上肢功率车在脊髓损伤截瘫患者心肺运动试验中的应用研究

摘要

目的:观察上肢功率车在脊髓损伤(spinal cord injury,SCI)截瘫患者心肺运动试验中应用的可行性并分析SCI截瘫患者的心肺功能状态,探讨SCI截瘫患者有氧运动适合的评价指标.方法:招募20例SCI截瘫患者(试验组)及20名健康人(对照组),所有受试者在K4b2气体分析仪的监测下,采用智能主被动上肢功率车进行心肺运动试验.受试者进入实验室,休息10min后开始上肢功率车运动,转速主动控制在50-60r/min.起始功率为0W,并以每2min增加10W的幅度递增,直至测试者出现限制性症状终止试验,监测整个运动过程的心肺指标、主观劳累程度、心率、血压等.结果:测试过程中两组受试者心率、收缩压及舒张压在时间效应上存在显著差异(P＜0.001);试验组与对照组比较发现,峰值摄氧量(19.38±2.56ml/min/kg,26.49±3.45ml/min/kg)、最大心率(143.35±20.01bmp,170.95±11.93bmp)、无氧阈时心率(102.35±12.16bmp,120.25±10.07bmp)、呼吸交换率的最大值(1.15±0.04,1.22±0.05)、运动时间(12.55±0.61min,13.47±1.13min)差异有显著性意义(P＜0.01);试验组无氧阈时所对应的主观劳累程度与对照组比较,差异无显著性意义(P＞0.05).试验组获得的最大心率约为预期值的67％,对照组获得的最大心率约为预期值得85％.结论:对SCI截瘫患者采用上肢功率车运动进行心肺运动试验具有一定的可行性,SCI截瘫患者的心肺功能均有不同程度下降;主观劳累程度可作为此类患者有氧运动强度的适宜参数.%Objective:To observe the application of the upper limb cycle ergometer for cardiopulmonary exercise in paraplegic spinal cord injury(SCI) patients.To analyze the cardiopulmonary function and explore the appropriate assessment indicators of aerobic exercise for the SCI patients.Method:Twenty SCI patients and 20 healthy control were recruited in this study.All subjects performed active arm MOTOmed exercise under the monitoring of K4b2.The exercise protocol was as follow:10 minutes' rest in sitting followed by the upper limb cycle ergometer exercise(50-60 round per minute,the starting resistance was 0 power increased with 10 watt every 2 minutes) until the ending criterion was reached.The cardiopulmonary and cardiovascular data of each subjects were monitored as well as the Rating of Perceived Exertion data.Result:All subjects showed significant change on the heart rate,systolic and diastolic blood pressure during the testing(P＜0.001).The two groups showed statistical significant difference in the peak oxygen uptake(19.38± 2.56,26.49± 3.45ml/min/kg),the peak heart rate (143.35 ±20.01,170.95 ± 11.93bmp),the heart rate at anaerobic threshold (102.35± 12.16,120.25± 10.07bmp),the maximum respiratory exchange rate (1.15±0.04,1.22±0.05) and the exercise test duration(12.55±0.61,13.47±1.13min)(P＜0.01);There is no statistical difference in the Rating of Perceived Exertion during the anaerobic threshold between groups(P＞0.05).The peak heart rate of the SCI group was 67％ of the predicted value while the peak heart rate of the control group was 85％ of the predicted value.Conclusion:Upper limb cycle ergometer was applicable in cardiopulmonary exercise test for paraplegia SCI patients.The cardiopulmonary function was declined in paraplagic SCI patients.The ratings of Perceived Exertion could be a suitable parameter used for the guide of the aerobic exercise for those patients.