Prognostic predictors for survival in patients with COPD using cardiopulmonary exercise testing

We studied the relationship between physiologic parameters in cardiopulmonary exercise testing (CPET) and prognosis in terms of survival time in patients with chronic obstructive pulmonary disease (COPD) in order to accurately assess the severity of the disease. From a group of 195 patients with COPD who had consecutively undergone CPET between July 1989 and October 1997, we enrolled 120 subjects (mean age 67.6 years, 104 males) with exertional dyspnoea into a cohort protocol. Of these subjects, 34 (28.3%) died during the 3-5-year follow-up period after CPET. By univariate analysis, the following factors were significantly associated with survival time: age, body mass index, %FVC, %FEV1, FEV1%, PaCO2 at rest, severity of exercise-induced hypoxemia evaluated by DeltaPaO2/DeltaVO2 (PaO2-slope), oxygen uptake, ventilation, tidal volume, PaCO2 and oxygen pulse at maximum exercise, as well as prescribing long-term oxygen therapy. By multivariate analysis, age and the PaO2-slope showed significance as independent prognostic factors, and the PaO2-slope was most closely associated with the survival time. These results reveal that CPET is a useful technique to accurately assess the relationship between the functional impairments and the prognosis of patients with COPD.     

Eccentric exercise training in patients with chronic obstructive pulmonary disease

The oxygen cost of eccentric exercise is lower than that of concentric exercise at similar work-loads. In this study, the response to eccentric cycle exercise training (EET) in addition to general exercise training (GET) on exercise performance and quality of life was investigated in 24 patients with severe chronic obstructive pulmonary disease (COPD). All patients had a normal resting PaO2 and an arterial oxygen saturation (SaO2) below 90% at Wmax, achieved during a maximal incremental concentric cycle exercise test. The patients participated in a comprehensive inpatient pulmonary rehabilitation programme of 10 weeks. They were randomly assigned either to GET (GET group: mean FEV 38% predicted) or to GET and additional EET (GET/EET group: FEV1 45% predicted). During EET, the patients were able to cycle eccentrically for 15 min continuously at a mean of 160 (69%) of Wmax whereas the Borg dyspnoea score did not exceed 3.0 and SaO2 did not fall below 90%. Parameters of cardiocirculatory fitness and gas exchange improved in the GET/EET group but no further improvement in exercise capacity occurred compared to GET. It is concluded that eccentric cycle exercise is a safe and attractive training modality for patients with severe COPD and can be performed at a high intensity without the patient becoming out of breath or needing supplemental oxygen.     

Role of pulmonary vascular disorder in determining exercise capacity in patients with severe chronic obstructive pulmonary disease

Summary. In patients with chronic obstructive pulmonary disease (COPD), the primary cardiovascular complication is the development of pulmonary hypertension, especially during exercise. The purpose of this study was to determine whether pulmonary vascular disorder plays an important role in determining exercise capacity in patients with severe COPD. Twenty-one male patients with severe COPD (mean FEV₁= 0.91 ? 0.26 1) performed a progressive incremental exercise test, until symptom-limited maximum, to determine maximal exercise capacity, and then a constant-load exercise test for 5 min at a workload (20–60 W) corresponding to 60% of maximal workload during right heart catheterization to characterize the haemodynamic behavior of pulmonary circulation during exercise. The severity of the pulmonary vascular disorder was assessed using the slope of the mean pulmonary arterial pressure (PAP) - cardiac index (CI) relationship during constant-load exercise (P-Q slope). A significant inverse correlation was found between the maximal oxygen consumption (VO_2max) and P-Q slope (r= -0.669), but not between VO_2max and indices of expiratory airflow obstruction. In addition, the P-Q slope was inversely correlated with mixed venous oxygen tension (PvO₂) at the end of constant-load exercise (r= -0–679) and with the change in oxygen delivery relative to oxygen consumption (ΔO₂/ΔVO₂) during constant-load exercise (r= -0.671). These findings suggest that in patients with COPD, the functional impairment of the pulmonary vasculature is associated with disturbance in oxygen transport to the peripheral muscle during exercise, resulting in reduction of exercise capacity. We conclude that pulmonary vascular disorder may be an important factor in determining the exercise capacity of patients with severe COPD.     

