摘要
目的探讨为期24周的透析中递增式抗阻运动训练对维持性血液透析(maintenance of hemodialysis,MHD)患者血红蛋白及铁代谢的影响。方法2019年4月—5月入选中国康复研究中心北京博爱医院血液透析室的MHD患者共62例,随机分为运动组和对照组各31例,两组患者均接受规律血液透析常规治疗,运动组在透析治疗时完成3次/周、为期24周的递增式抗阻运动训练:每次运动包括8~10个肌群(包含双手握力圈的抓握,砂袋负重的非血管通路侧的肘关节、肩关节以及双下肢的屈曲及伸展),每个动作重复15次为1组,一共3组,组间休息1~2 min,从低负荷运动训练开始,逐渐递增砂袋重量,以运动后Borg主观疲劳感觉评分在11~13分为目标。评估两组患者在基线及24周后血红蛋白、血清铁蛋白、转铁蛋白饱和度、血肌酐、超敏C反应蛋白、尿素清除指数、重组人红细胞生成素(recombinant human erythropoietin,rHuEPO)用量,以及两组患者研究期间的累计补铁剂量和血红蛋白变异状况。结果最终运动组和对照组分别有20、30例患者完成研究。经24周透析中递增式抗阻运动训练后,运动组的rHuEPO用量的中位数(下四分位数,上四分位数)由6000(6000,9000)U/周减少至6000(4500,7125)U/周,差异有统计学意义(Z=-2.599,P=0.009);而对照组治疗前后rHuEPO用量差异无统计学意义(Z=-1.340,P=0.180)。24周后运动组的血红蛋白、血红蛋白变异系数、血清铁蛋白、转铁蛋白饱和度及24周内累计静脉补铁量,与对照组相比差异均无统计学意义(P>0.05)。结论24周透析中递增式抗阻运动可以减少rHuEPO的用量,有益于优化MHD患者血红蛋白的管理。
Objective To investigate the effect of 24-week intradialytic progressive resistance exercise on hemoglobin and iron metabolism in maintenance hemodialysis(MHD)patients.Methods From April to May 2019,62 MHD patients were enrolled and randomly assigned into exercise group(n=31)and control group(n=31).Both groups of patients received regular routine hemodialysis,on that basis,patients in the exercise group completed intradialytic resistance exercise three times per week for 24 weeks.Each exercise included 8-10 muscle groups(grasping the grip ring with both hands,flexion and extension of the elbows and shoulders on the non-vascular side and lower limbs with sandbag),3 sets of 15 repetitions with a rest of 1-2 min between 2 sets.Exercise began with a low load,the sandbag weight was gradually increased,and the Borg score was aimed to be 11-13 points after exercise.Hemoglobin,serum ferritin,transferrin saturation,serum creatinine,high-sensitivity C-reactive protein,urea clearance index,recombinant human erythropoietin(rHuEPO)dosage at baseline and after 24 weeks,as well as the cumulative iron supplement dose and hemoglobin variation of the two groups during the study period were evaluated.Results There were 20 patients in the exercise group and 30 ones in the control group who completed the study.After 24 weeks of progressive resistance exercise,the medium(lower quartile,upper quartile)of the amount of rHuEPO in the exercise group decreased from6000(6000,9000)U/week to 6000(4500,7125)U/week(Z=-2.599,P=0.009),while that in the control group had no statistically significant difference(Z=-1.340,P=0.180);there was no statistically difference in hemoglobin,hemoglobin coefficient of variation,serum ferritin,transferrin saturation,or 24-week cumulative iron supplementation between the two groups.Conclusion Intradialytic progressive resistance exercise can reduce the amount of rHuEPO in MHD patients,which is benefitial to optimizing the management of hemoglobin.
作者
戴珊珊
于海艳
黎爽
郑涵絮
马迎春
DAI Shanshan;YU Haiyan;LI Shuang;ZHENG Hanxu;MA Yingchun(Department of Nephrology,Beijing Bo’ai Hospital,China Rehabilitation Research Center,School of Rehabilitation Medicine,Capital Medical University,Beijing 100068,P.R.China)
出处
《华西医学》
CAS
2020年第7期781-787,共7页
West China Medical Journal
基金
中国康复研究中心课题(2018ZX-11)。
关键词
递增式抗阻运动
维持性血液透析
铁代谢
血红蛋白
Progressive resistance exercise
Maintenance hemodialysis
Iron metabolism
Hemoglobin
