Boşnak Güçlü Meral, Inal İnce Deniz, Arıkan Hülya, Savcı Sema, Tülümen Erol, Tokgözoğlu Lale
Gazi Üniversitesi Sağlık Bilimleri Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, Ankara, Türkiye.
Anadolu Kardiyol Derg. 2011 Mar;11(2):101-6. doi: 10.5152/akd.2011.027. Epub 2011 Feb 2.
This cross-sectional, observational study was planned to compare pulmonary function, respiratory and peripheral muscle strength, and functional capacity in different functional classes of heart failure patients.
Thirty-four heart failure patients, in New York Heart Association (NYHA) Class II and III (68.59±9.84 years, left ventricular ejection fraction (LVEF) =34.24±7.59%) were included. Class II and III patients' pulmonary function was assessed using spirometry, respiratory muscle strength using a mouth pressure device, functional capacity using six minute walk test (6MWT), quadriceps femoris and biceps brachii muscle strength were evaluated using a hand-held dynamometer, and variables were compared. Student t, Chi-square, Mann-Whitney U tests, and Spearman correlation coefficients were used for statistical analysis.
There were no statistically significant differences in pulmonary function and respiratory muscle strength between the two groups (p>0.05). The 6MWT distance (328.35±101.56 m; vs. 480.05±104.19 m) quadriceps femoris (218.83±63.62 N; vs. 290.69±115.53 N) and biceps brachii (164.22±44.78 N; vs. 219.19±49.37 N) muscle strength of Class III patients were significantly lower than of Class II patients (p<0.05 for all). The NYHA classification system was significantly correlated with measured and predicted 6MWT distance (r=-0.59, r=-0.65, respectively), biceps brachii muscle strength (r=-0.46, r=-0.40, respectively), and % quadriceps femoris muscle strength (r=-0.43) (p<0.05).
Functional capacity and peripheral muscle strength decrease as the illness progresses in heart failure. Pulmonary function and respiratory muscle strength are preserved. The NYHA classification system is a reliable method in the detection of changes in functional capacity and peripheral muscle strength. Changes in functional capacity and peripheral muscle strength are consistent with the NYHA classification system.
本横断面观察性研究旨在比较不同心功能分级的心力衰竭患者的肺功能、呼吸及外周肌肉力量和功能能力。
纳入34例纽约心脏协会（NYHA）心功能Ⅱ级和Ⅲ级的心力衰竭患者（年龄68.59±9.84岁，左心室射血分数[LVEF]=34.24±7.59%）。采用肺活量测定法评估Ⅱ级和Ⅲ级患者的肺功能，使用口腔压力装置评估呼吸肌力量，采用6分钟步行试验（6MWT）评估功能能力，使用手持测力计评估股四头肌和肱二头肌力量，并对各项变量进行比较。采用学生t检验、卡方检验、曼-惠特尼U检验和斯皮尔曼相关系数进行统计分析。
两组间肺功能和呼吸肌力量无统计学显著差异（p>0.05）。Ⅲ级患者的6MWT距离（328.35±101.56米；对比480.05±104.19米）、股四头肌力量（218.83±63.62牛；对比290.69±115.53牛）和肱二头肌力量（164.22±44.78牛；对比219.19±49.37牛）均显著低于Ⅱ级患者（各项p<0.05）。NYHA分级系统与实测和预测的6MWT距离（分别为r=-0.59，r=-0.65）、肱二头肌力量（分别为r=-0.46，r=-0.40）以及股四头肌力量百分比（r=-0.43）显著相关（p<0.05）。
心力衰竭患者的心功能和外周肌肉力量随病情进展而下降。肺功能和呼吸肌力量得以保留。NYHA分级系统是检测功能能力和外周肌肉力量变化的可靠方法。功能能力和外周肌肉力量的变化与NYHA分级系统一致。
