监督性运动计划可改善等待腹主动脉瘤修复患者的有氧适能。

Supervised exercise program improves aerobic fitness in patients awaiting abdominal aortic aneurysm repair.

作者信息

Barakat Hashem M, Shahin Yousef, Barnes Rachel, Gohil Risha, Souroullas Panos, Khan Junaid, McCollum Peter T, Chetter Ian C

机构信息

Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK.

出版信息

Ann Vasc Surg. 2014 Jan;28(1):74-9. doi: 10.1016/j.avsg.2013.09.001.

DOI:10.1016/j.avsg.2013.09.001

PMID:24332259

Abstract

BACKGROUND

Aerobic fitness is an important predictor of postoperative outcome in major surgery. In this study, we assess the effects of a period of preoperative exercise on aerobic fitness as measured by cardiopulmonary exercise testing (CPET) in patients scheduled for abdominal aortic aneurysm (AAA) repair.

METHODS

As part of a randomized trial, the first patients recruited in the intervention group were enrolled in a supervised exercise program of six week duration. Treadmill CPET parameters were measured before and after exercise preoperatively for these patients. These parameters were as follows: peak oxygen uptake (VO2 peak), anaerobic threshold (AT), and ventilator equivalents for oxygen and carbon dioxide (VE/VO2 and VE/VCO2, respectively). Total exercise time and the time at which AT was achieved were also recorded. A comparison between pre- and postexercise parameters was made to detect for a possible improvement in aerobic fitness.

RESULTS

Twenty patients with AAA (17 men; mean age: 74.9 ± 5.9 years) were included in this study. Thirty-five percent of patients had a history of ischemic heart disease, 25% of obstructive airway disease, and 15% of cerebral vascular events. Seventy percent were previous smokers, and 15% were current smokers. Fifty-five percent of patients were taking aspirin and 75% were undergoing statin therapy. The median (interquartile range) VO2 peak at baseline was 18.2 (15.4-19.9) mL/kg/min, and after exercise was 19.9 (17.1-21.1; P = 0.048). Median AT at baseline was 12.2 (10.5-14.9), and 14.4 (12.3-15.4) after exercise (P = 0.023). Time of exercise tolerated also improved from a median of 379 to 604 sec (P = 0.001). No significant changes were seen in VE/VO2, VE/VCO2, or the time at which AT was achieved.

CONCLUSION

This study shows that cardiopulmonary aerobic fitness improves after a period of supervised exercise in patients scheduled for AAA repair. This is justification for a randomized trial to assess whether this affects morbidity and mortality after AAA repair.

摘要

背景

有氧适能是大手术术后结局的重要预测指标。在本研究中，我们评估了术前一段时间的运动对计划接受腹主动脉瘤（AAA）修复手术患者的有氧适能的影响，该适能通过心肺运动试验（CPET）进行测量。

方法

作为一项随机试验的一部分，干预组招募的首批患者参加了为期六周的有监督的运动计划。对这些患者在术前运动前后测量跑步机CPET参数。这些参数如下：峰值摄氧量（VO2峰值）、无氧阈值（AT）以及氧气和二氧化碳的通气当量（分别为VE/VO2和VE/VCO2）。还记录了总运动时间和达到AT的时间。对运动前后的参数进行比较，以检测有氧适能是否可能得到改善。

结果

本研究纳入了20例AAA患者（17例男性；平均年龄：74.9±5.9岁）。35%的患者有缺血性心脏病史，25%有阻塞性气道疾病史，15%有脑血管事件史。70%为既往吸烟者，15%为当前吸烟者。55%的患者服用阿司匹林，75%正在接受他汀类药物治疗。基线时VO2峰值的中位数（四分位间距）为18.2（15.4 - 19.9）mL/kg/min，运动后为19.9（17.1 - 21.1；P = 0.048）。基线时AT的中位数为12.2（10.5 - 14.9），运动后为14.4（12.3 - 15.4）（P = 0.023）。耐受运动的时间也从中位数379秒改善到604秒（P = 0.001）。VE/VO2、VE/VCO2或达到AT的时间未见显著变化。