个体化精准恒定功率运动前、后慢性病患者脉搏波波形特征改变初步分析
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摘要
目的探讨个体化精准恒定功率运动对慢性病患者脉搏波波形特征的影响。方法选取2017年6月在首都医科大学附属北京康复医院接受本团队管理的慢性病(以血糖、血脂、血压异常为主)患者中的11例为慢病组,同期选取在中国医学科学院阜外医院学习的正常人8例为正常组。以心肺运动试验评估制定个体化精准恒定功率运动处方,每天运动30 min,在运动前和运动后5、15、30、40 min测量其桡动脉脉搏波波形。对受试者脉搏波原始数据用Origin作图,对桡动脉脉搏波的上升、下降、切迹或平台等波形特征及其运动前后变化进行定性分析,并比较两组运动前、后切迹出现率。结果运动前慢病组切迹出现率低于正常组(P=0.010)。运动后两组脉搏波均较运动前的波峰变高、波形变窄。运动后5、15、30、40 min慢病组切迹出现率同运动前比较,差异无统计学意义(P>0.05),正常人切迹出现率始终为100.0%;运动后5、15、30、40 min慢病组切迹出现率与正常组比较,差异无统计学意义(P>0.05)。结论个体化精准恒定功率运动可改变脉搏波波形,其可能作为运动疗法有效管控慢性病的指标,其机制有待进一步研究。
Objective To investigate the effect of individualized constant power exercise on pulse wave in patients with chronic diseases.Methods Eleven patients with chronic diseases(blood sugar,blood lipids,and blood pressure abnormalities) managed by our team were enrolled as the patient group in the Beijing Rehabilitation Hospital affiliated to Capital Medical University in June 2017 and eight normal persons were enrolled in the Fuwai Hospital,Chinese Academy of Medical Sciences as the normal group during the same period.The individualized quantitative exercise prescription was developed by cardiopulmonary exercise test,and the radial artery pulse wave was measured before and at 5,15,30,40 min after exercise,with 30 minutes of exercise every day.The original data of pulse wave of subjects was plotted with Origin,and the waveform characteristics of the rise,fall,notch or plateau of the radial artery pulse wave and its changes before and after the exercise were qualitatively analyzed,and the pre-and post-existing notch occurrence rates were compared in two groups.Results The notch occurrence rate of the patient was lower than that of normal group(P=0.010) before exercise.After exercise,the pulse wave waveform of both groups became higher and narrower.There was no statistical significance in notch occurrence rate of patient group before and after 5 min,15 min,30 min,40 min of exercise(P>0.05).There was no significant difference in the notch occurrence rate between the patient group and the normal group after 5 min,15 min,30 min,40 min of exercise(P>0.05).Conclusion Individualized constant power exercise can change the pulse wave waveform,which may be an effective indicator for exercise control of chronic diseases and hypertension,but its mechanism needs further study.
Objective To investigate the effect of individualized constant power exercise on pulse wave in patients with chronic diseases.Methods Eleven patients with chronic diseases(blood sugar,blood lipids,and blood pressure abnormalities) managed by our team were enrolled as the patient group in the Beijing Rehabilitation Hospital affiliated to Capital Medical University in June 2017 and eight normal persons were enrolled in the Fuwai Hospital,Chinese Academy of Medical Sciences as the normal group during the same period.The individualized quantitative exercise prescription was developed by cardiopulmonary exercise test,and the radial artery pulse wave was measured before and at 5,15,30,40 min after exercise,with 30 minutes of exercise every day.The original data of pulse wave of subjects was plotted with Origin,and the waveform characteristics of the rise,fall,notch or plateau of the radial artery pulse wave and its changes before and after the exercise were qualitatively analyzed,and the pre-and post-existing notch occurrence rates were compared in two groups.Results The notch occurrence rate of the patient was lower than that of normal group(P=0.010) before exercise.After exercise,the pulse wave waveform of both groups became higher and narrower.There was no statistical significance in notch occurrence rate of patient group before and after 5 min,15 min,30 min,40 min of exercise(P>0.05).There was no significant difference in the notch occurrence rate between the patient group and the normal group after 5 min,15 min,30 min,40 min of exercise(P>0.05).Conclusion Individualized constant power exercise can change the pulse wave waveform,which may be an effective indicator for exercise control of chronic diseases and hypertension,but its mechanism needs further study.