心理护理在功率自行车肺康复治疗中的应用

目的:探讨在功率自行车肺康复治疗中实施心理护理,是否有助于提高慢性阻塞性肺疾病(COPD)稳定期患者的心肺功能。方法:将37例在该院进行功率自行车肺康复治疗的COPD稳定期患者随机分为A组(对照组)18例、B组(实验组)19例,A组常规处置,B组除常规处置外给予心理护理。干预前后,分别对两组患者进行心肺运动试验(CPET),比较两组患者最大运动负荷(Wmax)的差异有无统计学意义。结果:干预前,两组患者Wmax的差异无统计学意义(P0.05);干预后,实验组患者Wmax较对照组明显增加(P0.01),提示实验组患者运动能力与心肺功能的提高较对照组更为显著。结论:在功率自行车肺康复治疗中实施心理护理,有助于提高COPD稳定期患者的运动能力及心肺功能。     

Enhanced exercise-induced plasma cytokine response and oxidative stress in COPD patients depend on blood oxygenation

In healthy subjects, hypoxemia and exercise represent independent stressors promoting the exercise-induced cytokine response and oxidative stress. We hypothesized that hypoxemia in patients with chronic obstructive pulmonary disease (COPD) may affect the cytokine production and/or the changes in oxidant-antioxidant status in response to maximal exercise. Exercise-induced changes in PaO2 allowed to transiently increase or decrease baseline hypoxemia and to point out its specific action on muscle metabolism. COPD patients with severe to moderate hypoxemia (56 < PaO2 < 72 mmHg) performed an incremental cycling exercise until volitional exhaustion. Two cytokines [interleukin (IL)-6 and tumour necrosis factor (TNF)-alpha] and three blood indices of oxidative stress [plasma thiobarbituric acid reactive substances (TBARS) and two antioxidants, reduced erythrocyte glutathione (GSH), and reduced plasma ascorbic acid, RAA] were measured at rest, then during and after exercise. The changes in the cytokine levels and oxidant-antioxidant status were analysed in relation with the baseline PaO2 and its exercise-induced variations. Data were compared with those obtained in an age- and body mass index-matched group of healthy subjects. Compared with healthy subjects, COPD patients presented a marked accentuation of exercise-induced increase in IL-6 level and earlier changes in their oxidant-antioxidant status. Resting levels of IL-6 and TNF-alpha and exercise-induced peak variations of TBARS, IL-6 and TNF-alpha were negatively correlated with the baseline PaO2. In COPD patients, the peak increases in IL-6 and TBARS were attenuated when exercise hyperventilation reduced the baseline hypoxemia. Our study indicates that the PaO2 level affects both the exercise-induced oxidative stress and cytokine response in hypoxemic COPD patients.     

Acute effects of nifedipine administration in pulmonary haemodynamics and oxygen delivery during exercise in patients with chronic obstructive pulmonary disease: implication of the angiotensin-converting enzyme gene polymorphisms

The angiotensin-converting enzyme (ACE) DD genotype is associated with exaggerated pulmonary hypertension and disturbance in tissue oxygenation during exercise in patients with chronic obstructive pulmonary disease (COPD). This study was designed to examine the acute effects of nifedipine administration in pulmonary haemodynamics and oxygen delivery during exercise in COPD patients with II, ID, and DD genotypes. Thirty-three COPD patients (II = 12, ID = 11, DD = 10) with placebo or nifedipine (10 mg) underwent right heart catheterization with exercise, and systemic and pulmonary haemodynamic variables were examined. At rest, there was no significant difference in either mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR) or oxygen delivery (DO2) among the three groups. However, the magnitude of mPAP or PVR after exercise was the DD > ID > II genotype. In contrast, the magnitude of DO2 after exercise was the II > ID > DD genotype. We also found that nifedipine administration significantly decreased mPAP after exercise in all the three groups. However, we found no significant difference in PVR or DO2 between placebo and nifedipine administration in all the three groups. Thus, a single administration of nifedipine may not have the clinical efficacy for the treatment of pulmonary hypertension and impaired oxygen delivery during exercise in COPD patients with different ACE gene polymorphisms.     

