CAJ | 학술논문

背景:许多研究显示有氧运动疗法可增加迷走神经张力,迷走神经张力决定着稳定的心率,可提高心率变异性,减少心血管事件的发生. 目的:观察有氧运动疗法对老年卧床患者迷走神经张力的维持和对心率变异性相关指标的影响. 设计:随机对照观察. 单位:北京航天中心医院高干病房和解放军烟台疗养院综合内科. 对象:选择2002-02/2004-01航天中心医院高干内科和解放军烟台疗养院综合内科卧床老年患者45例.随机分成2组.治疗组23例,均为男性,平均年龄(69.5±8.0)岁;对照组22例,均为男性,平均年龄(71.4±6.5)岁. 干预:两组患者均给予改善循环和营养神经药物等治疗,在此基础上,治疗组采用有氧运动疗法:以靶心率为指标,即以通过运动获得的个人最高安全心率70%～85%作为每次运动的靶心率,开始时每次运动10～15 min,每运动4～6 min测一次心率或脉搏,运动以患者心率增加不超过20次/min、患者感觉不疲乏为度,以后逐渐增加运动时间,直至每次活动持续时间30-40 min,2次/d,每周治疗不少于5 d.两组分别于治疗前和治疗20周后检查24 h动态心电图,观察心率变异性各参数指标的变化. 主要观察指标:两组患者治疗前和治疗20周后心率变异性各参数指标(以正常R-R间期标准差评估迷走神经活性大小;以总功率谱评估心率变异性大小;以均值标准差评估交感-迷走神经平衡性;以低频段评估交感神经双重调节作用;以均方根评估短期内心率变化和迷走神经功能变化;以爱丁堡指数评估迷走神经活动作用;以高频评估迷走神经调节作用;以低频/高频评估交感神经活性效应). 结果:参与试验者46例,45例达到试验终点进入结果分析,1例死亡.①治疗组治疗20周后心率变异性指标中正常R-R间期标准差、均值标准差、均方根、爱丁堡指数、高频及总功率谱明显高于治疗前(t=12.5～38.4,P＜0.01).②对照组卧床20周后的心率变异性降低(P＜0.01). 结论:有氧运动疗法能增强卧床不起老年患者迷走神经的功能活性和交感-迷走神经平衡性,提高心率变异性,有助于降低心血管事件的发生. 揹景:許多研究顯示有氧運動療法可增加迷走神經張力,迷走神經張力決定著穩定的心率,可提高心率變異性,減少心血管事件的髮生. 目的:觀察有氧運動療法對老年臥床患者迷走神經張力的維持和對心率變異性相關指標的影響. 設計:隨機對照觀察. 單位:北京航天中心醫院高榦病房和解放軍煙檯療養院綜閤內科. 對象:選擇2002-02/2004-01航天中心醫院高榦內科和解放軍煙檯療養院綜閤內科臥床老年患者45例.隨機分成2組.治療組23例,均為男性,平均年齡(69.5±8.0)歲;對照組22例,均為男性,平均年齡(71.4±6.5)歲. 榦預:兩組患者均給予改善循環和營養神經藥物等治療,在此基礎上,治療組採用有氧運動療法:以靶心率為指標,即以通過運動穫得的箇人最高安全心率70%～85%作為每次運動的靶心率,開始時每次運動10～15 min,每運動4～6 min測一次心率或脈搏,運動以患者心率增加不超過20次/min、患者感覺不疲乏為度,以後逐漸增加運動時間,直至每次活動持續時間30-40 min,2次/d,每週治療不少于5 d.兩組分彆于治療前和治療20週後檢查24 h動態心電圖,觀察心率變異性各參數指標的變化. 主要觀察指標:兩組患者治療前和治療20週後心率變異性各參數指標(以正常R-R間期標準差評估迷走神經活性大小;以總功率譜評估心率變異性大小;以均值標準差評估交感-迷走神經平衡性;以低頻段評估交感神經雙重調節作用;以均方根評估短期內心率變化和迷走神經功能變化;以愛丁堡指數評估迷走神經活動作用;以高頻評估迷走神經調節作用;以低頻/高頻評估交感神經活性效應). 結果:參與試驗者46例,45例達到試驗終點進入結果分析,1例死亡.①治療組治療20週後心率變異性指標中正常R-R間期標準差、均值標準差、均方根、愛丁堡指數、高頻及總功率譜明顯高于治療前(t=12.5～38.4,P＜0.01).②對照組臥床20週後的心率變異性降低(P＜0.01). 結論:有氧運動療法能增彊臥床不起老年患者迷走神經的功能活性和交感-迷走神經平衡性,提高心率變異性,有助于降低心血管事件的髮生.
