有氧运动联合常规康复治疗对卒中偏瘫患者心肺运动功能及康复效果的影响

目的探讨有氧运动联合常规康复治疗对卒中偏瘫患者心肺运动功能及康复效果的影响。方法前瞻性连续纳入30例首次发病的卒中偏瘫患者,按随机数字表法随机分为试验组和对照组,每组15例。4例患者退出,最终26例患者完成研究,每组13例,两组患者均给予常规康复治疗,试验组在常规康复治疗基础上增加有氧运动训练,每天1次,每次30 min,共训练4周。分别于治疗前和治疗4周后对两组患者进行心肺运动试验[峰值摄氧量(VO2peak)、无氧阈(AT)、峰值分钟通气量(VEpeak)]以及运动功能[Fugl-Meyer评定量表(FMA)]、日常生活活动能力[Barthel指数(BI)]的评估,比较两组患者治疗前后的差异。结果 (1)心肺运动试验结果:与治疗前比较,试验组患者治疗后VO2peak、AT、VEpeak均明显提高[分别为(16±4)ml/(kg·min)比(13±3)ml/(kg·min)、(12.9±2.5)ml/(kg·min)比(10.0±2.7)ml/(kg·min)、(41±12)L/min比(34±9)L/min;t值分别为9.668、4.328、3.662,均P0.01],对照组患者治疗后与治疗前VO2peak、AT、VEpeak比较[分别为(14±4)ml/(kg·min)比(14±4)ml/(kg·min)、(11.8±2.6)ml/(kg·min)比(11.5±2.9)ml/(kg·min)、(29±8)L/min比(28±6)L/min],差异无统计学意义(t值分别为0.863、0.583、0.314,均P0.05);对照组患者治疗前后VO2peak、AT、VEpeak差值分别为0.4(0.2,0.6)、0.1(-0.5,0.7)ml/(kg·min)和0(-2.5,5.0)L/min,试验组患者治疗前后VO2peak、AT、VEpeak差值分别为3.0(2.2,3.9)ml/(kg·min)、2.7(1.8,5.3)ml/(kg·min)、7.0(1.0,13.0)L/min,两组间治疗前后VO2peak、AT、VEpeak差值差异有统计学意义(Z值分别为4.287、3.721、2.236,均P0.05)。(2)FMA评分与BI评估结果:与治疗前比较,试验组患者治疗后FMA评分、BI均明显提高[分别为(70±24)分比(52±28)分、(78±20)比(60±28);t值分别为4.076,4.239,均P0.01],对照组治疗后FMA评分、BI较治疗前有明显改善[分别为(68±25)分比(60±27)分、(69±22)比(59±26);t值分别为3.168,5.436,均P0.05]。对照组治疗前后FMA评分、BI差值分别为5.0(2.0,12.0)分、10.0(5.0,15.0),试验组治疗前后FMA评分、BI差值分别为10.0(4.5,32.0)分、11.0(10.0,27.5),组间差异无统计学意义(Z值分别为1.393、1.352,均P0.05)。结论卒中偏瘫患者在常规康复治疗基础上,增加有氧运动训练,能够提高其心肺运动功能。

Effect of aerobic exercise combined with routine rehabilitation therapy on cardiopulmonary exercise function and rehabilitation efficacy in stroke patients with hemiplegia

Objective To investigate the effect of aerobic exercise combined with routine rehabilitation therapy on cardiorespiratory exercise function and rehabilitation efficacy in stroke patients with hemiplegia.Methods Thirty consecutive stroke patients with the first-ever hemiplegia were enrolled prospectively.They were randomly assigned to an experimental group (n=13) or a control group (n=13) according to the random number table (n=15 in each group).Four patients withdrew,and finally 26 patients completed the study (n=13 in each group).The two groups of patients were given routine rehabilitation therapy.On the basis of routine rehabilitation therapy,the experimental group was also treated with aerobic exercise training,once a day,30 min each time for 4 weeks.The evaluations of cardiopulmonary exercise tests were performed on both groups before treatment and after 4 weeks of treatment (peak oxygen uptake [VO2peak]),anaerobic threshold [AT],peak minute ventilation [VEpeak]),and motor function (Fugl-Meyer assessment scale [FMA],activities of daily living (Barthel index [BI]) were performed.The differences between the two groups before and after treatment were compared.Results (1)Cardiopulmonary exercise test results:Compared with before treatment,VO2peak,AT,and VEpeak were increased significantly (16±4 ml/[kg·min] vs.13±3 ml/[kg·min],12.9±2.5 kg·min vs.10.0±2.7 ml/[kg·min],41±12 L/min vs.34±9 L/min,t=9.668,4.328,and 3.662,respectively,all P<0.01).There were no significant differences in VO2peak,AT,and VEpeak (14±4 ml/[kg·min] vs.14±4 ml/[kg·min],11.8±2.6 ml/[kg·min] vs.11.5±2.9 ml/[kg·min],29±8 L/min vs.28±6 L/min) in patients of the control group between before treatment and after treatment.There were no significant differences (t=0.863,0.583,and 0.314,respectively,all P>0.05).The differences in VO2peak,AT,and VEpeak in the patients of the control group before and after treatment were 0.4 (0.2,0.6),0.1 (-0.5,0.7 ml/kg·min) and 0 (-2.5,5.0 L/min),respectively.The differences of VO2peak,AT,and VEpeak in patients of the experimental group before and after treatment were 3.0 (2.2,3.9 ml/[kg·min],2.7 (1.8,5.3 ml/[kg·min],and 7.0 (1.0,13.0 L/min),respectively.There were significant differences in VO2peak,AT,and VEpeak before and after treatment between the two groups (Z=4.287,3.721,and 2.236,respectively,P<0.05).(2) FMA score and BI evaluation results:Compared with before treatment,the FMA score and Barthel index after treatment in patients of the experiment group were 70±24 vs.52±28 and 78±20 vs.60±28 respectively,t=4.076 and 4.239 respectively,P<0.01).Compared with before treatment,the FMA score and BI in the control group after treatment were improved significantly (68±25 vs.60±27 and 69±22 vs.59±26 respectively,t=3.168 and 5.436 respectively,all P<0.05).The FMA score and the difference of BI in the control group before and after treatment were 5.0 (2.0,12.0) and 10.0 (5.0,15.0) respectively,and those of the experimental group before and after treatment were 10.0 (4.5,32.0) and 11.0 (10.0,27.5) respectively,and there were no significant differences between the two groups (Z=1.393,1.352,all P>0.05).Conclusion On the basis of routine rehabilitation therapy,stroke patients with hemiplegia increasing aerobic exercise training may improve their cardiopulmonary exercise function.