新确诊慢性病患者单次个体化精准运动前后桡动脉脉搏波的改变  

Changes of radial artery pulse wave in patients with newly diagnosed chronic disease before and after a single precisely individualized exercise

作　　者：台文琦 孙兴国[1,2] 郝璐 张也 宋雅 刘方 王继楠[2] 冯静 曹建忠[4] TAI Wen-qi;SUN Xing-guo;HAO Lu;ZHANG Ye;SONG Ya;LIU Fang;WANG Ji-nan;FENG Jing;CAO Jian-zhong(Department of Functional Testing,National Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing,100037,China;Department of Cardiopulmonary Rehabilitation,The Affiliated Rehabilitation Hospital of Chongqing Medical University;Department of Cardiology,Beijing Rehabilitation Hospital Affiliated to Capital Medical University;Department of Cardiology,Beijing Rehabilitation Hospital)

机构地区：[1]国家心血管病中心中国医学科学院阜外医院功能检测科,北京100037 [2]重庆医科大学附属康复医院心肺康复科 [3]首都医科大学附属北京康复医院心内科 [4]北京第一康复医院心内科

出　　处：《中华高血压杂志》2022年第5期451-458,共8页Chinese Journal of Hypertension

基　　金：国家自然科学基金医学科学部面上项目(81470204);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项目(2012-YJR02);国家高技术研究发展计划(863计划)课题(2012AA021009);首都临床特色应用研究项目(Z141107002514084);首都临床特色应用研究与成果推广项目(Z161100000516127);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(T2017025,T2018046,G2019001660)。

摘　　要：目的观察新确诊慢性病患者的静息桡动脉脉搏波及单次个体化精准运动后脉搏波的变化情况。方法选取16例首次诊断尚未治疗,以高血压、高血脂、高血糖为主的慢性病患者,经心肺运动试验得到运动强度,完成30 min的单次运动。于运动前和运动后10、20、30 min采集连续50 s桡动脉脉搏波,分析比较运动前后相关指标:主波波峰点P1相对幅值(ΔY_(P1))、重搏波波谷点PL相对幅值(ΔY_(PL))、重搏波波峰点P2相对幅值(ΔY_(P2))、PL时间(T_(PL))(收缩期)、脉搏波结束点(E)时间(T_(E))(心动周期)、T_(E)-T_(PL)(舒张期)、脉率、主波升支斜率(S_(1))、重搏波升支斜率(S_(2)),重搏波幅度(ΔY_(P2)-ΔY_(PL))、重搏波时间(T_(P2)-T_(PL))及波峰明显的重搏波出现率;并与16名年轻正常人、16名中老年正常人和16例长期慢性病患者的脉搏波比较。结果静息时新确诊慢性病患者的ΔY_(P1)、ΔY_(P2)、S_(1)、S_(2)、ΔY_(P2)-ΔY_(PL)、T_(P2)-T_(PL)比年轻正常人小,脉率快(均P<0.05);而ΔY_(P1)、ΔY_(PL)比中老年正常人大,T_(P2)-T_(PL)较小(均P<0.05);与长期慢性病患者相比,ΔY_(P2)-ΔY_(PL)较大(P<0.05)。静息状态下,新确诊患者波峰明显的重搏波出现率低于年轻正常人和中老年正常人,高于长期慢性病患者(52.07%比94.48%比73.32%比28.65%,χ^(2)=876.120,P<0.001)。运动后10 min新确诊患者的T_(E)、T_(E)-T_(PL)减小,脉率变快,ΔY_(PL)减小,T_(P2)-T_(PL)增大,波峰明显的重搏波出现率增大(均P<0.05);与年轻正常人相比,ΔY_(PL)较大,波峰明显的重搏波出现率较小(均P<0.05);与中老年正常人相比,T_(E)-T_(PL)和波峰明显的重搏波出现率较小、脉率较大(均P<0.05);与长期慢性病患者相比,ΔY_(P1)、T_(E)、T_(E)-T_(PL)小,而脉率、波峰明显的重搏波出现率较大(均P<0.05)。运动后20和30 min的脉搏波变化趋势与运动后10 min相似。结论新确诊慢性病患者的桡动脉脉搏波主要表现为重搏�Objective To observe and investigate the resting radial artery pulse wave and its changes after a single precisely individualized exercise in patients with newly diagnosed chronic disease.Methods Sixteen patients with newly diagnosed chronic disease(mainly including hypertension,hyperlipidaemia and diabetes)before starting treatment were recruited and completed a single individualized exercise with exercise intensity specified via the cardiopulmonary exercise testing.Radial artery pulse wave within consecutive 50 s were recorded before and 10,20,30 min after exercise respectively,and the following indicators were analyzed and compared:the relative amplitude of the peak point(P1)of the main wave(ΔY_(P1)),the relative amplitude of the valley point(PL)of the dicrotic wave(ΔY_(PL)),the relative amplitude of the peak point P2 of the dicrotic wave(ΔY_(P2)),the time of T_(PL)(contraction period),the time of pulse wave end point(T_(E))(cardiac cycle),T_(E)-T_(PL)(diastolic period),pulse rate,ascending branch slope of main wave(S_(1)),ascending branch slope of dicrotic wave(S_(2)),the amplitude of dicrotic wave(ΔY_(P2)-ΔY_(PL)),the time of dicrotic wave(T_(P2)-T_(PL))and the occurrence rate of dicrotic wave with obvious crest.Meanwhile,the data was compared with the data of 16 healthy young people,16 healthy middle-aged to elderly people and 16 patients with long-term chronic diseases.Results At rest state,ΔY_(P1),ΔY_(P2),S_(1),S_(2),ΔY_(P2)-ΔY_(PL),T_(P2)-T_(PL) in patients with newly diagnosed chronic disease were smaller than those of healthy young people,but the pulse rate was larger(all P<0.05).ΔY_(P1),ΔY_(PL) were larger than those of healthy middle-aged to elderly people,but T_(P2)-T_(PL) was smaller(all P<0.05).Furthermore,ΔY_(P2)-ΔY_(PL) was larger(P<0.05)than those of patients with long-term chronic diseases.During rest state,the occurrence of dicrotic waves with obvious peaks in patients with newly diagnosed chronic disease was smaller than those of healthy young people and healthy middle-aged to e

关 键 词：新确诊慢性病 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：R544.1[医药卫生—心血管疾病] R589.2[医药卫生—内科学] R587.1[医药卫生—临床医学]