精准化运动处方对脑卒中患者心肺适能及睡眠质量的影响研究  

Effect of CPET-based Precisely Prescribed Aerobic Exercise on Cardiopulmonary Fitness and Sleep Quality in Stroke Patients

作　　者：钱贞 卢同波 何俊[1] 阮秋香[1] 汪超兰 王鑫 QIAN Zhen;LU Tongbo;HE Jun;RUAN Qiuxiang;WANG Chaolan;WANG Xin(Rehabilitation Department,Changzhou Dean Hospital,Changzhou 213000,China;Rehabilitation Department,Northern Jiangsu People's Hospital,Yangzhou 225000,China)

机构地区：[1]江苏省常州市德安医院康复科,213000 [2]苏北人民医院康复科,江苏省扬州市225000

出　　处：《中国全科医学》2022年第20期2468-2474,共7页Chinese General Practice

基　　金：常州市卫健委科技项目青年课题(QN202053);江苏省高层次卫生人才“六个一工程”拔尖人才科研项目(LGY2018027);常州市卫生健康青苗人才培养工程资助项目。

摘　　要：背景脑卒中患者的心肺问题常在临床康复治疗中被忽视,其会引起一系列危害;此外脑卒中患者的睡眠问题也常影响患者的康复效果,常规药物治疗效果不佳。目的观察精准化运动处方对脑卒中患者心肺适能及睡眠质量的影响。方法选取2020年4月至2021年8月在常州市德安医院康复科住院的脑卒中患者64例为研究对象。按照随机数字表法将患者分为对照组、试验组,各32例。患者进入康复训练前均进行心肺运动试验(CPET)以及匹兹堡睡眠质量指数(PSQI)评估,之后对照组进行常规康复训练,试验组在常规康复训练的基础上,根据CPET客观定量评估的结果制定精准化运动处方,患者进行12周有氧训练。比较康复训练前后CPET主要评估指标、Borg Scale自感劳累分级(呼吸困难、腿部劳累)及睡眠质量。结果试验组患者康复训练12周后峰值摄氧量(VO_(2)peak)、峰值摄氧量占预计值百分比(VO_(2)peak%pred)、峰值代谢当量(METpeak)、峰值心率(HRpeak)、峰值负荷(负荷peak)、无氧阈(AT)高于对照组,Borg Scale自感劳累分级(呼吸困难)、Borg Scale自感劳累分级(腿部劳累)低于对照组(P<0.05)。康复训练12周后试验组患者VO_(2)peak、VO_(2)peak%pred、METpeak、HRpeak、负荷peak、AT高于组内康复训练前,Borg Scale自感劳累分级(呼吸困难)、Borg Scale自感劳累分级(腿部劳累)低于组内康复训练前(P<0.05)。试验组患者康复训练12周后主观睡眠质量、睡眠潜伏期、睡眠持续性、睡眠紊乱、使用睡眠药物、白天功能紊乱评分及PSQI总分均低于对照组(P<0.05)。康复训练12周后试验组患者主观睡眠质量、睡眠潜伏期、睡眠持续性、习惯性睡眠效率、睡眠紊乱、使用睡眠药物、白天功能紊乱评分及PSQI总分均低于组内康复训练前(P<0.05)。结论通过CPET制定的精准化运动处方,能有效提高脑卒中患者的心肺适能、运动强度、运动耐力,改善Background Cardiopulmonary problems will increase the risk of health harms yet they are often neglected in clinical rehabilitation treatment for stroke patients.In addition,sleep problems also often affect the rehabilitation effect in these patients,while routine drug treatment could not achieve satisfactory effect.Objective To assess the effect of precisely prescribed exercise on cardiopulmonary fitness and sleep quality in stroke patients.Methods Sixty-four stroke inpatients were recruited from Rehabilitation Department,Changzhou Dean Hospital from April 2020 to August 2021,and equally randomized into a control group and an experimental group.At baseline,cardiopulmonary fitness was assessed using cardiopulmonary exercise testing(CPET),and sleep quality was assessed using Pittsburgh Sleep Quality Index(PSQI)for both groups.Then control group received 12-week routine rehabilitation training,while experimental group received 12-week routine rehabilitation training plus aerobic exercise precisely prescribed based on baseline CPET parameters.Intra-and inter-group comparisons were made between pre-and post-training major CPET parameters,dyspnea and leg fatigue measured by the Borg Scale and sleep quality.Results At the end of training,the experimental group demonstrated higher peak oxygen uptake(VO_(2)peak),percentage of predicted peak oxygen uptake(VO_(2)peak%pred),peak metabolic equivalent(METpeak),peak heart rate(HRpeak),peak load,and anaerobic threshold(AT),and lower intensity of perceived dyspnea and leg fatigue than the control group(P<0.05).The above-mentioned eight parameters improved significantly after training in the experimental group(P<0.05).The experimental group had lower post-training scores of six domains(subjective sleep quality,sleep latency,sleep duration,sleep disturbances,use of sleep medication,daytime dysfunction)and lower post-training total score of PSQI than the control group(P<0.05).The total score of PSQI and the scores of its seven domains were all lowered significantly when the training

关 键 词：卒中 心肺运动试验 精准化运动处方 峰值摄氧量 睡眠质量 心肺适能 

分 类 号：R743[医药卫生—神经病学与精神病学]