运动训练对低肺功能肺癌患者手术耐受性的影响

目的:探讨术前短期中高强度下肢运动训练对低肺功能肺癌患者肺切除手术耐受性的影响.方法:采用随机单盲设计,将61例可切除肺癌合并重度慢性阻塞性肺病患者,根据美国胸科医师协会肺切除术前评估指南分为可手术A组和不可手术B组;A组再随机分为A1亚组(训练亚组)和A2亚组(对照组).A1亚组和B组术前予每周5次、连续2周、强度达60％-80％峰值氧摄量VO2max的踏车运动训练,辅以胸腹联合缩唇呼吸训练.比较训练前后静态肺功能和运动心肺功能的变化;训练后重新评估B组手术风险;比较训练Al亚组和对照A2组肺切除术后并发症情况.结果:训练后,在A1亚组,心肺功能指标:肺一氧化碳弥散量DLCO(P=0.003)、VO2max(P＜0.001)、无氧阈AT(P=0.008)、氧脉VO2max/HR(P＜0.001)较训练前显著改善;在B组,心肺功能指标:用力肺活量FVC(P＜0.001)、分钟最大通气量MVV (P=0.001)、DL.CO (P＜0.001)、最大功率W(P=0.004)、VO2max (P＜0.001)、AT(P=0.002)、VO2max/HR (P=0.00l)、峰值通气量VEmax(P=0.015)、无氧阈时CO2通气当量VE/VCO2@AT (P=0.003)和运动后经皮血氧饱和度SPO2％(P=0.002)均较训练前显著改善;B组中59％(10/17)患者达手术标准;训练A1亚组较对照A2组,肺切除术后氧疗时间(P=0.04)、机械通气时间(P=0.036)和住院天数(P=0.025)均显著缩短.结论:术前短期中高强度下肢运动训练能有效、可行地提高低肺功能肺癌患者心肺功能适应性,有助于肺切除术后康复.     

Change in P wave height during progressive exercise in patients with chronic obstructive pulmonary disease

We examined changes in P wave height in lead II of electrocardiogram during progressive exercise in patients with chronic obstructive pulmonary disease (COPD), and obtained the slope (delta P/delta VO2, %/ml/min) of the regression line calculated from the relationship between percent change of P wave height and oxygen consumption (VO2). Four COPD patients, who had a decrease over 5 mmHg in arterial oxygen tension (PaO2) at maximal exercise (group A), had significantly greater slope (0.45 +/- 0.14%/ml/min, mean +/- S.E.) than in five COPD patients (group B, 0.14 +/- 0.05), who did not have a decrease over 5 mmHg in PaO2 at maximal exercise. The increase in P wave height during exercise was inhibited by oxygen inhalation at the given VO2 in group A. These findings suggest that increase in P wave height during exercise in COPD patients may be correlated with hypoxemia during exercise.     

Oxygen-assisted exercise training in adult cystic fibrosis patients with pulmonary limitation to exercise

Exercise training has been considered suitable only in cystic fibrosis (CF) patients with mild to moderate pulmonary dysfunction without progressive hypoxaemia during exercise. We trained 16 CF patients, all with advanced lung disease (mean standardized forced expiratory volume in 1 s (FEV1), 30% pred.), with a ventilatory limitation to exercise and a progressive hypoxaemia and hypercapnia at low maximal exercise capacity, Wmax (mean Wmax, 50% pred). Exercise training was performed on a cycle ergometer twice a day for 20 min at approximately 75% of the maximal predicted heart rate for at least 3 weeks. Supplemental oxygen was administered to reach a haemoglobin oxygen saturation of 90% during training. Patients considered malnourished because of a Quetelet Index of less than 20 kg m-2 received hyperalimentation orally or by duodenal tube (total 3500-4000 kcal day-1). Evaluation directly after the training period showed a statistically significant improvement in Wmax, maximal oxygen consumption, maximal minute ventilation, pulse, PaCO2 at rest, FEV1 and body weight. None of the pretraining variables was able to predict the outcome of the training programme in the individual patient. We detected no adverse effects of the programme. This study shows that oxygen-assisted exercise training in combination with correction of the nutritional status is safe and beneficial in CF patients with severe lung disease.     

