中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (01): 21-26.doi: 10.3969/j.issn.1671-4091.2026.01.005

• 临床研究 • 上一篇    下一篇

增强型体外反搏联合有氧、抗阻运动对老年维持性血液透析衰弱患者的影响

相二青   卞小莲   

  1. 210019 南京，1南京医科大学附属明基医院(南京明基医院)血液净化中心
  • 收稿日期:2025-03-24 修回日期:2025-10-13 出版日期:2026-01-12 发布日期:2025-12-31
  • 通讯作者: 卞小莲 E-mail:253544215@qq.com
  • 基金资助:
    南京医科大学科研立项项目(NMUB20220150)

Effect of enhanced external counterpulsation combined with aerobic and resistance exercise on elderly frail patients undergoing maintenance hemodialysis

XIANG Er-qing, BIAN Xiao-lian   

  1. Blood Purification Center,  Mingji Hospital Affiliated to Nanjing Medical University(Nanjing Mingji Hospital), Nanjing 210019, China
  • Received:2025-03-24 Revised:2025-10-13 Online:2026-01-12 Published:2025-12-31
  • Contact: 210019 南京，1南京医科大学附属明基医院(南京明基医院)血液净化中心 E-mail:253544215@qq.com

摘要： 目的 探讨增强型体外反搏(enhanced external counterpulsation，EECP)联合有氧、抗阻运动对老年维持性血液透析(maintenance hemodialysis，MHD)衰弱患者心肺储备能力及运动耐力的影响。 方法  前瞻性选取2023年1月—12月南京医科大学附属明基医院收治的老年MHD衰弱患者为研究对象，采用数字随机法分为运动组、EECP组及联合组。3组患者均持续观察3个月，主要评估指标为心肺储备能力、运动耐力及生活质量。 结果 共纳入129例患者，运动组、EECP组及联合组各43例。治疗后，3组每搏量(stroke volume，SV)、左心室收缩末期容积(left ventricle end-systolic volume，LVESV)及左心室射血分数(left ventricular ejection fraction，LVEF)比较差异有统计学意义(F值分别为8.015、7.832、3.992，P值分别为0.001、0.001、0.021)；治疗后，3组最大呼气流量(peak expiratory flow，PEF)、用力肺活量(forced vital capacity，FVC)、第一秒用力呼气容积(forced expiratory volume in the first second，FEV1)及潮气量(tide volume，VT)比较差异有统计学意义(F值分别为28.923、56.482、40.780、71.835，P值均＜0.001)；治疗后，3组峰值负荷功率(peak load power，WR)、峰值氧脉搏(peak VO2/HR)、峰值代谢当量(metabolic equivalent of task，METs)、无氧阈(anaerobic threshold，AT)、峰值摄氧量(peak Oxygen Uptake，peakVO2)、6 min步行距离(6-minute walk distance，6MWT)及30 s坐立试验(30-second sit-to-stand test，30s-STS)比较差异有统计学意义(F值分别为66.005、228.830、88.218、28.485、20.617、37.617、43.287，P值均＜0.001)；治疗后，3组Spitzer生活质量指数(spitzer quality of life index，SQLI)及Fried衰弱表型(frailty phenotype，FP)评分比较差异有统计学意义(F=44.025、64.500，P值均＜0.001)。 结论  EECP和有氧、抗阻运动均可以对老年MHD衰弱患者的心肺功能及运动耐力提升有着积极影响，两者联合干预效果更好。

关键词: 维持性血液透析, 衰弱, 增强型体外反搏, 运动耐力, 心肺储备能力

Abstract: bjective  To explore the effects of enhanced external counterpulsation (EECP) combined with aerobic and resistance exercise on cardiopulmonary reserve capacity and exercise endurance in MHD patients with frailty.  Methods  Elderly MHD patients with frailty admitted to Nanjing Medical University Affiliated BenQ Hospital from January to December 2023 were prospectively selected as the research subjects. They were randomly divided into the exercise group, EECP group, and combined group using the digital randomization method. All three groups were observed for 3 months, with primary assessment indicators including cardiopulmonary reserve capacity, exercise tolerance, and quality of life.  Result  A total of 129 patients were included, with 43 in each of the exercise, EECP, and combined groups. After treatment, significant differences were observed among the three groups in stroke volume (SV) (F=8.015, P=0.001), left ventricular end-systolic volume (LVESV) (F=7.832, P=0.001), and left ventricular ejection fraction (LVEF) (F=3.992, P=0.021). After treatment, significant differences were found among the three groups in peak expiratory flow (PEF) (F=28.923, P<0.001), forced vital capacity (FVC) (F=56.482, P<0.001), forced expiratory volume in the first second (FEV1) (F=40.780, P<0.001), and tidal volume (VT) (F=71.835, P<0.001). Post-treatment comparisons among the three groups revealed significant differences in peak load power (WR) (F=66.005, P<0.001), peak oxygen pulse (peak VO2/HR) (F=228.830, P<0.001), peak metabolic equivalent of task (METs) (F=88.218, P<0.001), anaerobic threshold (AT) (F=28.485, P<0.001), peak oxygen uptake (peakVO2) (F=20.617, P<0.001), 6-minute walk distance (6MWT) (F=37.617, P<0.001), and 30-second sit-to-stand test (30s-STS) (F=43.287, P<0.001).  After treatment, significant differences were observed among the three groups in the Spitzer Quality of Life Index (SQLI) and Frailty Phenotype (FP) scores (F=44.025, 64.500; both P<0.001).Conclusion  Both EECP and aerobic and resistance exercises have positive effects on improving cardiopulmonary function and exercise endurance in elderly MHD patientswith frailty, with combined intervention yielding better outcomes.

Key words: Maintenance hemodialysis, Frailty, Enhanced external counterpulsation, Exercise endurance, Cardiopulmonary reserve capacity

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