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.

Comparison of high-intensity and anaerobic threshold programs in rehabilitation for patients with moderate to severe chronic obstructive pulmonary disease

Objective To compare two training programs in rehabilitation for patients with moderate to severe chronic obstructive pulmonary disease (COPD). Methods Of the 54 patients who entered the study, 41 completed the rehabilitation program. Thirty-two COPD patients were randomly assigned to either the anaerobic threshold group (AT, n=15) or the high-intensity group (HI, n=17). Another group was the control group (NT, n =9). Bicycle exercise training was conducted for 2 days each week for a period of 12 weeks. The HI group received the highest level of intensity that could be tolerated. The AT group received a training intensity corresponding to the anaerobic threshold. Main assessments included lung function test, cardiopulmonary exercise testing, the St George's Respiratory Questionnaire and the Borg dyspnea scale before and after the rehabilitation program. The data of the baseline clinical characteristics of groups were presented as x±s. Comparison within two means were analysed through one-sample t test or paired t test. One-way analysis of variance was used to compare multiple means. The rates were analysised by Fish exact probabilities. The Wilcoxon rank sum test was used for comparisons within the groups and the Mann-Whitney u test for intergroup comparisons. Results Both the AT and HI groups showed significant improvement in Vo2peak% pre after rehabilitation, with the former increasing from (61±11)% to (69±14)%, and the latter increasing from (72±12)% to (79±13)%. The degree of improvement of both groups (AT and HI) were (14±17)% and (12±13) %, the difference being not significant (z = -0. 180,P > 0. 05). At 56 W work rate, the minute ventilation decreased from (36±4) L/rain to (33±5) L/min(t = 6. 167, P < 0. 01), the breathing frequency decreased from (32±1) beats/min to (31±3) beats/min(t = 2. 876, P < 0. 05), and the tidal volume increased from (1.2±0. 3) L to (1.3±0. 3) L (t = 2.587,P < 0. 05) in the HI group. After rehabilitation the heart rates [(109±39, 110±25) beats/min]were significantly lower than those of the baseline [(116±39, 114±42) beats/min]respectively in the AT and the HI groups. Oxygen pulse increased significantly from baseline (9. 6±3.7, 8. 5±4. 3) ml/beat to(10. 4±4.0, 9.0±3.2) ml/beat. This level of exertional dyspnea (△Borg/△Vo2) was significantly improved from (8. 6±3.2, 6. 5±2. 6) to (7.4±2. 5, 5.6±2. 4) in both the HI and the AT group (both P < 0. 05). The between-group difference for the change in △Borg/△Vo2, however, was not significant (z=-0. 378, P > 0. 05). Conclusions Both the HI and the AT groups had significant improvements in exercise capacity and dyspnea after pulmonary rehabilitation. The degree of improvement in both groups was similar. But the HI group showed significant improvement in the anaerobic threshold and decrease in ventilatory requirement.