| 心肺运动试验（CPET）评价个体化精准运动整体方案强化管控心脑血管慢病疗效的临床研究* |
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| 引用本文： | 宋雅,孙兴国,谢友红,台文琦,王继楠,张也,张艳芳,石超,何龙林,郝璐,刘方,冯静,张振英,刘艳玲,于红.心肺运动试验（CPET）评价个体化精准运动整体方案强化管控心脑血管慢病疗效的临床研究*[J].中国应用生理学杂志,2021,37(1):79-88. |
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| 作者姓名： | 宋雅 孙兴国 谢友红 台文琦 王继楠 张也 张艳芳 石超 何龙林 郝璐 刘方 冯静 张振英 刘艳玲 于红 |
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| 作者单位： | 1.国家心血管病中心,中国医学科学院阜外医院,北京协和医学院心血管疾病国家重点实验室,心血管疾病国家临床医学研究中心,北京 100037;2.重庆医科大学附属康复医院,重庆 400000;3.首都医科大学附属北京康复医院,北京 100144 |
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| 基金项目： | *国家高技术研究发展计划（863计划）课题资助项目（2012AA021009）; 国家自然科学基金医学科学部面上项目（81470204）; 中国康复医疗机构联合重大项目基金（20160102）; 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（2012-YJR02）; 首都临床特色应用研究与成果推广（Z161100000516127）; 北京康复医院2019-2021科技发展专项（2019-003）; 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（2015,2016,T2017025,T2018046,G2019001660）; 重庆市卫计委医学科研计划项目（2017MSXM090）; 重庆市科委社会事业与民生保障科技创新专项项目（cstc2017shmsA130063） |
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| 摘 要： | 目的: 探讨研究症状限制性极限运动心肺运动试验（CPET）评价个体化精准运动整体方案强化管控3月后（简称强化管控）的长期慢病患者整体功能的改善。方法: 选取2014年至2016年由我们团队强化管控的长期心脑血管代谢慢病为主的患者20例,签署知情同意书后完成CPET,根据CPET及连续功能学检测结果制定以个体化适度运动强度为核心的整体管理方案,强化管控3月后再行CPET,个体化分析每例患者强化管控前后CPET指标的变化、计算差值和百分差值。结果: 本研究心脑血管代谢性慢病为主的患者20例（18男2女）,年龄（55.75±10.80,26~73）岁,身高（172.20±8.63,153~190）cm,体重（76.35±15.63,53~105）kg,所有患者CPET和强化管控期间均无任何危险事件发生。①强化管控后患者静态肺功能指标及静息收缩压、心率收缩压乘积和空腹血糖等均显著改善（P<0.05）。②强化管控前峰值摄氧量为（55.60±15.69,34.37~77.45）%pred和无氧阈为（60.11±12.26,43.29~80.63）%pred;强化管控后峰值耗氧量为（71.85±21.04,42.40~102.00）%pred和无氧阈为（74.95±17.03,51.90~99.47）%pred;管控后较管控前峰值摄氧量和无氧阈显著提高分别达（29.09±7.38,17.78~41.80）%和（25.16±18.38,1.77~81.86）%（P均<0.01）;其他核心指标峰值氧脉搏、峰值负荷功率、摄氧通气效率平台和递增功率运动持续时间均显著升高（P均<0.01）,二氧化碳排出通气效率最低值及二氧化碳排出通气斜率也显著好转（P<0.01）。③个体化分析而言,强化管控后15例上述8项CPET核心指标全部改善,另5例7项指标改善;全部病例峰值摄氧量（%pred）提高>15%以上,16例>20%,13例>25%,10例>30%。结论: CPET能安全客观定量地评估人体整体功能状态和治疗效果、指导制定个体化精准运动强度。个体化精准运动整体方案强化管控三个月能安全有效逆转长期心脑血管代谢等慢病患者的整体功能状态和异常指标。
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| 关 键 词： | 心肺运动试验 客观定量整体功能评估 个体化精准运动整体方案 慢病有效诊疗 整体功能提高 |
| 收稿时间： | 2020-08-12 |
Cardiopulmonary exercise testing (CPET)to evaluate the efficacy after intensive control of personalized precise exercise training for cardiovascular and cerebrovascular chronic diseases |
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| SONG Ya,SUN Xing-guo,XIE You-hong,TAI Wen-qi,WANG Ji-nan,ZHANG Ye,ZHANG Yan-fang,SHI Chao,HE Long-lin,HAO Lu,LIU Fang,FENG Jing,ZHANG Zhen-ying,LIU Yan-ling,YU Hong.Cardiopulmonary exercise testing (CPET)to evaluate the efficacy after intensive control of personalized precise exercise training for cardiovascular and cerebrovascular chronic diseases[J].Chinese Journal of Applied Physiology,2021,37(1):79-88. |
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| Authors: | SONG Ya SUN Xing-guo XIE You-hong TAI Wen-qi WANG Ji-nan ZHANG Ye ZHANG Yan-fang SHI Chao HE Long-lin HAO Lu LIU Fang FENG Jing ZHANG Zhen-ying LIU Yan-ling YU Hong |
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| Affiliation: | 1. National Center for Cardiovascular Diseases, Fuwai Hospital,Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Diseases, Beijing 100037;2. The Affiliated Rehabilitation Hospital of Chongqing Medical University, Chongqing 400000;3. Beijing Rehabilitation Hospital, Beijing 100144, China |