배경:허다연구현시유양운동요법가증가미주신경장력,미주신경장력결정착은정적심솔,가제고심솔변이성,감소심혈관사건적발생. 목적:관찰유양운동요법대노년와상환자미주신경장력적유지화대심솔변이성상관지표적영향. 설계:수궤대조관찰. 단위:북경항천중심의원고간병방화해방군연태요양원종합내과. 대상:선택2002-02/2004-01항천중심의원고간내과화해방군연태요양원종합내과와상노년환자45례.수궤분성2조.치료조23례,균위남성,평균년령(69.5±8.0)세;대조조22례,균위남성,평균년령(71.4±6.5)세. 간예:량조환자균급여개선순배화영양신경약물등치료,재차기출상,치료조채용유양운동요법:이파심솔위지표,즉이통과운동획득적개인최고안전심솔70%～85%작위매차운동적파심솔,개시시매차운동10～15 min,매운동4～6 min측일차심솔혹맥박,운동이환자심솔증가불초과20차/min、환자감각불피핍위도,이후축점증가운동시간,직지매차활동지속시간30-40 min,2차/d,매주치료불소우5 d.량조분별우치료전화치료20주후검사24 h동태심전도,관찰심솔변이성각삼수지표적변화. 주요관찰지표:량조환자치료전화치료20주후심솔변이성각삼수지표(이정상R-R간기표준차평고미주신경활성대소;이총공솔보평고심솔변이성대소;이균치표준차평고교감-미주신경평형성;이저빈단평고교감신경쌍중조절작용;이균방근평고단기내심솔변화화미주신경공능변화;이애정보지수평고미주신경활동작용;이고빈평고미주신경조절작용;이저빈/고빈평고교감신경활성효응). 결과:삼여시험자46례,45례체도시험종점진입결과분석,1례사망.①치료조치료20주후심솔변이성지표중정상R-R간기표준차、균치표준차、균방근、애정보지수、고빈급총공솔보명현고우치료전(t=12.5～38.4,P＜0.01).②대조조와상20주후적심솔변이성강저(P＜0.01). 결론:유양운동요법능증강와상불기노년환자미주신경적공능활성화교감-미주신경평형성,제고심솔변이성,유조우강저심혈관사건적발생.
BACKGROUND: Some researches show that aerobic kinesitherapy can strengthen the vagal tone that determines heart rate stability, increase the heart rate variability, and reduce the occurrence of cardiovascular events. OBJECTIVE: To observe the effect of aerobic kinesitherapy on vagal tone maintenance and the relevant indices of heart rate variability in elderly bedridden patients. DESIGN: A randomized controlled observation. SETTING: The Cadre Ward of Beijing Aerospace Central Hospital and Department of Comprehensive Internal Medicine, Yantai Convalescent Hospital of PLA. PARTICIPANTS: Totally 45 bedridden elderly male patients were selected from the patients admitted in the Cadre Ward of Beijing Aerospace Central Hospital and Department of Comprehensive Internal Medicine,Yantai Convalescent Hospital of PLA from February 2002 to January 2004.The patients were randomly divided into in treatment group (n =23, mean age of 69.5±8.0 years) and control group (n =22, mean age of 71.4±6.5). INTERVENTIONS: The therapeutic methods were similar in the two groups, I.e. Medications for amelioration of the circulation and neurotrophic treatment. On the basis of these treatments, the patients in the treatment group also had aerobic kinesitherapy through limb and trunk exercises with assistance to improve oxygen consumption of the body and increase the heart rate. In each session of exercise, the patients were supposed to attain the target heart rate of 70％ to 85％ of the personal highest safe heart rate.At the beginning, each session of exercise lasted for 10-15 minutes and the heart rate or pulse was measured every 4-6 minutes, with the patients'heart rate allowed to increase by no more than 20/minute and the patients not feeling tired. The subsequent exercise time gradually increased but not over 30-40 minutes, twice a day for no less than 5 days a week. Before and after the 20-week treatment, 24-hour dynamic electrocardiogram was examined to analyze the changes in the indices of heart rate variability. MAIN OUTCOME MEASURES: Before and after the 20-week treatment,the indices for heart rate variability were analyzed. The standard deviation of successive normal-to-normal R-R interval was determined for assessing the magnitude of vagus nerve activity, total power spectrum for the degree of heart rate variability, standard deviation of the mean value for the balance between the sympathetic nerve and vagus, low frequency for the dual regulation of the sympathetic nerves, root-mean-square derivations for short-term vagal function and heart rate changes, Edinburgh index for the sudden heart rate variationand the vagal activativity, high frequency for vagal regulation,and ratio of low frequency and high frequency for sympathetic nerve activity. RESULTS: This study involved initially 46 patients, 45 of whom completed the study and 1 patient died. After the 20-week treatment in treatment group, standard deviation of successive normal-to-normal R-R interval,standard deviation of the mean value, root mean square, Edinburgh index,high frequency and total power spectrum of heart rate variability were increased compared with those before treatment (t =12.5-38.4, P ＜ 0.01).The indices of heart rate variability was decreased in the control group 20weeks later (P ＜ 0.01). CONCLUSION: Aerobic kinesitherapy can improve the vagus nerve activity and the sympathetic-vagal balance, raise heart rate variability and reduce the occurrence of cardiovascular events.