基于呼吸—运动协同干预机制下的联合训练改善老年脑卒中偏瘫患者心肺适能重塑的随机对照研究^*

Effects of combined training based on a breathing-movement synergistic intervention mechanism on cardiopulmonary fitness remodeling in hemiplegia after senile stroke:a randomized controlled study

摘要

目的 探讨基于呼吸—运动协同干预模式对Brunnstrom Ⅱ~Ⅲ期老年脑卒中恢复期偏瘫患者心肺适能及运动能力的改善效果。方法 选取2023年1月—2025年1月上海市同仁医院康复科住院的老年脑卒中恢复期偏瘫患者80例作为研究对象,采用评估者盲法的随机对照试验研究,两组均给予常规康复训练。试验组在此基础上采用呼吸—运动整合干预方案,即坐姿改良八段锦及下肢功率车训练,6 d/周,连续12周。比较干预前后及两组间肺功能指标(FVC、FEV1、PEF)、运动能力指标(Work_peak、HRR)、心脏自主神经功能相关指标(HRR at1 min、SBPrest、DBPrest、HRrest)。结果 干预后,与干预前比较,两组FVC、FEV1、PEF均升高,且试验组高于对照组(P＜0.05);试验组Work_peak、HRR均提高,且试验组高于对照组(P＜0.05);试验组SBPrest、DBPrest及HRrest降低,HRR at 1 min升高,对照组仅HRR at 1 min升高(P＜0.05);与对照组比较,干预后试验组的SBPrest、DBPrest及HRrest降低,HRR at 1 min升高(P＜0.05)。结论 呼吸—运动协同干预模式的训练方案可显著改善Brunnstrom Ⅱ~Ⅲ期老年脑卒中恢复期患者的心肺适能与运动能力,为脑卒中后康复提供了创新有效的干预范式。

Abstract

Objective To explore the improvement effect of a breathing-movement synergistic interventionmodel on cardiopulmonary fitness and motor ability in elderly hemiplegic patients with Brunnstrom stage Ⅱ-Ⅲ during the recovery period of stroke. Methods A total of 80 elderly patients with hemiplegia in the recovery period after stroke who were hospitalized in the Department of Rehabilitation of Shanghai Tongren Hospital from January 2023 to January 2025 were selected as the research subjects. A randomized controlled trial with assessor blinding was conducted. Both groups were given conventional rehabilitation training. On this basis, the experimental group was supplemented with a breathing-movement integration intervention program: seated modified Baduanjin andlower-limb cycle ergometer training, 6 days a week for 12 consecutive weeks. To compare the pulmonary function indicators (FVC, FEV1, PEF), exercise capacity indicators (Work_peak, HRR), and cardiac autonomic nerve function related values (HRR at 1min, SBPrest, DBPrest, HRrest) within groups before and after intervention and between the two groups. Results After the intervention, compared with before the intervention, FVC, FEV1, and PEF in both groups increased, and the experimental group was higher than the control group (P < 0.05); Work_peak and HRR in the experimental group improved, and the experimental group was higher than the control group (P < 0.05); SBPrest, DBPrest, and HRrest in the experimental group decreased, and HRR at 1 min increased, while in the control group only HRR at 1 min increased (P < 0.05); compared with the control group, after the intervention, SBPrest, DBPrest, and HRrest in the experimental group decreased, and HRR at 1 min increased (P < 0.05). Conclusion The breathing-movement synergistic intervention model can significantly improve the cardiopulmonary fitness and motor ability of elderly hemiplegic patients with Brunnstrom stage Ⅱ-Ⅲ during the recovery period of stroke, providing an innovative and effective intervention paradigm for post-stroke rehabilitation.

关键词

坐姿改良八段锦 / 下肢功率车 / 老年脑卒中后偏瘫 / 呼吸—运动协同干预 / 心肺适能

Key words

Seated modified Baduanjin / Lower-limb cycle ergometer / Hemiplegia after senile stroke / Breathing-movement synergistic intervention / Cardiopulmonary fitness