标题：有氧运动对脑卒中合并冠心病患者运动能力及血脂的影响

      作者：盛富强 1，周仁娣 2，朱云霞 1，郭进 1    上海市养志康复医院上海市阳光康复中心心肺康复科 1、医学影像科 2，上海 松江 201600

      卷次： 2020年31卷19期

      【摘要】 目的 探讨有氧运动对脑卒中合并冠心病患者运动能力和血脂的影响。方法 选取2018年8月至2019年12月上海市养志康复医院心肺康复科收治且完成心肺运动试验的脑卒中合并冠心病患者40例，依据随机数表法分为常规治疗组和有氧运动组，每组20例。常规治疗组进行常规步态、平衡、力量和关节活动度训练，有氧运动组进行常规治疗+有氧运动，均持续12周。比较两组患者干预前后的心肺运动试验参数、血压、血脂和6 min步行试验结果。此外，观察两组患者干预过程中不良心脏事件的发生情况。结果 干预前，两组患者的临床资料和试验观察指标比较差异均无统计学意义(P>0.05)；两组患者的峰值摄氧量(VO2peak)与6 min步行距离相关(r=0.701、0.976，P<0.01)；干预后，有氧运动组患者的VO2peak、6 min步行距离与高密度脂蛋白(HDL)增加值差值分别为(1.91±0.59) mL·kg-1·min-1、(52.5±19.3) m、(0.47±0.18) mmol/L，明显高于或长于常规治疗组的(0.04±0.16) mL·kg-1·min-1、(2.5±6.4) m、(0.02±0.03) mmol/L，差异均有显著统计学意义(P<0.01)；干预后，有氧运动组患者的收缩压、舒张压、最大心率、总胆固醇、低密度脂蛋白(LDL)和甘油三酯降低值差值明显大于或高于常规治疗组，差异均有显著统计学意义(P<0.01)；常规治疗组干预后所有指标与干预前比较差异均无统计学意义(P>0.05)；有氧运动组中，VO2peak变化值与总胆固醇、LDL、HDL和甘油三酯的变化值具有相关性(r=0.949、0.920、0.927、0.856，P<0.01)；两组患者在干预过程中均无心脏事件发生。结论 有氧运动能增加脑卒中合并冠心病患者的运动能力并改善血脂，患者运动能力的改善与血脂水平的改善相关。
      【关键词】 有氧运动；脑卒中；冠心病；峰值摄氧量；运动能力；血脂
      【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1003—6350（2020）19—2462—05

Effect of aerobic exercise on exercise capacity and blood lipid in patients with stroke combined with coronaryartery disease.
SHENG Fu-qiang 1, ZHOU Ren-di 2, ZHU Yun-xia 1, GUO Jin 1. Department of CardiopulmonaryRehabilitation 1, Department of Radiology 2, Shanghai Yangzhi Rehabilitation Hospital, Songjiang 201600, Shanghai, CHINA
【Abstract】 Objective To investigate the effect of aerobic exercise on exercise capacity and blood lipid in pa-tients with stroke combined with coronary artery disease. Methods Forty patients who had completed cardiopulmonaryexercise test (CPET) admitted to the Department of Cardiopulmonary Rehabilitation, Shanghai Yangzhi RehabilitationHospital from August 2018 to December 2019 were enrolled. The patients were divided into aerobic exercise group andusual care group according to the random number table method, with 20 patients in each group. Patients in usual caregroup received conventional exercise training including gait, balance, strength, and range of motion activities, and pa-tients in aerobic exercise group received usual care as usual care group and aerobic exercise training, both exercised for12 weeks. The variables of CPET, blood pressure, blood lipid, and 6-minute walking test in two groups before and afterintervention were analyzed. Additionally, the occurrence of adverse cardiac events during the course of intervention be-tween two groups was observed. Results Before intervention, clinical data and experimental observation variables be-tween two groups had no significant statistical difference (P>0.05), and the VO2peak was related to 6-minute walking dis-tance in both groups (r=0.701, 0.976, P<0.01); after intervention, the differences in increased VO2peak, 6-minute walkingdistance, and high-density lipoprotein (HDL) in aerobic exercise group were (1.91±0.59) mL·kg-1·min-1, (52.5±19.3) m,(0.47±0.18) mmol/L, significantly higher or longer than (0.04±0.16) mL·kg-1·min-1, (2.5±6.4) m, (0.02±0.03) mmol/L inusual care group (P<0.01). The differences in decreased systolic blood pressure, diastolic blood pressure, maximal heartrate, total cholesterol, low-density lipoprotein (LDL) and triglyceride were larger or higher in aerobic exercise group thanin usual care group (P<0.01). All variables after intervention of the patients in usual care group showed no significant sta-tistical difference compared with those before intervention (P>0.05). The changes of VO2peak were related to the changes oftotal cholesterol, LDL, HDL, and triglyceride in aerobic exercise group (r=0.949, 0.920, 0.927, 0.856, P<0.01). There wereno cardiac adverse events in both groups during the course of intervention. Conclusion Aerobic exercise can increase ex-ercise capacity and improve serum level of blood lipid in patients with stroke combined with coronary artery disease, andthe improvement of exercise capacity was associated with improved serum level of blood lipid.
      【Key words】 Aerobic exercise; Stroke; Coronary artery disease; Peak oxygen consumption; Exercise capacity;Blood lipid