Oxidative stress in patients with COPD and pulmonary hypertension

OBJECTIVE: Oxidative stress plays an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD). Oxidant/antioxidant imbalance has also been reported in various forms of pulmonary hypertension. The present study aimed to assess systemic oxidative stress, as reflected by serum malondialdehyde (MDA) concentrations and activities of antioxidant enzymes in erythrocytes [glutathione peroxidase (GPX), superoxide dismutase (SOD) and catalase (CAT)] in patients with and without pulmonary hypertension secondary to COPD. PATIENTS AND METHODS: Seventy-five patients (58 male) with COPD (mean age 65.1 +/- 1.2 years; mean smoking history 35.6 +/- 3.8 pack-years) were studied. Twenty-one healthy non-smokers served as a control group. Pulmonary function was evaluated with body plethysmography; mean and systolic pulmonary artery pressures (Ppa) were assessed with Doppler echocardiography. Serum concentrations of MDA and activities of GPX, SOD and CAT in washed red blood cells were measured using spectrophotometry. RESULTS: Pulmonary hypertension was present in 28 patients with COPD (systolic Ppa: 46.4 +/- 2.3 mmHg; mean Ppa: 26.0 +/- 1.9 mmHg) and absent in 47 (systolic Ppa: 22.9 +/- 0.8 mmHg; mean Ppa: 13.4 +/- 0.6 mmHg). Compared with the healthy control group, all the patients (with or without pulmonary hypertension) had higher serum MDA concentrations (1.5 +/- 0.1 versus 2.3 +/- 0.1 versus 2.3 +/- 0.1 nmol/mL, ANOVA, P < 0.001) and lower erythrocyte GPX activity (51.3 +/- 3.2 versus 42.2 +/- 2.0 versus 41.3 +/- 2.5 U/g Hb, P = 0.029), whereas SOD (1121.1 +/- 29.0 versus 1032.6 +/- 21.8 versus 1032.7 +/- 36.2 U/g Hb, P = 0.063) and CAT activities (4.9 +/- 0.2 versus 4.6 +/- 0.1 versus 4.7 +/- 0.2 U/g Hb; P= 0.454) were similar. No differences were observed in serum MDA concentrations or activities of GPX, SOD and CAT in erythrocytes between COPD patients with and without pulmonary hypertension. CONCLUSION: The study demonstrates the presence of oxidative/antioxidative imbalance in the systemic circulation in patients with COPD: compared with healthy subjects, COPD patients had higher serum MDA concentrations and lower GPX activity in erythrocytes. The magnitudes of the increase in MDA and reduction in GPX activity were similar in COPD patients with pulmonary hypertension and in those with normal pulmonary artery pressures.     

心肺强化间歇训练对老年慢性阻塞性肺疾病康复期患者心肺氧合能力和运动能力的影响

目的 研究心肺强化间歇训练对老年慢性阻塞性肺疾病(COPD)康复期患者心肺氧合能力和运动能力的影响.方法 我院诊治的168例老年COPD患者,随机信封法分为常规组(83例)和强化组(85例),前者给予常规康复训练,后者在其基础上给予心肺强化间歇训练.比较两组干预前后心肺氧合能力、运动能力、血气指标和肺功能,评估患者生活...     

Cardiopulmonary effects of the alpha2-adrenoceptor agonists medetomidine and ST-91 in anesthetized sheep

To test the hypothesis that pulmonary alterations are more important than hemodynamic changes in alpha2-agonist-induced hypoxemia in ruminants, the cardiopulmonary effects of incremental doses of (4-[1-(2,3-dimethylphenyl)ethyl]-1H-imadazole) hydrochloride (medetomidine; 0.5, 1.0, 2.0, and 4 micrograms/kg) and 2-(2, 6-diethylphenylamino)-2-imidazol (ST-91; 1.5, 3.0, 6.0, and 12 micrograms/kg) were compared in five halothane-anesthetized, ventilated sheep using a placebo-controlled randomized crossover design. Pulmonary resistance (RL), dynamic compliance, and tidal volume changes in transpulmonary pressure (DeltaPpl) were determined by pneumotachography, whereas cardiac index (CI), mean pulmonary artery pressure (Ppa), and pulmonary artery wedge pressure (Ppaw) were determined using thermodilution and a Swan-Ganz catheter. The most important finding was the fall in partial pressure of oxygen in arterial blood (PaO2) after administration of medetomidine at a dose (0.5 micrograms/kg) 20 times less than the sedative dose. The PaO2 levels decreased to 214 mm Hg as compared with 510 mm Hg in the placebo-treated group. This decrease in PaO2 was associated with a decrease in dynamic compliance and an increase in RL, DeltaPpl, and the intrapulmonary shunt fraction without changes in heart rate, CI, mean arterial pressure, pulmonary vascular resistance, Ppa, or Ppaw. On the other hand, ST-91 only produced significant changes in PaO2 at the highest dose. After this dose of ST-91, the decrease in PaO2 was accompanied by a 50% decrease in CI and an increase in mean arterial pressure, Ppa, Ppaw, and the intrapulmonary shunt fraction without significant alterations of RL and DeltaPpl. The study suggests that the mechanism(s) by which medetomidine and ST-91 produce lower PaO2 are different and that drug-induced alterations in the pulmonary system are mainly responsible for the oxygen-lowering effect of medetomidine.     