引文
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[2]陈研,陈刚,Zhou Maigeng,等.中国糖尿病发病率和检出率地域性差异——98058例成年受试者数据多水平空间分析[J].创伤与急诊电子杂志,2015,3(4):82-83.DOI:10.16746/j.cnki.11-9332/r.2015.04.014.
[3]诸骏仁,高润霖,赵水平,等.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,31(10):937-953.DOI:10.3969/j.issn.1000-3614.2016.10.001.ZHU J R,GAO R L,ZHAO S P,et al.Guidance for prevention and treatment of dyslipidemia in Chinese adults(revised edition2016)[J].Chinese Circulation Journal,2016,31(10):937-953.DOI:10.3969/j.issn.1000-3614.2016.10.001.
[4]孙兴国.服务于人的生命科学和医学工作者必须坚持整体观[J].中国应用生理学杂志,2015,31(4):289-294.DOI:10.13459/j.cnki.cjap.2015.04.001.SUN X G.Establishing the idea of holistic integrative medicine,optimizing the quality of health care service in prevention and treatment[J].Chinese Journal of Applied Physiology,2015,31(4):289-294.DOI:10.13459/j.cnki.cjap.2015.04.001.
[5]沈素兴,郭琪,练艺影,等.不同运动处方对勺型及非勺型高血压影响的研究进展[J].中国康复医学杂志,2014,29(5):489-491.DOI:10.3969/j.issn.1001-1242.2014.05.022.
[6]陶蕊,李宁川,陆伟,等.有氧运动对中老年高血压患者血压、血脂的影响[J].运动,2015(13):153-154.DOI:10.3969/j.issn.1674-151x.2015.13.083.
[7]凡永艳.高强度运动对心血管系统损伤的机制及预防研究[D].北京:中国人民解放军医学院,2015.
[8]孙兴国.生命整体调控新理论体系与心肺运动试验[J].医学与哲学(A),2013,34(3):22-27.SUN X G.New theoretical system of holistic control and regulation for life and cardiopulmonary exercise testing[J].Medicine and Philosophy(A),2013,34(3):22-27.
[9]孙兴国.整体整合生理学医学新理论体系概论Ⅰ:呼吸调控新视野[J].中国应用生理学杂志,2015,31(4):295-301.DOI:10.13459/j.cnki.cjap.2015.04.002.SUNXG.Newtheoryofholisticintegrativephysiologyand medicineⅠ:new insight of mechanism of control and regulation of breathing[J].Chinese Journal of Applied Physiology,2015,31(4):295-301.DOI:10.13459/j.cnki.cjap.2015.04.002.
[10]孙兴国.整体整合生理学医学新理论体系概论Ⅱ:循环调控新视野[J].中国应用生理学杂志,2015,31(4):302-307.DOI:10.13459/j.cnki.cjap.2015.04.003.SUN X G.New theory of holistic integrative physiology and medicineⅡ:new insight of the control and regulation of circulation[J].Chinese Journal of Applied Physiology,2015,31(4):302-307.DOI:10.13459/j.cnki.cjap.2015.04.003.
[11]孙兴国.整体整合生理学医学新理论体系概论Ⅲ:呼吸循环代谢一体化调控环路中神经体液作用模式[J].中国应用生理学杂志,2015,31(4):308-315.DOI:10.13459/j.cnki.cjap.2015.04.004.
[12]葛万刚,孙兴国,刘艳玲,等.心肺运动试验精准制定个体化适度强度运动康复处方治疗高血压的疗效研究[J].中国全科医学,2016,19(35):4316-4322.DOI:10.3969/j.issn.1007-9572.2016.35.006.GE W G,SUN X G,LIU Y L,et al.Effects of CPET-based precise formulation of individualized moderate-intensityexercise prescription on hypertension[J].Chinese General Practice,2016,19(35):4316-4322.DOI:10.3969/j.issn.1007-9572.2016.35.006.
