摘要
目的:探讨研究连续动态左心功能指标变化评价个体化精准运动整体方案强化管控3个月后的长期慢病患者心血管功能的改善情况。方法:选取2018年至2021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21例,签署知情同意书后完成症状限制性极限心肺运动试验(CPET)和无创左右心功能同步检测仪(N-ISCFD)连续记录50 s心电图、桡动脉脉搏波、颈静脉脉搏波和心音图数据,根据CPET及连续功能学监测下滴定结果制定以个体化适度运动强度为核心的整体方案进行3个月强化管控后再重复N-ISVCD数据收集。所有N-ISCFD的50 s数据按阜外医院优化报告模式进行分析计算52项左心功能学指标;强化管控前后的数据比较采用配对t检验统计学分析组群变化情况。结果:21例长期慢病患者(16男5女),年龄为(54.05±12.77,29~75)岁,BMI为(25.53±4.04,16.62~31.7)kg/m^(2)。与强化管控前基础值比较,患者3个月强化管控后①一般指标:体重、BMI、收缩压和舒张压均显著降低(P<0.01);②CPET核心指标Peak VO_(2)从(64.93±24.22,26.96~103.48)%Pred提高为(85.22±30.31,43.95~140.48)%Pred(P<0.01),显著平均提升(35.09±27.87,0.12~129.35)%;其他AT、Peak VO_(2)/HR、Peak Work Rate、OUEP、FVC、FEV_(1)、FEV_(3)/FVC%和MVV也均较管控前显著升高(P<0.01);而Lowest VE/VCO_(2)和VE/VCO_(2)Slope则显著降低(P<0.01);③左右心功能核心指标:射血分数(EF)从(0.60±0.12,0.40~0.88)%显著提高为(0.66±0.09,0.53~0.87)%(P<0.01),平均提升(12.39±14.90,-12.32~41.11)%;总阻力(TPR)从(1579.52±425.45,779.46~2409.61)G/(cm^(4)·s)显著降低为(1340.44±261.49,756.05~1827.01)G/(cm^(4)·s)(P<0.01),平均降低(12.00±17.27,-37.79~28.61)%;其他左心搏指数(LSI),心脏总功率(CTP),射流压力(EP),左室舒张末期血量(LVEDV)等指标也均显著改善(P<0.05)。结论:CPET和连续功能学监测可安全有效制定慢病患者个体化运动整体方案,长期强化管控可安全有效
Objective:To explore and study the clinical usefulness of continuous dynamic recording of left cardiac function changes forevaluation the improvement in patients with chronic disease after 3 months of intensive control of individualized precision exercise overall manage program.Methods:From^(2)018 to 2021,21 patients with chronic cardiovascular and cerebrovascular metabolic diseases mainly controlled by our team were selected to complete the cardiopulmonary exercise test(CPET)and Non-invasive synchronous cardiac function detector(N-ISCFD),electrocardiogram,radial pulse wave,jugular pulse wave and cardiogram data were continuously recorded for 50s.According to the titration results under CPET and continuous functional parameters monitoring,a holistic plan with individualized moderate exercise intensity as the core was developed for 3 months of intensive management,and then N-ISCFD data collection was repeatedafter signing the informed consent.All N-ISCFD data were analyzed in the 50s according to the optimal report mode of Fuwai Hospital and 52 cardiac functional indexes were calculated.The data before and after the enhanced control were compared and the paired T-test was used to statistically analyze the changes of groups.Results:Twenty-one patients with chronic diseases(16 male and 5 female)were(54.05±12.77,29~75)years,BMI(25.53±4.04,16.62~31.7)kg/m^(2).Comparison with baseline,the whole group analysis:①The body weight,BMI,systolic blood pressure and diastolic blood pressure of patients were significantly decreased(P<0.01).②CPET Peak VO_(2)was(64.93±24.22,26.96~103.48)%Pred before enhanced control,and(85.22±30.31,43.95~140.48)%Pred after enhanced control,and increased(35.09±27.87,0.12~129.35)%after enhanced control compared with before enhanced control.The AT,Peak VO_(2)/HR,Peak Work Rate,OUEP,FVC,FEV_(1),FEV3/FVC%and MVV were significantly increased(P<0.01)and the Lowest VE/VCO_(2)and VE/VCO_(2)Slope were significantly decreased(P<0.01).③Core indicators of left heart function:Ejection fraction was si
作者
张艳芳
孙兴国
王继楠
台文琦
周晴晴
宋雅
陈嘉豪
黄疆
颉奔
徐凡
石超
刘方
张也
李浩
谢友红
ZHANG Yan-fang;SUN Xing-guo;WANG Ji-nan;TAI Wen-qi;ZHOU Qing-qing;SONG Ya;CHEN Jia-hao;HUANG Jiang;JIE Beng;XU Fan;SHI Chao;LIU Fang;ZHANG Ye;LI Hao;XIE You-hong(The Affiliated Rehabilitation Hospital of Chongqing Medical University,Chongqing 400050;State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,National Research Center of Clinical Medicine for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037;Peking University Third Hospital,Beijing 100191,China)
出处
《中国应用生理学杂志》
CAS
CSCD
北大核心
2022年第6期595-603,共9页
Chinese Journal of Applied Physiology
基金
国家重点研发计划课题(2022YFC2010003)
国家自然科学基金医学科学部面上项目(81470204)
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(Z141107002514084)
首都临床特色应用研究与成果推广(课题编号Z161100000516127)
国家高技术研究发展计划(863计划)课题(2012AA021009)
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)
重庆市科学技术局技术创新与应用发展专项重点项目(cstc2019jscx-gksbx0023)
重庆市渝中区科技局基础研究与前沿探索项目(20180120)。
关键词
整体整合生理学医学
心肺运动试验
个体化精准运动强化管控方案
心血管功能
慢性病管控
holistic integrative physiology and medicine
cardiopulmonary exercise testing
individualized precision movement overall control scheme
cardiovascular function
chronic disease control
