简化杨氏太极拳对稳定性心血管疾病患者血流动力学指标的影响

目的:探讨简化杨氏太极拳对稳定性心血管疾病患者血流动力学指标的影响,为临床采用太极拳作为稳定性心血管疾病患者的运动康复手段提供理论依据。方法:于2017年3月至2017年6月在北京大学人民医院心脏康复门诊连续入组46~75岁稳定性心血管疾病患者60例,随机分为两组:太极拳组(n=30)初次学习简化杨氏太极拳12周,每周3次,每次30 min,达到熟练掌握程度;对照组(n=30)每周进行150 min中等强度的快走运动,共观察12周。采用运动心肺仪和无创心排仪评估两组患者12周后以及太极拳组患者先后进行一次太极拳和快走运动时的血流动力学变化,分析两种运动对血流动力学指标的影响。结果:太极拳组患者接受12周简化杨氏太极拳训练后,峰值摄氧量较基线显著增加(24.25±5.78)ml/(min·kg)vs.(21.48±5.96)ml/(min·kg),P=0.000],与对照组(23.06±6.83)ml/(min·kg)vs.(21.89±5.02)ml/(min·kg)]的差异均无统计学意义(P均>0.05)。太极拳组患者先后进行太极拳和快走运动达到相同心率时,太极拳运动时的峰值摄氧量(11.14±3.08)ml/(min·kg)vs.(14.42±3.77)ml/(min·kg)]和心脏做功指数4.62(1.13)kg·m/m² vs.8.86(4.19)kg·m/m²]明显低于快走运动,动静脉血氧含量差显著高于快走运动(113.26±39.87)ml/L vs(.82.18±24.13)ml/L];两种运动达到相同摄氧量时,太极拳运动时的峰值心率(95.91±19.07)次/min vs.(121.50±28.88)次/min]和心脏做功指数4.44(0.90)kg·m/m² vs.7.48(2.37)kg·m/m²]显著低于快走运动,动静脉血氧含量差显著高于快走运动(171.88±79.28)ml/L vs(.135.20±70.40)ml/L],以上差异均有统计学意义(P均<0.05)。结论:简化杨氏太极拳不显著增加稳定性心血管疾病患者的心率和心肌收缩力,对摄氧能力的改善作用与快走运动时相似,其机制可能与增加外周动静脉血氧含量差有关。

Effects of Simplified Tai Chi on Hemodynamics in Patients With Stable Cardiovascular Disease

Objectives:To explore the effects of simplified Tai Chi on hemodynamics in patients with stable cardiovascular disease,and to provide theoretical basis for clinical application of simplified Tai Chi.Methods:60 patients aged 46-75 years with stable cardiovascular disease were consecutively enrolled in the cardiac rehabilitation outpatient of Peking University People's Hospital from March 2017 to June 2017.They were randomly divided into two groups,30 in Tai Chi group and 30 in control group.Patients in Tai Chi group received simplified Tai Chi training for 12 weeks,3 times a week,30 minutes each time.Contorl group received 150 minutes of moderate intensity brisk walking exercise per week.After 12 weeks,the hemodynamic changes of the two groups and the hemodynamic parameters of patients in Tai Chi group post consecutive Tai Chi and walking exercise(30 minutes rest in between)were evaluated by cardiopulmonary exercise test and non-invasive cardiac output test.Parameters during Tai Chi and brisk walking were compared.Results:For Tai Chi group,after 12 weeks training,the peak oxygen uptake(VO2peak)increased significantly compared with baseline(24.25±5.78]ml/min·kg]vs.21.48±5.96]ml/min·kg],P=0.000).VO2peak in Tai Chi group were similar with control group(23.06±6.83]ml/min·kg]vs.21.89±5.02]ml/min·kg]).Patients in Tai Chi group carried out Tai Chi and walking exercise consequently,at the same heart rate,VO2peak(11.14±3.08]ml/min·kg]vs.14.42±3.77]ml/min·kg])and left cardiac work index(LCWi)of Tai Chi were significantly lower than those of brisk walking(4.621.13]kg·m/m² vs.8.864.19]kg·m/m²),and arterio-mixed venous oxygen content difference(Ca-vO2)was significantly higher than that of brisk walking(113.26±39.87]ml/L vs.82.18±24.13]ml/L).At the same oxygen uptake level,heart rate(95.91±19.07]beats/min vs.121.50±28.88]beats/min)and LCWi(4.440.90]kg·m/m² vs.7.482.37]kg·m/m²)during Tai Chi were lower than those of brisk walking,while Ca-vO2 was distinctly higher than that of brisk walking(171.88±79.28]ml/L vs.135.20±70.40]ml/L).The differences were all statistically significant(all P<0.05).Conclusions:The simplified Tai Chi can achieve the similar cardiopulmonary capacity under the condition of less heart work compared with brisk walking.The mechanism may be related to the increase of Ca-vO₂.