长期慢病患者单次精准功率运动前后脉搏波波形特征个体化分析研究  

Individualized analysis of pulse wave shape before and after a single accurate power exercise in patients with long-term chronic diseases

作　　者：台文琦 孙兴国[1,2] 郝璐 宋雅 徐凡 周晴晴 徐丹丹 张也[1] 刘方 王继楠[2] 石超 于红 冯静 曹建忠[5] TAI Wen-qi;SUN Xing-guo;HAO Lu;SONG Ya;XU Fan;ZHOU Qing-qing;XU Dan-dan;ZHANG Ye;LIU Fang;WANG Ji-nan;SHI Chao;YU Hong;FENG Jing;CAO Jian-zhong(Department of Cardiology,Fuwai Hospital,Chinese Academy of Medical Sciences/National Center for Cardiovascular Diseases/State Key Laboratory of Cardiovascular Diseases/Chinese Academy of Medical Sciences/Peking Union Medical College,Beijing 100037;The Affiliated Rehabilitation Hospital of Chongqing Medical University,Chongqing 400050;Hubei Hospital of Traditional Chinese Medicine,Wuhan 430000;Beijing Rehabilitation Hospital of Capital Medical University,Beijing 100144;Beijing First Rehabilitation Hospital,Beijing 100144,China)

机构地区：[1]国家心血管病中心,中国医学科学院阜外医院,北京协和医学院心血管疾病国家重点实验室,心血管疾病国家临床医学研究中心,北京100037 [2]重庆医科大学附属康复医院,重庆400050 [3]湖北省中医院,湖北省中医药研究院,武汉430006 [4]首都医科大学附属北京康复医院,北京100144 [5]北京第一康复医院,北京100044

出　　处：《中国应用生理学杂志》2021年第2期177-188,共12页Chinese Journal of Applied Physiology

基　　金：国家高技术研究发展计划(863计划)课题资助项目(2012AA021009);国家自然科学基金医学科学部面上项目(81470204);中国康复医疗机构联合重大项目基金(20160102);中国医学科学院国家心血管病中心阜外医院科研开发启动基金(2012-YJR02);首都临床特色应用研究与成果推广(Z161100000516127);北京康复医院2019-2021科技发展专项(2019-003);北京协和医学院教学改革项目(2018E-JG07);北京协和医学院-国家外国专家局外国专家项目(2015,2016,T2017025,T2018046,G2019001660);重庆市卫计委医学科研计划项目(2017MSXM090);重庆市科委社会事业与民生保障科技创新专项项目(cstc2017shmsA130063)。