[13]宋相和,王耘.脉搏波:沟通中医和西医的桥梁[J].中西医结合学报,2008(9):891-896.SONG X H,WANG Y.Pulse wave:a bridge between Chinese medicine and Western medicine[J].Journal of Chinese Integrative Medicine,2008(9):891-896.
[14]罗志昌,张松,杨文鸣,等.脉搏波波形特征信息的研究[J].北京工业大学学报,1996(1):71-79.LUO Z C,ZHANG S,YANG W M,et al.Research on pulse waveform feature information[J].Journal of Beijing Polytechnic of Technology,1996(1):71-79.
[15]王礼立,王晖,杨黎明,等.论脉搏波客观化和定量化研究的症结所在[J].中华中医药杂志,2017,32(11):4855-4863.WANGLL,WANGH,YANGLM,etal.Thecruxof objectifying and quantifying pulse wave[J].China Journal of Traditional Chinese Medicine and Pharmacy,2017,32(11):4855-4863.
[16]孟丽琴,利定建,傅应昌,等.H型高血压患者血管内皮功能及脉搏波传导速度的研究[J].中国循证心血管医学杂志,2017,9(8):934-936.DOI:10.3969/j.issn.1674-4055.2017.08.10.MENGLQ,LIDJ,FUYC,etal.Studyonvascular endothelial function and pulse wave velocity in H-type hypertension patients[J].Chinese Journal of Evidence-Based Cardiovascular Medicine,2017,9(8):934-936.DOI:10.3969/j.issn.1674-4055.2017.08.10.
[17]唐世凡,王朝晖,程锡华,等.2型糖尿病患者大血管病变与踝臂脉搏波传导速度的相关性研究[J].中国糖尿病杂志,2017,25(3):204-207.DOI:10.3969/j.issn.1006-6187.2017.03.003.TANG S F,WANG Z H,CHENG X H,et al.Relevance between macrovascular disease and brachial-ankle pulse wave velocity in patients with type 2 diabetes mellitus[J].Chinese Journal of Diabetes,2017,25(3):204-207.DOI:10.3969/j.issn.1006-6187.2017.03.003.
[18]杨慧,吴寿岭,李晓芳,等.甘油三酯与臂踝动脉脉搏波传导速度的关系[J].中国循环杂志,2017,32(5):470-474.DOI:10.3969/j.issn.1000-3614.2017.05.012.YANG H,WU S L,LI X F,et al.Relationship between blood triglyceride level and brachial-ankle pulse wave velocity in relevant population[J].Chinese Circulation Journal,2017,32(5):470-474.DOI:10.3969/j.issn.1000-3614.2017.05.012.
[19]刘力生.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.DOI:10.16439/j.cnki.1673-7245.2011.08.009.LIULS.2010Chineseguidelinesforthemanagementof hypertension[J].Chinese Journal of Hypertension,2011,19(8):701-743.DOI:10.16439/j.cnki.1673-7245.2011.08.009.
[20]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志,2014,22(8):2-42.
[21]WASSERMAN K,HANSEN J E,SUE D Y,et al.Principles of exercise testing and interpretation including pathophysiology and clinical aplications[M].5th ed.Philadelphia(USA):LIPPINCOTT WILLIAMS&WILKINS,2012.
[22]SUN X G,HANSEN J E,OUDIZ R J,et al.Gas exchange detection of exercise-induced right-to-left shunt in patients with primary pulmonary hypertension[J].Circulation,2002,105(1):54-60.
[23]HANSEN J E,SUN X G,STRINGER W W,et al.A simple new visualization of exercise data discloses pathophysiology and severity of heart failure[J].J Am Heart Assoc,2012,1(3):e001883.DOI:10.1161/JAHA.112.001883.
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