稳定期慢性阻塞性肺疾病患者肺康复下肢运动训练处方的研究

目的 观察下肢运动训练对稳定期慢性阻塞性肺疾病(COPD)患者的肺功能、运动耐力及运动心肺功能的影响,同时对肺康复中运动训练的方式、强度、频度等的设定进行探索,为制定出适合中国COPD患者的肺康复运动处方提供依据.方法 选择稳定期COPD患者29例,随机分为对照组10例,训练组19例.对照组接受常规的内科药物治疗,维持日常活动量;训练组除接受常规内科药物治疗外,还接受为期8周,每周2次,每次40 min的下肢运动训练.训练方式采用下肢功率踏车训练,初始训练强度为70%最大运动负荷(WRmax),当患者能够连续2次完成预设的训练强度和时间时,以10% WRmax的梯度增加训练负荷作为下一个训练强度直至8周末.结果 经过8周的下肢运动训练,训练组患者的运动耐力指标6 min步行距离(6MWD)较训练前平均增加(45.3±27.3)m(P<0.05),WRmax增加(10.8±6.9)watt,峰值摄氧量(VO2 Peak)增加(158.9±137.3)ml/min,VO2/kg增加(2.6±2.6)ml·min-1·kg-1,无氧阈(AT)增加(93.1±91.2)ml/min,差值均具有统计学意义(P<0.01);通气指标二氧化碳生成量(VCO2)增加(102.6±177.9)ml/min(P<0.05),分钟通气量(VE)增加(5.3±4.9)L/min(P<0.01);心功能指标最大氧脉(O2 pulse)和最大心率(HRmax)较对照组显著提高(P<0.05);静态肺功能指标于训练前后未见明显变化.同时,对照组上述各组指标在8周前后均无明显变化.结论 下肢高强度运动训练可以提高稳定期COPD患者的运动耐力,改善患者在运动中的通气功能和心功能,但是对静态肺功能无明显改善作用;下肢功率踏车训练,为期8周,每周2次,每次40 min,以70% WRmax作为起始训练强度,在能连续2次完成规定的训练强度和时间的前提下,以10% WRmax为梯度递增训练强度直至8周末,这一肺康复下肢运动训练处方对于中重度COPD患者来说安全、可行,值得推广.

Research on the lower-limb exercise program in pulmonary rehabilitation for the patients with stable COPD

Objective To discover the effects of lower-limb exercise training on pulmonary function, exercise tolerance and cardiopulmonary function in exercise of the patients with stable chronic obstructive pulmonary disease（ COPD）;To try to set the exercise training pattern, intensity, frequency, period etc in pulmonary rehabilitation,so as to provide the basis for a suitable exercise training program in pulmonary rehabilitation for the patients with COPD in China. Methods 29 patients with stable COPD were randomly divided into control group of 10 cases and training group of 19 cases. Patients of the control group received conventional medical therapy and maintained the daily activity, while patients of training group received directly observed lower-limb exercise training, which was for a period of 8 weeks ,2 times per week, each 40 minutes, as well as the conventional medical therapy. The exercise training took the form of the fixed power treadmill training, with 70% WRmas the start training intensity. Once the patient can complete the training with given intensity and time twice in a row, the training intensity went up to 10% WRmax higher than the prior one until 8 weeks ending. Results After 8 weeks lower-limb exercise training, several indexes of the training group had following average increases ： （45.3 ± 27. 3 ）m in 6MWD, （10. 8 ±6.9）watt in WRmax,（158.9 ±137.3）ml/min in VozPoak,（2.6 ±2.6）ml · min-1· kg-1 in V o2/kg,（93.1 ± 91.2） ml/min in AT, and all these increases were statistically significant（ P 〈 0. 01 ）. Meantime, the cardiac function indexes Oz pulse and HR~= of the training group had significantly increased compared to the control group,while the static pulmonary function had no notable increase before and after the training. On the other side, all the indexes mentioned above of the control group remained almost the same. Conclusions Lower-limb high-intensity exercise training can improve the exercise tolerance,the ventilation function and cardiac function of patients with COPD during exercise,but has no notable benefit to static pulmonary function. Lower-limb treadmill training for a period of 8 weeks ,twice a week ,40 minutes a time ,with 70% WRmax as the start training intensity ,and a 10% WRmax increase if the patient can complete the training with given intensity and time for 2 times in a row, as a lower-limb exercise training program in pulmonary rehabilitation, was safe and practicable for the patients with moderate to severe COPD, and it should be promoted.