有氧运动康复对慢性心力衰竭患者运动耐力的影响

目的 探讨有氧运动康复对慢性心力衰竭患者运动耐力的影响.方法 左心室射血分数(LVEF) ＜49％的慢性心力衰竭患者50例,分为运动组25例及非运动组25例,并实施心肺运动试验(CPET).运动组执行以无氧代谢阈值(AT)前10 J/s为运动强度而制定的有氧运动处方,非运动组要求日常活动.先进行6次医院监护下的有氧运动训练,之后采用家庭有氧运动训练.3个月后复查CPET.结果 两组患者无氧代谢阈值氧耗量(VO2AT)、峰值氧耗量、AT负荷、峰值负荷、峰值每搏摄氧量(峰值VO2/HR)、二氧化碳通气当量斜率(VE/VCO2斜率)基线水平差异均无统计学意义(均P ＞0.05).经过3个月有氧运动康复后,运动组VO2 AT、峰值氧耗量、AT负荷、峰值负荷、峰值VOJHR较基线增加,VE/VCO2斜率较基线减小,3个月前后,VO2 AT、峰值氧耗量、AT负荷、峰值负荷、峰值VO2/HR、VE/VCO2斜率变化值分别以ΔVO2AT、Δ峰值氧耗量、ΔAT负荷、Δ峰值负荷、Δ峰值VO2/HR、ΔVE/VCO2斜率表示,两组患者ΔVO2 AT、Δ峰值氧耗量、ΔAT负荷、Δ峰值负荷、Δ峰值VO2/HR差异均有统计学意义运动组与非运动组分别为,ΔVO2AT:2.8(1.2 ～ 3.5) ml·kg-1·min -1,-0.3(-2.8～0.1)ml· kg-1·min-1,P＜0.01;Δ峰值氧耗量:3.4(1.8～4.6)ml·kg-1·min -1,-0.5(-1.4～0.3)ml·kg-1·min-1,P＜0.01;ΔAT负荷:15.0(2.5～22.5) J/s,0.5(-4.2～3.8)J/s,P＜0.01;Δ峰值负荷:15.0(1.3～25.0) J/s,0.0(～8.8～15.0)J/s,P＜0.05;Δ峰值VO2/HR:2.3(0.0～4.0)ml·kg-1·beat-1,-0.1(-0.7 ～1.2)ml·kg-1·beat -1,P＜0.01],ΔVE/VCO2斜率差异无统计学意义运动组与非运动组:-2.3(-12.2 ～1.8),1.0(-0.4 ～2.6),P＞0.05].结论 3个月的有氧运动康复可以改善慢性心力衰竭患者的运动耐力.

Effects of aerobic exercise on exercise tolerance in patients with chronic heart failure

Objective To explore the effects of aerobic exercise on exercise tolerance in patients with chronic heart failure (CHF).Methods A total of 50 CHF patients with left ventricular ejection fraction (LVEF) ＜ 49％ by echocardiography were enrolled.And they were randomly divided into exercise group ( n =25) and non-exercise group (n =25).Cardiopulmonary exercise testing (CPET) was performed.The patients of exercise group underwent an aerobic exercise program in which exercise intensity was decided by anaerobic threshold (AT) before 10 J/s while those of non-exercise group performed daily activities.After 6 sessions of supervised aerobic exercise,the home-based aerobic exercise training began.CPET was reexamined 3 months later.Results The VO2 AT,VO2 peak,Load AT,Load peak,peak VO2/HR and VE/VCO2 slope at baseline were similar between exercise group and non-exercise group ( P ＞ 0.05 ).The VO2 AT,VO2 peak,Load AT,Load peak and peak VO2/HR in patients of exercise group were increased compared with baseline,The differences between baseline and 3 months later expressed as ΔVO2 AT,ΔVO2 peak,ΔLoad AT,ΔLoad peak,Δpeak VO2/HR and ΔVE/VCO2 slope,The differences of ΔVO2 AT,ΔVO2 peak,ΔLoad AT,ΔLoad peak and Δpeak VO2/HR between two groups were statistically significant ΔVO2 AT:2.8(1.2-3.5)ml · kg-1 · min-1 vs -0.3( -2.8-0.1)ml · kg-1 · min-1,P ＜0.01;ΔVO2 peak:3.4(1.8-4.6)ml · kg-1 · min-1 vs -0.5(-1.4-0.3) ml · kg-1 · min-1,P＜0.01;ΔLoad AT:15.0(2.5 -22.5) J/s vs 0.5( -4.2 -3.8) J/s,P ＜0.01 ; ΔLoad peak:15.0( 1.3 -25.0)J/s vs0.0 ( -8.8 -15.0) J/s,P＜0.05; Δpeak VO2/HR:2.3(0.0-4.0)ml · kg-1 · beat-1 vs -0.1( -0.7- 1.2) ml · kg-1 · beat-1,P ＜0.01].The difference of ΔVE/VCO2 slope was not statistically significant -2.3( -12.2-1.8)vs 1.0( -0.4 - 2.6),P ＞ 0.05].Conclusion After 3 months of aerobic exercise,exercise capacity may improve in the CHF patients.