摘　　要：目的:观察研究长期慢病患者的静息桡动脉脉搏波及单次个体化运动后脉搏波的变化情况。方法:选取被明确诊断为高血压和(或)糖尿病和(或)高脂血症的长期(病程≥5年)慢病患者16例,完成症状限制性极限心肺运动试验(CPET),计算Δ50%功率为个体化精准运动强度,完成持续30 min的单次个体化运动。于运动前和运动后10 min、20 min、30 min分别测量50 s桡动脉脉搏波,得到每个脉搏波特征点:起始点(B)、主波波峰点(P1)、重搏波波谷点(PL)、重搏波波峰点(P2)、结束点(E),从仪器中导出各点对应的横坐标(时间T)和纵坐标(幅值Y)的原始数据,将上一个脉搏波的结束点E视为下一个波的起始点B,TB归零,得到主要观察指标:YB、YP1、YPL、YP2及TP1、TPL、TP2、TE,并计算出ΔYP1、ΔYPL、ΔYP2,TE-TPL、(TE-TPL)/TPL、脉率,S1、S2,ΔYP2-ΔYPL、TP2-TPL作为次要观察指标;计算波峰明显的重搏波出现率;对每位患者运动前后的50 s脉搏波数据个体化分析,再将所有数据求均值进行整体分析。结果:(1)16例长期慢病患者(男14女2),年龄(53.7±12.6,28~80)岁,身高(171.7±6.6,155~183)cm,体质量(80.0±13.5,54~98)kg。(2)静息时YB(91.5±10.8,71.1~108.6)、YP1(203.6±24.7,162.7~236.3)、YPL(127.1±6.2,118.2~140.3)、YP2(125.9±6.2,115.7~137.7)、TP1(137.2±22.3,103.0~197.1)、TPL(368.7±29.5,316.3~434.0)、TP2(422.7±32.8,376.9~494.7)、TE(883.4±95.0,672.2~1003.3),ΔYP1(112.1±33.8,60.3~157.5)、ΔYPL(35.5±14.2,17.5~66.2)、ΔYP2(34.4±13.3,20.0~62.9)、TE-TPL(514.6±85.4,341.4~621.9)、(TE-TPL)/TPL(1.4±0.2,1.0~1.7)、脉率(68.8±8.4,59.8~89.3)、S1(0.9±0.3,0.4~1.4)、S2(0.0±0.0,-0.1~0.0)、ΔYP2-ΔYPL(-1.2±2.6,-6.5~2.5)、TP2-TPL(54.0±10.8,33.6~81.1)。(3)运动后10 min,YB、YPL、YP2、TPL、TE减小,YP1增大;ΔYPL、TE-TPL、(TE-TPL)/TPL减小,而ΔYP1、脉率、S1、ΔYP2-ΔYPL、TP2-TPL增大(P均<0.05)。运动后20 min和30 min的脉搏波变化趋势与运动后10 min保持一致,但从10 min后�Objective:To observe and study the resting radial artery pulse wave and changes after a single individualized exercise in patients with long-term chronic diseases.Methods:We selected 16 patients with chronic disease(disease duration≥5 years)who have been clearly diagnosed as hypertension and/or diabetes and/or hyperlipemia,and first completed the symptomrestricted limit cardiopulmonary exercise testing(CPET).Then a single individualized exercise withΔ50%power as the exercise intensity was completed within one week after CPET.We measured and recorded 50 s pulse wave data before exercise and 10 min,20 min,30 min after exercise,then obtained each pulse wave characteristic point:starting point(B),main wave peak point(P1),trough of a repulse point(PL),crest of a repulse point(P2),and end point(E).The raw data of the abscissa(time T)and ordinate(amplitude Y)corresponding to each point were derived from the instrument.We treated the end point E of the previous pulse wave as the start point B of the next wave,returned TB to zero,and got the main observation indicators:YB,YP1,YPL,YP2 and TP1,TPL,TP2,TE,and calculated outΔYP1,ΔYPL,ΔYP2,TE-TPL,(TE-TPL)/TPL,pulse rate,S1,S2,ΔYP2-ΔYPL and TP2-TPL as secondary observation indicators.Then calculated the occurrence rate of dicrotic wave with obvious crest.Finally we analyzed individually the 50 s pulse wave data of each patient before and after exercise,and then averaged all the data for overall analysis.Results:(1)16 patients with long-term chronic diseases(males 14,females 2),ages(53.7±12.6,28~80)years old,height(171.7±6.6,155~183)cm,body weight(80.0±13.5,54~98)kg.(2)YB(91.5±10.8,71.1~108.6),YP1(203.6±24.7,162.7~236.3),YPL(127.1±6.2,118.2~140.3),YP2(125.9±6.2,115.7~137.7),TP1(137.2±22.3,103.0~197.1),TPL(368.7±29.5,316.3~434.0),TP2(422.7±32.8,376.9~494.7),TE(883.4±95.0,672.2~1003.3),ΔYP1(112.1±33.8,60.3~157.5),ΔYPL(35.5±14.2,17.5~66.2),ΔYP2(34.4±13.3,20.0~62.9),TE-TPL(514.6±85.4,341.4~621.9),(TE-TPL)/TPL(1.4±0.2,1.0~1.7),pulse rate(68.8±8.4,59.8~89.3

关 键 词：长期慢病患者 心肺运动试验 个体化精准运动 桡动脉脉搏波 重搏波 波峰明显的重搏波出现率 

分 类 号：R339.4[医药卫生—人体生理学]