly and returned the data via postal mail. Outcome variables were duration of aerobic and stretching exercises. Two separate multivariate models for longitudinal data were built with adjustment for in-treatment adherence and time. Pretreatment characteristics (self efficacy, pain, disability, stress, exercise barriers and benefits, and age) and changes during treatment (pain, disability, stress, and exercise barriers and benefits) were considered potential predictors of exercise maintenance. RESULTS: Stretching significantly decreased in the 3 months following treatment. High stress at baseline and increases in stress during treatment were associated with poor maintenance of stretching. Disability at baseline (measured with the Fibromyalgia Impact Questionnaire), an increase in barriers to exercise during treatment, and increases in upper-body pain during treatment were associated with worse maintenance of aerobic exercise in the 3 months following treatment. CONCLUSION: The maintenance of an exercise program in women with FM appears to be contingent on being able to deal with stress, pain, barriers to exercise, and disability.     

Increase in bicarbonate stores with exercise.

We previously described bicarbonate exchange dynamics in humans at rest and during exercise using a three-compartment model. In the present study we tested the effect of certain assumptions of this model on the prediction of the change in exchangeable bicarbonate with the increased metabolic rate of exercise. We compared this prediction with a measurement of CO2 retention after exercise onset determined from gas exchange data. The change in tissue bicarbonate stores was estimated from differences in the kinetics of adjustment of VO2 and VCO2, and this was added to an estimate of the changes in venous blood gas stores to estimate the total change in bicarbonate. When the commonly held assumption that endogenous CO2 production, thought to occur in a rapidly equilibrating peripheral compartment at rest, was also applied to the exercise condition, the three-compartment bicarbonate model predicted an unphysiologically large increase in bicarbonate stores (700 mmol, or over 15 L). In contrast, the 'gas exchange' approach predicted a relatively small increase in bicarbonate (26 mmol), consistent with other reports. The incompatibility of these findings with the assumption about the source of endogenous CO2 production in the bicarbonate model requires that the underlying physiological correlates of the three compartments change from rest to exercise.     

运动训练对老年稳定型心绞痛患者运动耐量的影响

目的 探讨运动训练对老年稳定型心绞痛患者运动耐量的影响. 方法 60例老年稳定型心绞痛患者随机分为运动训练组(n=30)和常规治疗组(n=30),同时接受12周相同的冠心病药物治疗,运动训练组同时给予运动训练.用平板运动试验和6 min步行试验评估运动耐量. 结果 6 min步行距离与平板运动代谢当量显著相关(r＝0.816,P＜0.01);运动训练组和常规治疗组6 min步行距离较治疗前明显延长(P＜0.01或P＜0.05),运动训练组较常规治疗组延长更明显,差异有显著性(P＜0.05). 结论 运动训练能显著提高稳定型心绞痛患者的运动耐量,6 min步行试验可用来评估稳定型心绞痛患者的运动耐量.     

运动训练联合居家运动在老年肺康复病人中的应用

目的 探讨运动训练联合居家运动在老年肺康复病人中的应用效果及对圣乔治呼吸问卷(SGRQ)、呼吸困难指数(mMRC)评分的影响.方法 选择2017年6月至2019年6月进行肺康复锻炼的60例老年病人,按随机数字表法分为2组,每组30例.对照组给予常规康复模式,观察组采用运动训练方案联合居家运动,2组均完成4周干预.比较2...     

Usefulness of exercise echocardiography in ischemic heart disease: comparison with exercise cardiac scintigraphy

Exercise echocardiography and exercise thallium-201 (201Tl) single photon emission computed tomography (SPECT) were performed in 152 patients with suspected coronary artery disease, including 61 patients with old myocardial infarction. All patients underwent coronary arteriography, and coronary artery disease was defined as > or = 75% diameter stenosis. Digital two-dimensional echocardiography was performed before and after the treadmill exercise test, and wall motion abnormality was evaluated using quad-screen. Sensitivity and specificity for the diagnosis of coronary artery disease were similar for the 2 exercise tests (77% and 80% for echocardiography and 75%, and 83% for SPECT, respectively). Diagnoses for one-vessel disease, 2-vessel disease and 3-vessel disease were similar for echocardiography (79%, 72% and 77%, respectively) and SPECT (74%, 75% and 77%, respectively). Sensitivity for the diagnosis of ischemia at the area remote from infarct area was low for both exercise echocardiography and exercise SPECT (45% and 48%, respectively). Exercise echocardiography has comparable diagnostic value to SPECT for the detection of coronary artery disease. However, both exercise tests have limitations for the diagnosis of ischemia at the area remote from infarct area.