心梗后患者递增负荷运动中ST段降低与VO_2、VE、BL和RPP变化的关系  

The Relationship between ST Segment Depression and VO_2,VE,BL,RPP during Graded Exercise Test in Post Myocardial Infarction Patients

作　　者：刘洵[1] Brodie DA 解垚[1] 吕云[1] Bundred PE 

机构地区：[1]天津体育学院运动人体科学系,天津300381 [2]Research Centre for Health Studies,Buckinghamshire Chilterns University College,Buckinghamshire HP8 4AD,UK [3]Department of Primary Care,University of Liverpool,Liverpool L69 3BX,UK

出　　处：《中国运动医学杂志》2009年第5期495-497,525,共4页Chinese Journal of Sports Medicine

基　　金：天津市高等学校科技发展基金(项目编号:2005xk22)

摘　　要：目的:探讨心梗后(PMI)患者递增负荷运动中生理反应与心电图ST段水平变化的关系,旨在根据服用和不服用β-受体阻滞剂患者的不同反应,为心脏康复中适宜运动强度的制定提供依据。方法:46名服用β-受体阻滞剂的和55名不服用β-受体阻滞剂的男性PMI患者,依据改良布鲁斯方案在活动跑台上进行递增负荷运动试验。运动中每30s测量一次摄氧量(VO2)和通气量(VE),每3min记录一次心率血压乘积(RPP)和血乳酸浓度(BL),并连续监测12导心电图。结果:(1)ST段下降水平与VO2、VE和BL的关系,两组患者间无显著差异(P>0.05)。但两组在相同RPP时,其ST段水平却存在显著差异(P<0.01);(2)ST段下降1mm时,患者的VO2、VE和BL分别约为30ml.kg-1.min-1、63L.min-1和5.3mmol.L-1;(3)ST段下降1mm时,服用和不服用β-受体阻滞剂患者的RPP分别为190beats.mmHg.100-1和230 beats.mmHg.100-1。结论:为了减少心肌缺血的发生,结果(2)和(3)中生理指标的数值,应被作为心脏康复中PMI患者运动强度的上限。Objective To examine the relationships between physiological and clinical variables during a graded exercise test in post myocardial infarct（PMI） patients with and without beta blockade medication in order to provide evidence for improving planning exercise intensity of cardiac rehabilitation program. Methods Forty-six male recent PMI patients with beta blockade therapy and 55 male recent PMI patients without beta blockade therapy performed a graded exercise test （modified Bruce protocol） on a treadmill. Oxygen uptake （VO2） and volume of expired gas （VE） were measured every 30 seconds during exercise. Rate pressure product（RPP） and blood lactate（BL） were recorded every three minutes, and 12 lead electrocardiogram was monitored continuously. Results （1） There was no significant difference in ST segment levels between the two groups in relation to VO2,VE and BL （P〉0.05）. However,there was a significant difference in ST segment levels between the two groups when comparing RPP values （P〈0.01）; （2） Values of VO2,VE and BL were 30 ml.kg^-1 .min^-1,63 L.min^-1 and 5.3 mmol-L^-1,respectively for the PMI patients, when their ST segment depression reached 1 mm; （3） Patients on beta blockade and patients not on beta blockade presented RPP values of 190 and 230 beats ＂mmHg＂ 1001,respectively,when their ST segment depression reached 1 mm. Conclusion In practice,the value of physiological variables demonstrated in the results （2） and （3） should be taken as an upper limit for the PMI patients in relation to exercise intensity during cardiac rehabilitation for decreasing the occurrence of myocardial ischemia.

关 键 词：运动心脏康复 心梗后患者 心肌缺血 适宜运动强度 

分 类 号：R542.22[医药卫生—心血管疾病] R87[医药卫生—内科学]