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| Abstract: | Objective: To study the symptom-restricted extreme cardiopulmonary exercise testing (CPET) to evaluate the improvement of the overall function of patients with long-term chronic diseases after intensive control of personalized precise exercise training for 3 months. Methods: We selected 20 patients with chronic cardiovascular and cerebrovascular metabolic diseases who were intensively controlled by our team from 2014 to 2016. After signing the informed consent form, based on the results of CPET and continuous functional tests, we formulated the overall management plan with individualized moderate exercise intensity as the core. After 3 months, CPET was performed. The changes of CPET indicators before and after intensive control in each patient were analyzed individually. Then the difference value and percentage difference value were calculated. Results: In this study, 20 patients (18 males and 2 females) with chronic cardiovascular and cerebrovascular metabolic diseases, aged (55.75±10.80, 26~73) years, height (172.20±8.63, 153~190) cm, weight (76.35±15.63, 53~105) kg, all patients were not any dangerous events during the period of CPET and intensive control.①After intensive control, the static pulmonary function index, resting systolic blood pressure, rate blood pressure product and fasting blood glucose were significantly improved (P<0.05).②Before intensive control, the peak oxygen uptake is (55.60±15.69, 34.37~77.45) % pred and anaerobic threshold is (60.11±12.26, 43.29~80.63)% pred; after intensive control, the peak oxygen uptake is (71.85±21.04, 42.40~102.00) % pred and anaerobic threshold (74.95±17.03, 51.90~99.47) %pred. Compared with before the intensive control, the peak oxygen uptake and anaerobic threshold of all patients after intensive control were significantly increased by (29.09±7.38,17.78~41.80) % and(25.16±18.38, 1.77~81.86)%(all P<0.01). Other core indexes were also improved significantly, including peak oxygen uptake,peak heart rate, peak work rate, oxygen uptake efficiency plateau, lowest value of carbon dioxide ventilatory efficiency, slope of ventilatory equivalent for carbon dioxide, ramp exercise duration(all P<0.01).③In terms of individualized analysis, after intensive control, the above 8 CPET core indexes were all improved in 15 cases, and 7 indexes in 5 cases were improved; the peak oxygen uptakeof all cases increased by more than 15%, 16 cases > 20%, 13 cases > 25%, 10 cases > 30%. Conclusion: CPET can safely, objectively and quantitatively evaluate the overall functional status and therapeutic effects, and guide the formulation of individualized precise exercise intensity. The overall plan of individualized precision exercise for three months can safely and effectively reverse the overall functional status of patients with long-term cardio-cerebrovascular metabolism diseases. |
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| Keywords: | cardiopulmonary exercise testing objective quantitative overall function assessment the overall program of personalized precise exercise training effective diagnosis and treatment of chronic diseases the improvement overall function |
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