Prolonged hypoxemia after 10 min walking exercise in aged patients with chronic obstructive pulmonary disease

Although the behavior and factors of exercise tolerance have been studied during exercise in patients with chronic obstructive pulmonary disease (COPD), little attention has been paid to the after-effects of such activity. Arterial oxygen saturation (SaO2) was monitored during and after a 10 min walking exercise in aged patients with COPD. Neither baseline SaO2 nor mean SaO2 during exercise correlated to the 10 min walking distance. However, the recovery time of SaO2 to the baseline value shows significant correlation to the 10 min walking distance. Careful attention should be paid to prolonged hypoxemia after exercise in severe cases of COPD.     

单肺移植治疗伴有肺动脉高压的终末期肺病

目的观察单肺移植治疗对伴有肺动脉高压的终末期肺病患者的疗效。方法2002年9月—2005年11月我院22例单肺移植患者,其中肺气肿10例、肺纤维化10例、矽肺1例、肺淋巴管平滑肌瘤病1例。受体肺移植术前评估肺动脉压均显示有不同程度的升高。手术方式:左肺移植10例,右肺移植12例。术前常规心脏超声监测肺动脉收缩压,并通过动脉血气分析计算氧合指数(PaO2/FiO2)。结果术后1周用Swan-Ganz导管测定患者平均肺动脉收缩压,较术前有明显下降,从(50.00±13.00)mmHg(1mmHg=0.133kPa)降至(39.50±7.36)mmHg(P<0.05);PaO2/FiO2明显改善,从(241.26±79.54)mmHg升到(348.23±99.31)mmHg(P<0.05)。结论单肺移植是治疗伴肺动脉高压终末期肺病的有效和可选方法。     

稳定期中重度慢性阻塞性肺疾病患者运动能力影响因素分析

目的探讨中重度慢性阻塞性肺疾病(COPD)患者运动能力的影响因素。方法30例稳定期中重度COPD患者,运动前均进行常规肺功能检查、血气分析和生命质量问卷词查。运动过程中监测胸腹呼吸运动之和与潮气容积之比(代D/VT)。结果相关分析显示,反映最大运动能力的各指标与一氧化碳弥散量占预计值比、残/总百分比、用力肺活量、第一秒用力呼气容积、最大呼气流速和静息时动脉氧分压均有较强的相关性;与生命质量评分VEmax和VTmax均显著相关。结论中重度COPD患者运动时通气限制是影响运动能力的重要因素,最大运动能力下降与基础肺功能损害特别是弥散障碍有关;生存质量下降可显著影响患者的运 动能力。     

慢性阻塞性肺疾病患者睡眠低氧的临床研究

目的 探讨慢性阻塞性肺疾病(COPD)患者睡眠低氧对睡眠相关指标的影响及其与日间指标的关系.方法 选择中度至极重度COPD患者204例,年龄40～75岁,平均(70.41±7.84)岁.按多导睡眠图(PSG)结果将研究对象分为低氧组和非低氧组,均行血气分析、肺功能和PSG监测.结果 睡眠低氧者95例,低氧率为46.57%.与非低氧组比较,睡眠低氧组日间动脉血氧饱和度(SaO2,0.90±0.04比0.94±0.01)和夜间平均动脉血氧饱和度(MSaO2,0.83±0.08比0.93±0.02)均明显降低(均P<0.01).低氧组和非低氧组间部分睡眠指标如醒觉时间(min:97.86±41.74、76.13±55.15)、醒觉次数(次:31.50±15.69、23.23±19.81)、平均心率(次/min:80.80±12.80、66.21±6.53)以及睡眠结构[(S1+S2)%:(74.36±16.52)%、(67.55±12.62)%,(S3+S4)%:(12.99±12.18)%、(19.35±12.71)%]比较差异均有统计学意义(均P<0.01).动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、1秒用力呼气容积(FEV1)占预计值百分比、用力肺活量(FVC)占预计值百分比、FEV1/FVC占预计值百分比分别与睡眠低氧指标如睡眠中SaO2<0.90的时间占总睡眠时间的百分比(T90)、MSaO2、最低动脉血氧饱和度(miniSaO2)存在相关关系,其中PaCO2与之的相关性最强(r1=0.767,r2=-0.758,r3=-0.689,均P<0.01).结论 中度至极重度COPD患者睡眠低氧普遍存在.睡眠低氧组与非低氧组在日间SaO2、夜间SaO2、睡眠监测指标方面存在差异.日间指标与睡眠低氧存在相关,部分可作为预测睡眠低氧的指标.     

