中重度慢性阻塞性肺疾病患者肺康复运动强度的评估

目的探索反映中重度慢性阻塞性肺疾病（COPD）患者运动强度的较好指标和方法，用于制订和监测个体化运动强度。方法分析30例中重度男性COPD患者心肺运动试验中获得的运动强度指标，比较在不同最大摄氧量百分比（VO2max％）运动强度下各指标的分布，采用多元回归方法分析心率和Borg指数与VO2max％的相关关系。结果在取值上，心率储备百分比（HRR％）的实际值接近于VO2max％，而HRR％的预计值与VO2max％相差较远。在不同VO2max％运动强度下，HRR％实际值比预计值的分布变异更大。Borg指数越大越能准确反映COPD患者的VO2max％运动强度，Borg指数分别为3分（轻度气促）、4分（中度气促）和5分（比较重的气促）的运动强度分别达到60％、72％和78％VO2max心率和Borg指数与VO2max％的相关系数分别为0．807和0．834，在已知心率和Borg指数时，采用VO2max％运动强度的预计方程式可预计患者实际达到的运动强度。结论HRR％实际值能更好地反映VO2max％运动强度，建议采用心肺运动试验中获得的实际最大心率制订中重度男性COPD患者的运动强度。Borg指数是简单适用的运动强度制订和监测指标，建议中重度男性COPD患者在肺康复运动训练中应达到Borg指数4分。VO2max％运动强度的预计方程式可用于运动强度的监测。

Evaluation of exercise intensity for pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

OBJECTIVE: To investigate proper methods and parameters of exercise intensity in pulmonary rehabilitation for patients with chronic obstructive pulmonary disease (COPD). METHODS: Symptom-limited cardiopulmonary exercise test (CPET) was performed in 30 male patients with moderate to severe COPD by cycle ergometer. Exercise intensity parameters, including the measured heart rate reserve (HRR%meas), the predictive heart rate reserve (HRR%pred) and the Borg scale were obtained. The distribution of these parameters ranged from 10% to 90% VO2max were compared. Multiple regression analysis was applied to analyze the relationship among heart rate (HR), the Borg scale and VO2max%. RESULTS: The HRR%meas was close to VO2max%. The coefficient of variation (CV) of HRR%meas was larger than HRR%pred. The larger was the Borg scale, the smaller was the distribution of VO2max%. While the Borg scale were 3, 4, and 5, the exercise intensity achieved 60%, 72%, and 78% VO2max, respectively. Predicted equation (VO2max%=1.026xHR+27.688xBorg-0.179xHRxBorg-63.313, r=0.920, P=0.00) was obtained. CONCLUSION: HRR%meas was a better parameter than HRR%pred for prescribing the exercise intensity. The Borg scale is a simple and applicable method to prescribe and monitor the exercise intensity. It is suggested that Borg scale should reach 4 (moderate dyspnea) in pulmonary rehabilitation for the male patients with moderate to severe COPD. Predicted equation for VO2max% is recommended for monitoring the exercise intensity.