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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10～15min,每运动4～6min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30～40min,2次/d,每周治疗不少于5d。两组分别于治疗前和治疗20周后检查24h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。
Background: Many studies have shown that aerobic exercise therapy can increase vagal tone, vagal tone determines a stable heart rate, can improve heart rate variability and reduce the incidence of cardiovascular events. Objective: To observe the effects of aerobic exercise therapy on the maintenance of vagal tone and the indexes related to heart rate variability in elderly bedridden patients. Design: Randomized controlled observation. Unit: Beijing Aerospace Center Hospital dry high and the PLA General Hospital of Yantai Sanatorium. PARTICIPANTS: A total of 45 elderly patients were selected in the Department of Internal Medicine of the Center for Aerospace Medicine and Yantai Sanatorium of Chinese People ’s Liberation Army from 2002-02 / 2004-01. Randomly divided into two groups. Twenty-three patients in the treatment group were male, with an average age of (69.5 ± 8.0) years. In the control group, 22 patients were male, with an average age of (71.4 ± 6.5) years. Intervention: both groups were given to improve circulation and neurotrophic drugs and other treatments, on this basis, the treatment group using aerobic exercise therapy: the target heart rate as an indicator, that is, through personal exercise to obtain the highest safe heart rate of 70% to 85% As the target heart rate of each exercise, the beginning of each exercise 10 ~ 15min, measured every 4 to 6min heart rate or pulse, exercise to increase the patient’s heart rate does not exceed 20 beats / min, the patient feels not tired for the degree, then gradually increased Exercise time until the duration of each activity 30 ~ 40min, 2 times / d, weekly treatment of not less than 5d. Two groups before treatment and after 20 weeks of treatment, check 24h dynamic electrocardiogram, observe the changes of heart rate variability parameters. MAIN OUTCOME MEASURES: The parameters of heart rate variability before treatment and after 20 weeks of treatment were determined by the standard deviation of normal RR interval, the magnitude of heart rate variability was evaluated by total power spectrum, Vagal balance; assessment of sympathetic dual regulatory function at low frequency; assessment of short-term changes in heart rate and vagal function with root mean square; assessment of vagal activity by Edinburgh index; assessment of vagal modulation by high frequency; Sympathetic activity effect). Results: 46 patients participated in the trial, and 45 patients reached the end of the trial to enter the result analysis. One patient died. ① The standard deviation, mean standard deviation, root mean square, Edinburgh index, high frequency and total power spectrum of normal RR interval in treatment group after 20 weeks of treatment were significantly higher than those before treatment (t = 12.5-38.4, P < 0.01). ② The heart rate variability of the control group decreased after 20 weeks (P <0.01). CONCLUSION: Aerobic exercise therapy can enhance vagal activity and sympathetic-vagal balance in elderly patients with bedriddenness, increase heart rate variability, and reduce the incidence of cardiovascular events.