摘要目的 探讨有氧运动康复对慢性心力衰竭患者运动耐力的影响.方法 左心室射血分数(LVEF) ＜49％的慢性心力衰竭患者50例,分为运动组25例及非运动组25例,并实施心肺运动试验(CPET).运动组执行以无氧代谢阈值(AT)前10 J/s为运动强度而制定的有氧运动处方,非运动组要求日常活动.先进行6次医院监护下的有氧运动训练,之后采用家庭有氧运动训练.3个月后复查CPET.结果 两组患者无氧代谢阈值氧耗量(VO2AT)、峰值氧耗量、AT负荷、峰值负荷、峰值每搏摄氧量(峰值VO2/HR)、二氧化碳通气当量斜率(VE/VCO2斜率)基线水平差异均无统计学意义(均P ＞0.05).经过3个月有氧运动康复后,运动组VO2 AT、峰值氧耗量、AT负荷、峰值负荷、峰值VOJHR较基线增加,VE/VCO2斜率较基线减小,3个月前后,VO2 AT、峰值氧耗量、AT负荷、峰值负荷、峰值VO2/HR、VE/VCO2斜率变化值分别以ΔVO2AT、Δ峰值氧耗量、ΔAT负荷、Δ峰值负荷、Δ峰值VO2/HR、ΔVE/VCO2斜率表示,两组患者ΔVO2 AT、Δ峰值氧耗量、ΔAT负荷、Δ峰值负荷、Δ峰值VO2/HR差异均有统计学意义[运动组与非运动组分别为,ΔVO2AT:2.8(1.2 ～ 3.5) ml·kg-1·min -1,-0.3(-2.8～0.1)ml· kg-1·min-1,P＜0.01;Δ峰值氧耗量:3.4(1.8～4.6)ml·kg-1·min -1,-0.5(-1.4～0.3)ml·kg-1·min-1,P＜0.01;ΔAT负荷:15.0(2.5～22.5) J/s,0.5(-4.2～3.8)J/s,P＜0.01；Δ峰值负荷:15.0(1.3～25.0) J/s,0.0(～8.8～15.0)J/s,P＜0.05；Δ峰值VO2/HR:2.3(0.0～4.0)ml·kg-1·beat-1,-0.1(-0.7 ～1.2)ml·kg-1·beat -1,P＜0.01],ΔVE/VCO2斜率差异无统计学意义[运动组与非运动组:-2.3(-12.2 ～1.8),1.0(-0.4 ～2.6),P＞0.05].结论 3个月的有氧运动康复可以改善慢性心力衰竭患者的运动耐力.

abstractsObjective To explore the effects of aerobic exercise on exercise tolerance in patients with chronic heart failure (CHF).Methods A total of 50 CHF patients with left ventricular ejection fraction (LVEF) ＜ 49％ by echocardiography were enrolled.And they were randomly divided into exercise group ( n =25) and non-exercise group (n =25).Cardiopulmonary exercise testing (CPET) was performed.The patients of exercise group underwent an aerobic exercise program in which exercise intensity was decided by anaerobic threshold (AT) before 10 J/s while those of non-exercise group performed daily activities.After 6 sessions of supervised aerobic exercise,the home-based aerobic exercise training began.CPET was reexamined 3 months later.Results The VO2 AT,VO2 peak,Load AT,Load peak,peak VO2/HR and VE/VCO2 slope at baseline were similar between exercise group and non-exercise group ( P ＞ 0.05 ).The VO2 AT,VO2 peak,Load AT,Load peak and peak VO2/HR in patients of exercise group were increased compared with baseline,The differences between baseline and 3 months later expressed as ΔVO2 AT,ΔVO2 peak,ΔLoad AT,ΔLoad peak,Δpeak VO2/HR and ΔVE/VCO2 slope,The differences of ΔVO2 AT,ΔVO2 peak,ΔLoad AT,ΔLoad peak and Δpeak VO2/HR between two groups were statistically significant [ΔVO2 AT:2.8(1.2-3.5)ml · kg-1 · min-1 vs -0.3( -2.8-0.1)ml · kg-1 · min-1,P ＜0.01;ΔVO2 peak:3.4(1.8-4.6)ml · kg-1 · min-1 vs -0.5(-1.4-0.3) ml · kg-1 · min-1,P＜0.01;ΔLoad AT:15.0(2.5 -22.5) J/s vs 0.5( -4.2 -3.8) J/s,P ＜0.01 ; ΔLoad peak:15.0( 1.3 -25.0)J/s vs0.0 ( -8.8 -15.0) J/s,P＜0.05; Δpeak VO2/HR:2.3(0.0-4.0)ml · kg-1 · beat-1 vs -0.1( -0.7- 1.2) ml · kg-1 · beat-1,P ＜0.01].The difference of ΔVE/VCO2 slope was not statistically significant [-2.3( -12.2-1.8)vs 1.0( -0.4 - 2.6),P ＞ 0.05].Conclusion After 3 months of aerobic exercise,exercise capacity may improve in the CHF patients.