个体化运动锻炼为核心的整体管理对老年慢性心力衰竭患者通气效率和运动耐力的影响  

Effects of personalized exercise training-based management on ventilatory efficiency and exercise tolerance in elderly patients with CHF

作　　者：张振英[1] 王立中 孙晓静[1] 张柳 许志萍[1] 杨澄 李艳芳[2] Zhang Zhenying;Wang Lizhong;Sun Xiaojing;Zhang Liu;Xu Zhiping;Yang Cheng;Li Yanfang(Cardiac Rehabilitation Center,Beijing Rehabilitation Hospital,Capital Medical University,Beijing 100144,China)

机构地区：[1]首都医科大学附属北京康复医院心脏康复中心,100144 [2]首都医科大学附属北京安贞医院心内科,100144

出　　处：《中华老年心脑血管病杂志》2023年第5期457-460,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：北京市科技计划项目(Z161100000516127);首都医科大学附属北京康复医院科技发展专项(2020-002)。

摘　　要：目的探讨个体化运动锻炼为核心的整体管理对老年慢性心力衰竭(CHF)患者通气效率和运动耐力的影响。方法选择2019年6月至2021年6月首都医科大学附属北京康复医院临床诊断的CHF患者40例,随机分为对照组20例和运动组20例,对照组进行常规管理,运动组采用常规管理联合12周个体化运动锻炼为核心的整体管理。评估康复治疗前和12周康复治疗后患者心肺运动试验、心脏超声、6 min步行距离(6MWD)和明尼苏达心力衰竭生活质量(QOL)评分等指标。结果治疗后运动组患者二氧化碳排出通气当量最低值[(31.7±3.4)vs(35.1±4.9),P<0.05]、二氧化碳排出通气当量斜率[(28.8±3.7)vs(32.8±5.1),P<0.01]较对照组明显降低,峰值摄氧量[(18.3±5.1)ml/(min·kg)vs(12.7±2.6)ml/(min·kg),P<0.01]、摄氧通气效率峰值平台[(38.2±6.5)vs(33.2±5.7),P<0.05]较对照组明显升高。治疗后运动组患者6MWD[(485.0±70.3)m vs(395.9±72.0)m,P<0.01]、LVEF[(42.5±6.5)%vs(38.2±4.8)%,P<0.05]较对照组明显升高,QOL评分[(12.4±6.2)分vs(38.5±12.0)分,P<0.01]较对照组明显降低。结论个体化运动锻炼为核心的整体管理可显著改善CHF患者通气效率和运动耐力,通气效率的改善参与了患者整体功能的提高。Objective To determine the effects of personalized exercise training-based holistic management on ventilatory efficiency and exercise tolerance in elderly patients with chronic heart failure(CHF).Methods Forty CHF patients diagnosed in Beijing Rehabilitation Hospital from June 2019 to June 2021 were recruited and then randomly divided into control group(n=20)and exercise training group(n=20).Those in the control group received conventional cardiac rehabilitation without exercise training,while those in the exercise training group received holistic cardiac rehabilitation with 12-week personalized exercise training.The parameters from cardiopulmonary exercise test,echocardiography,6-min walking distance(6MWD)test and Minnesota quality of life(QOL)score of the 2 groups before and after treatment were recorded.Results After 12 weeks treatment,the exercise training group had lower lowest value of ventilatory equivalent for carbon dioxide(31.7±3.4 vs 35.1±4.9,P<0.05)and slope of ventilatory equivalent for carbon dioxide(28.8±3.7 vs 32.8±5.1,P<0.01),and higher peak oxygen uptake[18.3±5.1 ml/(min·kg)vs 12.7±2.6 ml/(min·kg),P<0.01]and oxygen uptake efficiency plateau(38.2±6.5 vs 33.2±5.7,P<0.05)when compared with the control group after 12-week intervention.Whats more,the distance of 6MWD(485.0±70.3 m vs 395.9±72.0 m,P<0.01)and value of left ventricular ejection fraction[(42.5±6.5)%vs(38.2±4.8)%,P<0.05]were significantly higher,and the QOL score(12.4±6.2 vs 38.5±12.0,P<0.01)was obviously lower in the exer-cise training group than the control group.Conclusion Personalized exercise training-based holis-tic management can improve ventilatory efficiency and exercise tolerance,and the enhancement of ventilatory efficiency contributes to the improvement of holistic function in CHF patients.

关 键 词：心力衰竭 肺通气 身体耐力 运动 整体管理 

分 类 号：R541.6[医药卫生—心血管疾病]