基于心肺运动试验的脑卒中偏瘫患者心肺适能的特征  

Characteristics of cardiorespiratory fitness in patients with post-stroke hemiplegia based on cardiopulmonary exercise testing

作　　者：陈蒙晔 曲庆明 朱杰 陈祥贵 贾杰[2,4] CHEN Mengye;QU Qingming;ZHU Jie;CHEN Xianggui;JIA Jie(The Fourth Affiliated Hospital of Soochow University(Suzhou Dushu Lake Hospital),Suzhou,Jiangsu 215000,China;Huashan Hospital,Fudan University,Shanghai 200040,China;The Affiliated Hospital of Nantong University,Nantong,Jiangsu 226000,China;Jing'an District Central Hospital,Jing'an Branch,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]苏州大学附属第四医院(苏州市独墅湖医院),江苏苏州市215000 [2]复旦大学附属华山医院,上海市200040 [3]南通大学附属医院,江苏南通市226000 [4]复旦大学附属华山医院静安分院,上海市200040

出　　处：《中国康复理论与实践》2025年第4期441-447,共7页Chinese Journal of Rehabilitation Theory and Practice

基　　金：国家重点研发计划项目(No.2018YFC2002300)。

摘　　要：目的基于心肺运动试验(CPET)分析脑卒中偏瘫患者在心、肺、骨骼肌方面的特征性变化,探索卒中后心肺适能(CRF)的主要影响因素。方法2021年12月至2023年7月,复旦大学附属华山医院静安分院有效脑卒中偏瘫患者79例,社会面招募性别和年龄相匹配的健康受试者12例(对照组)。所有受试者均进行CPET评估。分析配对的12对脑卒中患者(试验组)与对照组间CPET衍生参数的差异,并采用多元线性回归模型分析脑卒中偏瘫患者CRF的主要影响因素。结果试验组的峰值摄氧量(VO_(2)peak)、无氧阈占峰值摄氧量预计值百分比(AT/VO_(2)peak%pred)显著低于对照组(∣t∣>7.027,P<0.001),峰值死腔分数(VD/VTpeak)明显高于对照组(t=4.217,P<0.01),峰值氧脉搏(O_(2)pulse peak)低于对照组(Z=-2.433,P<0.05)。排除年龄的混杂干扰后,O_(2)pulse peak(B=0.461)、AT/VO_(2)peak%pred(B=19.340)是脑卒中偏瘫患者VO_(2)peak的主要影响因素(P<0.01),AT/VO_(2)peak%pred对CRF的影响最大。结论脑卒中偏瘫患者的CRF水平显著低于健康人;卒中后患者的每搏输出量、换气效率、骨骼肌有氧代谢能力均降低,通气功能所受影响较小。骨骼肌有氧代谢能力和心脏泵血功能是脑卒中偏瘫患者CRF水平的主要影响因素,特别是骨骼肌有氧代谢能力。Objective To analyze the characteristics in heart,lung and skeletal muscles of patients with post-stroke hemiplegia,and explore the main contributors to the cardiorespiratory fitness(CRF)after stroke with cardiopulmonary exercise testing(CPET).Methods From December,2021 to July,2023,79 eligible stroke patients with hemiplegia were recruited from Shanghai Jing'an District Central Hospital;meanwhile,twelve age-and gender-matched healthy subjects were recruited as controls.All the subjects received CPET.Paired-samples t test or Wilcoxon signed rank test was used to compare the differences of the CPET derived parameters between twelve stroke patients and healthy subjects.Multiple linear regression was used to analyze the main contributors to the CRF of stroke patients with hemiplegia.Results The peak oxygen uptake(VO_2peak),anaerobic threshold(AT)/VO_2peak%pred(∣t∣>7.027,P<0.001),and O_(2)pulse peak(Z=-2.433,P<0.05)were lower,and the volume of dead space(VD)/tidal volume(VTpeak)was higher in the patients than in the controls(t=4.217,P<0.01).Multiple linear regression analysis indicated that O_(2)pulse peak(B=0.461)and AT/VO_2peak%pred(B=19.340)were the main contributors to the VO_(2peak)of stroke patients with hemiplegia(P<0.01)after the removal of the interference of age,and AT/VO_2peak%pred was the largest contributor.Conclusion The CRF of hemiplegic patients after stroke has decreased,especially for the output volume,the efficiency of gas exchange and aerobic capacity of skeletal muscles.Skeletal muscle aerobic capacity and cardiac bloodpumping function are the main contributors to the CRF,especially the aerobic capacity of skeletal muscles.

关 键 词：脑卒中 心肺适能 心肺运动试验 运动耐量 

分 类 号：R743.3[医药卫生—神经病学与精神病学]