Abstract: Background　Chronic obstructive pulmonary disease（COPD） is a disease with progressive decrease of exercise tolerance and repetitive acute exacerbations in the later stage,pulmonary rehabilitation is an important treatment for COPD.Objective　The individualized target heart rate can be deduced from the peak heart rate of the cardiopulmonary exercise testing（CPET）,which can guide the sub-maximal exercise rehabilitation of lower extremity of COPD patients,the effects need to be evaluated.Methods　Forty COPD patients who were treated in Shanghai Pudong New Area People’s Hospital from January 2013 to February 2014,were assigned randomly to rehabilitation group（20 cases） and control group（20 cases） by random number table method.The peak heart rate of patients in rehabilitation group was detected by CPET,which was used to calculate the individualized target heart rate,then patients in rehabilitation group accomplished lower extremity sub-maximal exercise rehabilitation（30 min/d,3 times/week,lasted for 12 weeks） on the basis of the original drug treatment.Patients in control group received the original drug treatment and rehabilitation education,and carried out rehabilitation training according to their wishes without guidance.Before and after rehabilitation,all patients completed 6-minute walk distance（6MWT）,COPD Assessment Test（CAT） and Borg Scale（10 point judging system）.Results　The measured peak heart rate of patients in rehabilitation group was 87-149 times/min,with an average value of（116.7±16.4） times/min;the estimated peak heart rate of patients in rehabilitation group was 142-171 times/min,with an average value of（157.4±8.3） times/min,there was significant difference between the two sets of figures（P<0.01）.There were no significant difference in 6MWD，CAT score and Borg score between two groups at baseline（P>0.05）.After rehabilitation,there were significant differences in CAT score and Borg score between two groups（P<0.05）.6MWD of patients in control group after rehabilitation was significantly longer than that before rehabilitation（P<0.05）.There were no significant difference in CAT score and Borg score between before rehabilitation and after rehabilitation（P>0.05）.6MWD of patients in rehabilitation group after rehabilitation was significantly longer than that before rehabilitation,CAT score and Borg score in rehabilitation group after rehabilitation were significantly lower than those before rehabilitation（P<0.05）.Conclusion　Using individualized target heart rate deduced from CPET-detected peak heart rate to guide lower extremity sub-maximal exercise rehabilitation could improve exercise tolerance and ameliorate dyspnea symptoms in COPD patients.

Key words: Pulmonary disease,chronic obstructive, Rehabilitation, Cardiopulmonary exercise testing, Treatment outcome

摘要： 背景　慢性阻塞性肺疾病（COPD）患者疾病后期运动耐力下降，易反复急性加重，肺康复是COPD的重要治疗措施。目的　研究通过心肺运动试验（CPET）峰值心率计算个体化目标心率指导男性COPD患者下肢亚极量运动康复的效果。方法　选取2013年1月—2014年2月在上海市浦东新区人民医院住院治疗好转的男性COPD患者40例，采用随机数字表法分为肺康复组20例，对照组20例。肺康复组患者康复前完成CPET检测峰值心率，根据峰值心率计算个体化目标心率，在原有药物治疗基础上，完成为期12周，3次/周，30 min/次的下肢亚极量运动康复锻炼；对照组给予原有药物治疗及康复宣教，患者根据自己的意愿进行康复锻炼，不提供指导。患者康复前后均完成6 min步行试验（6MWT），评价自我评估测试问卷（CAT评分）和呼吸困难Borg量表（10分制）评分（Borg评分）。结果　肺康复组患者采用CPET测得峰值心率实测值为87～149次/min，平均（116.7±16.4）次/min；峰值心率预计值为142～171次/min，平均（157.4±8.3）次/min，差异有统计学意义（P<0.01）。康复前，两组患者6 min步行距离（6MWD）、CAT评分和Borg评分比较，差异无统计学意义（P>0.05）；康复后，两组患者CAT评分和Borg评分比较，差异有统计学意义（P<0.05）。对照组患者6MWD康复后较康复前增加（P<0.05）；对照组患者康复后CAT评分和Borg评分与康复前比较，差异无统计学意义（P>0.05）；肺康复组患者康复后6MWD较康复前增加、CAT评分和Borg评分较康复前降低（P<0.05）。结论　通过CPET检测峰值心率计算个体化目标心率指导下肢亚极量运动康复能安全、有效地改善COPD患者的运动耐力和呼吸困难症状。

关键词: 肺疾病,慢性阻塞性, 康复, 心肺运动试验, 治疗结果