高原地区肺心病患者血清碱性成纤维细胞生长因子水平与肺动脉压的关系

目的探讨血清碱性成纤维细胞生长因子(bFGF)在低氧性肺动脉高压发病中的作用。方法采用双抗体夹心酶联免疫吸附法(ELISA)检测高原地区(海拔2260~3300m)38例慢性肺源性心脏病(肺心病)急性加重期患者、30例慢性阻塞性肺疾病(COPD)缓解期患者和30例当地健康人血清bFGF含量,并使用彩色多普勒超声心动仪测定肺动脉血流频谱,计算平均肺动脉压(MPAP),使用血气分析仪测定动脉血氧分压(PaO2)。结果肺心病组血清bFGF(87.54±12.15)ng/L、MPAP(45.86±5.63)mmHg(1mmHg=0.133kPa)显著高于COPD组分别为(55.72±9.08)ng/L和(22.95±2.56)mmHg,P均<0.01,COPD组显著高于健康对照组分别为(49.83±8.78)ng/L和(20.34±2.23)mmHg,P均<0.05;肺心病组PaO2(38.79±4.56)mmHg显著低于COPD组(58.22±6.18)mmHg,P<0.01,COPD组则显著低于健康对照组(66.57±5.48)mmHg,P<0.01。肺心病组和COPD组血清bFGF水平与MPAP均呈显著正相关(r肺心病=0.788,rCOPD=0.674,P均<0.01),与PaO2均呈显著负相关(r肺心病=-0.735,rCOPD=-0.587,P均<0.01)。结论慢性肺心病患者血清bFGF水平明显升高,可能与其慢性低氧性肺动脉高压形成有一定关系。     

Comparison of different exercise tests in assessing outcomes of pulmonary rehabilitation

INTRODUCTION: Common modalities of clinical exercise testing for outcome measurement after pulmonary rehabilitation (PR) include walk tests, progressive cycle ergometry, and cycle endurance testing. We hypothesized that patients' responses to PR, as measured by those 3 tests, are differentially correlated, and we designed a study to investigate the tests' capacity to detect changes after PR. METHODS: We prospectively tested 37 male patients with stable chronic obstructive pulmonary disease who completed a comprehensive 6-week PR program that included supervised exercise training that emphasized steady-state lower-limb aerobic exercise. Before and after the PR program the patients underwent 6-minute walk test, progressive cycle ergometry, and cycle endurance testing (at 80% of the peak work rate achieved during progressive cycle ergometry). The exercise performance indices of interest were the peak oxygen uptake (VO2max) and maximum work-rate (Wmax) during progressive cycle ergometry, the cycling endurance time, and the 6-minute walk distance (6MWD). RESULTS: After PR there were statistically significant improvements in 6MWD (16%, p <0.001), VO2max (53%, p=0.004), Wmax (30%, p=0.001), and cycling endurance time (144%, p <0.001). The changes in VO2max and Wmax were significantly correlated (r=0.362, p=0.027), as were the changes in endurance time and Wmax (r=0.406, p=0.013). There was no significant correlation between changes in any other exercise index. CONCLUSIONS: Among the frequently used exercise tests in PR, the most responsive index is the endurance time. The correlation between the post-PR changes in the various exercise indices is poor.     

步行锻炼对COPD患者肺功能和生存质量的影响

目的 :探讨步行锻炼对慢性阻塞性肺疾病 (chronicobstructiveplumonarydisease,COPD)患者肺功能和生存质量的影响。方法 :28例轻、中度COPD患者每天进行30min以上的匀速步行锻炼 ,持续2个月 ,锻炼前后分别测试肺功能指标 (FVC、FEV1、%FVC、?V1、FEV1/FVC % )和评估生存质量。结果 :COPD患者锻炼后肺功能指标无明显差异 (P均>0.05) ,但生存质量评分明显优于锻炼前 (P均>0.05)。结论 :生存质量指标评估肺康复更敏感。     

有氧运动联合低强度抗阻运动训练在重度慢性阻塞性肺疾病患者中的应用

目的 探讨有氧运动联合抗阻运动对重度慢性阻塞性肺疾病患者的肺功能、运动能力及生活质量的影响.方法 选择2017年1月-2018年12月在我院治疗的120例重度慢性阻塞性肺疾病患者,采用随机数字表法将其分为对照组和观察组,每组各60例.2组患者均给予常规药物治疗和护理,对照组给予适度有氧运动;观察组实施有氧运动联合渐进式...