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
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.
Zhongguo Ying Yong Sheng Li Xue Za Zhi. 2021 Jan;37(1):79-88. doi: 10.12047/j.cjap.0092.2021.109.
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. 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. In this study, 20 patients (18 males and 2 females) with chronic cardiovascular and cerebrovascular metabolic diseases, aged (55.75±10.80, 2673) years, height (172.20±8.63, 153190) cm, weight (76.35±15.63, 53105) 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, 34.3777.45) % pred and anaerobic threshold is (60.11±12.26, 43.2980.63)% pred; after intensive control, the peak oxygen uptake is (71.85±21.04, 42.40102.00) % pred and anaerobic threshold (74.95±17.03, 51.9099.47) %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±7.38,17.7841.80) % 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%. 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.
研究症状限制性极量心肺运动试验（CPET），以评估长期慢性病患者在3个月个性化精准运动训练强化控制后整体功能的改善情况。我们选取了2014年至2016年由本团队进行强化控制的慢性心脑血管代谢疾病患者。签署知情同意书后，根据CPET结果和连续功能测试，制定以个体化中等运动强度为核心的整体管理计划。3个月后进行CPET。对每位患者强化控制前后CPET指标的变化进行个体分析。然后计算差值和百分比差值。本研究中，20例慢性心脑血管代谢疾病患者（男18例，女2例），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，所有患者在CPET及强化控制期间均未发生任何危险事件。①强化控制后，静态肺功能指标、静息收缩压、心率血压乘积和空腹血糖均显著改善（P<0.05）。②强化控制前，峰值摄氧量为（55.60±15.69，34.37～77.45）%预计值，无氧阈为（60.11±12.26，43.29～80.63）%预计值；强化控制后，峰值摄氧量为（71.85±21.04，42.40～102.00）%预计值，无氧阈为（74.95±17.03，51.90～99.47）%预计值。与强化控制前相比，所有患者强化控制后的峰值摄氧量和无氧阈均显著增加（29.09±7.38，17.78～41.80）%和（25.16±18.38，1.77～81.86）%（均P<0.01）。其他核心指标也显著改善，包括峰值摄氧量、峰值心率、峰值功率、摄氧效率平台、二氧化碳通气效率最低值、二氧化碳通气当量斜率、斜坡运动持续时间（均P<0.01）。③个体分析方面，强化控制后，上述8项CPET核心指标在15例患者中均有改善，5例患者7项指标有改善；所有病例的峰值摄氧量均增加超过15%，16例>20%，13例>25%，10例>30%。CPET能够安全、客观、定量地评估整体功能状态和治疗效果，并指导个体化精准运动强度的制定。为期三个月的个体化精准运动整体计划能够安全、有效地逆转长期心脑血管代谢疾病患者的整体功能状态。
