心肺疾病病人其心跳速率轉折點與無氧呼吸閾值之相關性探討

The Relationship between Heart Rate Turning Point and Anaerobic Threshold in Patients with Cardiopulmonary Diseases

蘇怡恬(Yi-Tien Su) ； 洪素鶯(Su-Ying Hung) ； 周正亮(Chen-Liang Chou)

《台灣復健醫學雜誌》 41卷4期 (2013/12) Pp. 243-249

https://doi.org/10.6315/2013.41(4)05

摘要

許多研究證實心肺運動訓練對於許多不同的疾病都有助益，且可改善病患的生活品質。因此，訂定適合的運動強度以達到最佳效果，是許多臨床工作者的目標。為了達到運動訓練的最佳效果，臨床上我們希望能將訓練強度提高但同時兼顧安全性，而以無氧呼吸閾值來訂定運動強度，便是一個有效且相對安全的方式。以分析運動測試的氣體來判定無氧呼吸閾值是臨床判定的黃金標準，但傳統氣體分析之心肺運動測試所需的儀器及人力並非所有醫院所能提供。已有許多研究顯示以心跳速率轉折點（heart rate turning point）對於判定無氧呼吸閾值亦有可信度。然而目前研究主要是針對心臟衰竭之病人以及健康人，尚未有針對所有心肺疾患病人的研究。此外，也尚未有針對東方人的研究資料，所以本研究即在探討針對心肺疾患的國人，以簡易的直接觀察法判定心跳速率轉折點，並以此法所得之無氧呼吸閾值與以換氣當量判定無氧呼吸閾值的差異。本研究為回溯性研究，回顧從2008年1月至2012年12月來本月接受心肺運動測試的病人之病歷，以呼吸代償點所得無氧呼吸閾值的耗氧量以及心跳速率，與以心跳速率轉折點所得之無氧呼吸閾值的耗氧量以及心跳速率相比較。共87位病人列入統計，統計顯示由呼吸代償點以及心跳速率轉折點所得，在無氧呼吸閾值之心跳以及耗氧量並無統計學上顯著的差異，且以兩方法所得之心跳速率成強烈相關（r = 0.914）。由本研究結果顯示，以直接觀察法所得的心跳速率轉折點與呼吸代償點方法，所得的無氧呼吸閾值是相當接近的。利用此直接觀察的方式，臨床工作者僅需簡單的設備便能估算個案的無氧呼吸閾值，為個案設計適合的運動強度，以期達到運動訓練的效益。

關鍵字

心肺復健（cardiopulmonary rehabilitation） ； 心跳速率轉折點（heart rate turning point） ； 無氧呼吸閾值（anaerobic threshold）

並列摘要

Background: Exercise training is an efficient way to improve physical performance. Training at an intensity of a certain level of the anaerobic threshold (AT) is a successful and frequently adopted method to increase both maximal and submaximal exercise capacity. Several methods are currently used to detect the AT. Analysis of the respiratory gas exchange allows identification of the AT and is currently advocated as the ＂gold standard＂. The heart rate turning point (HRTP) is a downward or upward change from the linear HR work relationship evidenced during incremental exercise testing and has been reported to coincide with AT. Purpose: The aim of this study was to identify the AT using direct observation of the HRTP, and to evaluate the differences (HR and oxygen consumption, VO_2) in the AT between the gaseous analyses and the HRTP method. Methods: This was a retrospective study. We reviewed the charts of patients who came for our cardiopulmonary exercise testing clinic from January 2008 to December 2012. The oxygen consumption and HR at AT were recorded using two different methods, accordingly. Two physiatrists were asked to identify the HRTP with direct visual inspection; if there was disagreement, a third physiatrist was enlisted. Results: There was no significant difference between HR and oxygen consumption at the respiratory compensation point and the HRTP (P ＞ 0.050). Strong correlation between the HR at the RCP and HRTP was found (r = 0.914). Conclusion: Identifying the AT using direct visual inspection of the HRTP is feasible on occasions in where the necessary equipment is not available. Using the HRTP is a simpler way to identify the AT so as to approach the desired exercise intensity.