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[运用左心功能参数变化及心肺运动试验评估慢性病个体化精准运动整体方案管理的临床效果I——组间分析]

[Using changes of left cardiac functional parameters and CPET evaluated the clinical effectiveness of individualized precise exercise overall program management of chronic disease I --Analysis between groups].

作者信息

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

机构信息

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.

出版信息

Zhongguo Ying Yong Sheng Li Xue Za Zhi. 2022 Nov;38(6):595-603. doi: 10.12047/j.cjap.0106.2022.001.

DOI:10.12047/j.cjap.0106.2022.001
PMID:37308402
Abstract

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. From 2018 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. Twenty-one patients with chronic diseases (16 male and 5 female) were (54.05±12.77,2975) years, BMI (25.53±4.04,16.6231.7) kg/m.Comparison with baseline,the whole group analysis: ①The body weight, BMI, systolic blood pressure and diastolic blood pressure of patients were significantly decreased(<0.01).②CPET Peak VO was (64.93±24.22, 26.96103.48) %Pred before enhanced control, and (85.22±30.31, 43.95140.48) %Pred after enhanced control, and increased (35.09±27.87, 0.12129.35) % after enhanced control compared with before enhanced control. The AT, Peak VO/HR, Peak Work Rate, OUEP, FVC, FEV, FEV3/FVC% and MVV were significantly increased (<0.01) and the Lowest VE/VCO and VE/VCO Slope were significantly decreased(<0.01).③Core indicators of left heart function:Ejection fraction was significantly increased from (0.60±0.12,0.400.88) to(0.66±0.09, 0.530.87)(< 0.01), by (12.39±14.90,-12.3241.11)%. The total peripheral resistance was significantly decreased from (1579.52±425.45,779.462409.61) G/(cm·s),to(1340.44±261.49,756.051827.01) G/(cm·s)(<0.01), by (12.00±17.27,37.79~28.61) %.The left stroke index, cardiac total power, ejective pressure and left ventricular end diastolic volumewere significantly improved (<0.05).The change analysis of each indicator for each patient is shown in the individualized analysis section of this study. Use CPET and continuous functional monitoring we can safely and effectively develop the overall program of individualized exercise in patients with chronic diseases. Long-term intensive management and control can safely and effectively significantly improve the cardiovascular function of patients. Continuous dynamic recording of changes in left and right cardiac functional parameters can be a simple way to supplement CPET to evaluate cardiovascular function.

摘要

为探索和研究连续动态记录左心功能变化在评估个体化精准运动整体管理方案强化控制3个月后慢性病患者改善情况中的临床应用价值。2018年至2021年,选取由本团队主要管理的21例慢性心脑血管代谢疾病患者,完成心肺运动试验(CPET)和无创同步心功能检测仪(N-ISCFD),连续记录50秒心电图、桡动脉脉搏波、颈静脉脉搏波和心动图数据。根据CPET滴定结果和连续功能参数监测,制定以个体化中等运动强度为核心的整体方案进行3个月强化管理,签署知情同意书后重复进行N-ISCFD数据采集。所有N-ISCFD数据按阜外医院最佳报告模式在50秒内进行分析,计算52项心功能指标。比较强化控制前后的数据,采用配对t检验对组间变化进行统计学分析。21例慢性病患者(男16例,女5例),年龄(54.05±12.77,29~75)岁,BMI(25.53±4.04,16.62~31.7)kg/m²。全组分析与基线比较:①患者体重、BMI、收缩压和舒张压显著降低(<0.01)。②CPET峰值摄氧量在强化控制前为(64.93±24.22,26.96~103.48)%预计值,强化控制后为(85.22±30.31,43.95~140.48)%预计值,强化控制后较强化控制前增加(35.09±27.87,0.12~129.35)%。无氧阈、峰值摄氧量/心率、峰值功率、氧摄取效率峰值、用力肺活量、第1秒用力呼气量、第1秒用力呼气量/用力肺活量%和最大分钟通气量显著增加(<0.01),最低每分通气量/二氧化碳排出量和每分通气量/二氧化碳排出量斜率显著降低(<0.01)。③左心功能核心指标:射血分数从(0.60±0.12,0.40~0.88)显著增至(0.66±0.09,0.53~0.87)(<0.01),增幅为(12.39±14.90,-12.32~41.11)%。总外周阻力从(1579.52±425.45,779.46~2409.61)G/(cm·s)显著降至(1340.44±261.49,756.05~1827.01)G/(cm·s)(<0.01),降幅为(12.00±17.27,37.79~28.61)%。左心搏出指数、心脏总功率、射血压力和左心室舒张末期容积显著改善(<0.05)。本研究个体化分析部分展示了每位患者各指标的变化分析。使用CPET和连续功能监测,我们可以安全有效地为慢性病患者制定个体化运动整体方案。长期强化管理和控制可安全有效地显著改善患者心血管功能。连续动态记录左右心功能参数变化可作为补充CPET评估心血管功能的一种简便方法。

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