运动试验后心率恢复与稳定期慢性阻塞性肺疾病患者运动耐力的相关性研究  

Correlation of heart rate recovery after exercise test with exercise capacity in patients with stable chronic obstructive pulmonary disease

作　　者：刘海舰[1] 刘锦铭[2] 杨文兰[2] 孙兴国 陈淑娟[2] 张艳[2] 谭晓越[2] 

机构地区：[1]苏州大学医学院,215006 [2]同济大学附属上海市肺科医院呼吸科 [3]St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Cali-fornia, US

出　　处：《中华全科医师杂志》2013年第1期34-39,共6页Chinese Journal of General Practitioners

基　　金：中华医学会临床医学科研专项资金（08020420120）;上海市科委医学引导项目（114119a3000）;上海市科委临床医学科技创新重点项目（11411951302）

摘　　要：目的研究运动试验后心率恢复与慢性阻塞性肺疾病（COPD）患者疾病严重程度的相关性，评估心率恢复对COPD患者运动耐力的影响。方法对60例稳定期COPD患者及50例健康志愿者做动脉血气分析、常规肺功能测定和心肺运动试验，并根据运动后心率恢复情况将COPD患者分为心率恢复正常组（41例）和异常组（19例）。结果COPD患者的运动耐力（峰值摄氧量占预计值百分比）、峰值心率、心率恢复明显低于正常组，分别为66±15比89±11、（134±21）比（149±13）次／min和（18±9）比（27．4-10）次／min，均P〈0．01，静息心率明显高于正常组[（83±13）比（77±13）次rain，P〈0．01]。心率恢复异常组较正常组第一秒用力呼气容积占预计值百分比和峰值摄氧量占预计值的百分比下降更显著，分别为38±15比52±16（P〈0．05）和57±12比71±14（P〈0．01）。心率恢复与第一秒用力呼气容积占预计值百分比和峰值摄氧量占预计值百分比呈显著性相关（r=0．422，P〈0．01和r=0．523，P〈0．01）。多变量回归分析显示，第一秒用力呼气容积占预计值百分比和心率恢复是预测COPD患者运动耐力的独立变量（P〈0．01和P=0．012）。结论运动后心率恢复不仅与COPD患者疾病严重程度相关，而且可作为预测COPD患者运动耐力的独立预测指标。Objective To explore the correlation between heart rate recovery after exercise test and disease severity in patients with chronic obstructive pulmonary disease （COFD） and assess its impact on the exercise capacity of COPD patients. Methods Arterial blood gas analysis, pulmonary lung function test and cardiopulmonary exercise testing were performed in 60 patients with stable COPD and 50 healthy volunteers. Based on the heart rate recovery after exercise test, COPD patients were divided into normal heart rate recovery group （n = 41 ）and abnormal heart rate recovery group （n = 19 ）. Results The C OPD patients had lower exercise capacity （peak oxygen uptake as percentage of predicted value, peak V 02% pred） （66 ＋ 15 vs. 89＋11, P〈0.01） , peak heart rate [（134 ＋21） vs. （149 -＋13） beats/rain, P〈0.01], heart rate recovery[ （18 -＋9） vs. （27 ＋ 10） beats/min, P 〈0.011 and higher resting heart rate [（83 -＋ 13） vs. （77 -＋ 13 ） beats/rain, P 〈 0. 011 than the controls. Compared with normal heart rate recovery group, forced expiratory volume in one second as percentage of predicted （ FEV, % pred） and exercise capacity decreased more significantly in abnormal heart rate recovery group（38 -＋ 15 vs. 52 ±16, P 〈0. 05 and 57±12 vs. 71 ±14, P〈 0. 01 ）. Heart rate recovery was significantly correlated with FEV1% pred and peak V Oz% pred （r = 0. 42, P 〈 0. 01 and r = 0. 52, P 〈 0. 01 ）. Multivariate regression analysis showed that heart rate recovery and FEV1 % pred could be used as independent predictors of exercise capacity in COPD patients. Conclusion In COPD patients, heart rate recovery is correlated with the degree of disease severity and it may be an independent predictor of exercise capacity.

关 键 词：肺疾病 慢性阻塞性 心率 运动试验 

分 类 号：R563.9[医药卫生—呼吸系统]