心肺运动试验下定制个体化康复运动方案对慢性心力衰竭患者心功能和预后的影响  

Effects of personalized rehabilitation exercise program customized under cardiopulmonary exercise test on cardiac function and prognosis of patients with chronic heart failure

作　　者：武会志 于海侠[2] 高玉军[3] 周景霞[1] 赵益树 Wu Huizhi;Yu Haixia;Gao Yujun;Zhou Jingxia;Zhao Yishu(Department of Second Ward of Intensive Care Medicine,Chengde Central Hospital,Chengde 067000,Hebei,China;Department of Emergency,Chengde Central Hospital,Chengde 067000,Hebei,China;Department of Radiology,Chengde Central Hospital,Chengde 067000,Hebei,China)

机构地区：[1]河北省承德市中心医院重症医学二病区,河北承德067000 [2]河北省承德市中心医院急诊科,河北承德067000 [3]河北省承德市中心医院放射科,河北承德067000

出　　处：《中国中西医结合急救杂志》2023年第5期551-556,共6页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：河北省承德市科技研究与发展计划(201706A025)。

摘　　要：目的根据心肺运动试验(CPET)结果定制个体化康复运动方案对慢性心力衰竭(CHF)患者心功能及预后的影响.方法选择2020年2月至2021年9月承德市中心医院收治的52例CHF患者作为研究对象.将患者按随机对照原则分为观察组和对照组,每组26例.对照组给予不包括运动的康复治疗;观察组给予基于CPET指导下的常规康复治疗及高强度康复运动方案,以无氧阈以上Δ50%功率为运动强度,运动时间为30 min/d,每周4d,干预周期12周.于干预前及干预12周后测定CPET功能指标及血清脑钠肽(BNP)、左室舒张期期末内径(LVEDD)、左室射血分数(LVEF)、6 min步行距离(6MWD)等;采用明尼苏达CHF生活质量问卷(LiHFe)评价患者生活质量,随访1年内再入院率及心源性死亡情况,采用单因和多因素Logistic回归分析影响CHF患者再入院的因素.结果①心肺功能指标:对照组干预前后CPET功能指标无氧阈、峰值摄氧量、峰值氧脉搏比较差异均无统计学意义,观察组干预后CPET功能指标均较干预前明显升高,且干预后观察组上述指标均明显高于对照组[无氧阈(mL·min^(-1)·kg^(-1)):10.77±1.40比9.59±1.11,无氧阈(%ped):78.95±11.39比70.09±6.48,峰值摄氧量(mL·min^(-1)·kg^(-1)):15.63±1.36比14.27±1.72,峰值摄氧量(%ped):72.42±6.91比63.41±7.31,峰值氧脉搏(mL/次):11.38±1.29比9.05±1.64,峰值氧脉搏(%ped):90.23±10.16比80.53±6.73,均P<0.05].②血清指标、心功能指标、运动能力指标、生活质量评价:两组干预前血清指标BNP、心功能指标LVEDD、LVEF、运动能力指标6MWD和生活质量LiHFe评分比较差异均无统计学意义,干预后BNP、LiHFe评分均较干预前明显降低,LVEF和6MWD均较干预前升高,且观察组上述指标的变化较对照组更显著[BNP(ng/L):313.25±77.91比445.89±110.67,LVEF:0.41±0.08比0.37±0.06,6MWD(m):495.62±91.35比416.04±65.29,LiHFe评分(分):23.27±6.02比29.50±4.61,均P<0.05].③预后随访:观察组1年内再�Objective To evaluate the impact of customized rehabilitation exercise plans based on the results of cardiopulmonary exercise test(CPET)on cardiac function and prognosis in patients with chronic heart failure(CHF).Methods A total of 52 CHF patients admitted to Chengde Central Hospital from February 2020 to September 2021 were selected as the study subjects,and the patients were divided into observation group and control group according to the principle of randomized contrlled study,with 26 cases in each group.The control group received rehabilitation treatment excluding exercise.The observation group was given routine rehabilitation treatment and high-intensity rehabilitation exercise plans based on CPET guidance.Above anaerobic threshold△50%power was exercise intensity,exercise time was 30 minutes/day,4 days/week,and intervention period was 12 weeks.Before and 12 weeks after intervention,CPET functional indicators,serum brain natriuretic peptide(BNP),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),and 6-minute walking distance(6MWD)were measured.The Minnesota CHF quality of life questionnaire(LiHFe)was used to evaluate patient's quality of life,readmission rate and cardiogenic mortality within 1 year of follow-up,and univariate and multivariate Logistic regression analysis was used to analyze factors affecting readmission of CHF patients.Results Cardiopulmonary function indicators:there was no statistically significant difference in the anaerobic threshold,peak oxygen uptake,and peak oxygen pulse of CPET functional indicators before and after intervention in the control group,after intervention,the CPET functional indicators in the observation group were significantly higher than those before intervention,and the above indexes in the observation group were significantly higher than those of the control group[anaerobic threshold(mL·min^(-1)·kg^(-1)):10.77±1.40 vs.9.59±1.11,anaerobic threshold(%ped):78.95±11.39 vs.70.09±6.48,peak oxygen uptake(mL·min^(-1)·kg^(-1)):

关 键 词：慢性心力衰竭 康复运动 心肺运动试验 预后 

分 类 号：R541.6[医药卫生—心血管疾病]