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研究生:簡辰霖
研究生(外文):Chien, Chen-Lin
論文名稱:運動訓練在心臟移植後患者之成效
論文名稱(外文):Efficacy of Exercise Training in Heart Transplant Recipients
指導教授:吳英黛吳英黛引用關係賴金鑫賴金鑫引用關係王水深王水深引用關係周迺寬周迺寬引用關係
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:物理治療學研究所
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2001
畢業學年度:89
語文別:中文
論文頁數:96
中文關鍵詞:心臟移植運動訓練運動耐力生活品質
外文關鍵詞:Orthotopic Heart TransplantationExercise CapacityExercise TrainingQuality of Life
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研究背景和目標:運動耐力不足是心臟移植患者術後常見的問題。本研究是由物理治療師設計一個合併有氧運動與肌力運動的訓練計畫,以強調居家自我運動的訓練方式,評估8週後患者的有氧耐力、下肢肌力與肌耐力、身體組成、以及健康相關生活品質方面的改變。研究方法與受試者:共31位心臟移植患者參與本研究,其中12位為運動訓練組,19位為控制組,平均年齡分別為60.0 ± 6.4歲與52.8 ± 12.2歲(p < 0.05),平均移植術後的時間分別為21.1 ± 21.8月與33.4 ± 24.8月(p > 0.05),所有的受試者無任何急性排斥與身體不適症狀。運動訓練組接受為期8週、每週3次、每次約60分鐘的居家自我運動訓練,運動訓練包括了上下肢阻力運動、有氧運動與階梯運動,並且每兩週或是每ㄧ週回院追蹤ㄧ次,而控制組則未接受任何運動訓練。受試者在8週之前後均接受身體組成、肌力、肌耐力、健康相關生活品質、心肺耐力、日常活動量與飲食紀錄的評估,研究期間每4週均對受試者進行藥物、日常活動量與飲食的評估與紀錄。本研究採用敘述性統計與t檢定法比較兩組受試者在前測值與兩次測試差值之組間的差異。結果:運動訓練組與控制組的ㄧ分鐘坐到站的次數前測值間有明顯差異(21.2 ± 5.5次v.s. 26.3 ± 5.1次,p < 0.05),其餘測量項目的前測值兩組間並無明顯差異。8週之後,與控制組相比,運動訓練組的右膝伸肌耐力(+ 10.3 ± 10.6 % v.s. — 3.1 ± 7.2 %,p < 0.05)、ㄧ分鐘坐到站的次數(+ 5.9 ± 3.2次 v.s. — 1.0 ± 4.4次,p < 0.05)、最大運動攝氧量(+ 1.2 ± 2.7 ml/kg/min v.s. — 0.6 ± 2.0 ml/kg/min,p < 0.05)、最大運動量(+ 11.3 ± 13.3 瓦 v.s. — 1.2 ± 8.4瓦,p < 0.05)與持續運動時間(+ 1.3 ± 1.0分鐘v.s. — 0.2 ± 0.8分鐘,p < 0.05),生活品質評估中的生理健康範疇(+ 0.71 ± 1.83分v.s. — 0.66 ± 1.38分,p < 0.05)有明顯的改善。然而在體脂肪比例(+ 1.2 ± 3.7 % v.s. + 0.2 ± 2.5 %,p > 0.05)、非脂肪組織重量(- 0.4 ± 3.0 Kg v.s. + 0.4 ± 2.0 Kg,p > 0.05)、右膝伸肌肌力(+ 10.4 ± 18.7 N-m .vs. + 0.2 ± 20.4 N-m,p > 0.05)的前後測試的差值兩組間則無明顯差異。運動訓練組受試者的休息心率與血壓在8週運動訓練後的改變則與控制組無顯著差異。運動訓練組與控制組心臟移植患者在3次的飲食評估結果,組間與組內均無顯著差異;運動訓練組在後測值與前測值的日常活動量差值則明顯大於控制組(+ 282 ± 132大卡/日 v.s. + 53 ± 266大卡/日,p < 0.05),可能是運動訓練介入導致日常活動度增加的關係。結論:短期的運動訓練可以增加心臟移植患者的肌肉耐力與心肺耐力,並改善其生理健康方面的生活品質,並調整患者的生活型態,增加其日常體能活動;但是對於降低體脂肪比例、增加非脂肪組織重量與肌力的效果則不大。未來研究應朝向增加肌力訓練的項目與強度,並增加運動訓練的時間,同時深入研究運動耐力改善的機制與運動訓練對於心臟神經再生的影響。
關鍵字:心臟移植,運動耐力,運動訓練,生活品質
Background. Aerobic and strength combined training has been proposed to apply to cardiac rehabilitation program. The purpose of this study was to evaluate the effect of this kind of exercise training on health-related fitness and quality of life after orthotopic heart transplantation. Methods and Subjects. Thirty-one heart transplant recipients were recruited and assigned to exercise group ( n = 12 ) and control group ( n = 19 ). Subjects in exercise group were similar to control group in basic characteristics except age, persons in exercise group were older than control group ( 60.0 ± 6.4 years v.s. 52.8 ± 12.2 years, p < 0.05 ). The exercise group took a prescribed, structured, and home-based exercise training program 3 times a week for 8 weeks. They were asked to come to physical therapy department once every 1 — 2 weeks. Body composition, muscular strength and endurance, cardiopulmonary endurance and quality of life were evaluated before and after 8 weeks for each subject. In addition, assessment of daily physical activity and diet-calories intake were inquired every 4 weeks. Independent t test was used to compare the differences of 1st-test and re-test between groups. Results. As compared with the control group, the exercise group showed similar performance except lower general muscular endurance in pre-test. After 8-week follow-up study, the exercise group had significantly greater increases in endurance of right knee ( fatigue index: + 10.3 ± 10.6 % v.s. — 3.1 ± 7.2 % ), sit-to-stand rate in 1 minute ( +5.9 ± 3.2 v.s. —1.0 ± 4.4 ), peak VO2 ( + 1.2 ± 2.7 ml/kg/min v.s. — 0.6 ± 2.0 ml/kg/min ), peak workload ( + 11.3 ± 13.3 watts v.s. —1.2 ± 8.4 watts ), and the score in physical capacity domain of WHO quality of life questionnaire after training. However, the change of body composition and strength of right knee extensor were not significantly different between the groups, neither did the resting heart rate nor blood pressure. Subjects in the exercise group spent more energy expenditure than these in the control group and the increases might be largely due to the training program intervention. Both groups had similar dietary-calories intake throughout the study period. Conclusion. OHT recipients demostrated greater improvement in muscular endurance, cardiopulmonary endurance, and quality of life after short-term home-based exercise training.
Key Word: Orthotopic Heart Transplantation, Exercise Capacity, Exercise Training, Quality of Life
中文摘要 1
英文摘要 3
第一章 前言 5
第一節 研究背景 5
第二節 研究目的 6
第三節 實驗假說 7
第四節 研究的重要性 8
第二章 文獻回顧 9
第一節 心臟移植 9
第二節 心臟移植手術後的運動耐力 11
第三節 心臟移植後的肌力與骨骼肌變化 16
第四節 心臟移植後的身體組成與肥胖 18
第五節 心臟移植後的生活品質研究 19
第六節 阻力運動訓練合併有氧訓練對於心臟病患者的效果 21
第七節 心臟移植患者的運動訓練計劃 22
第三章 方法與程序 24
第一節 受試者 24
第二節 測試儀器與步驟 25
身體組成 26
肌力 26
肌耐力 27
健康相關生活品質評估 27
心肺耐力 28
日常活動量評估 29
飲食紀錄(24小時飲食回憶法) 30
第三節 運動訓練 30
第四節 統計方法 32
第四章 結果 33
第一節 受試者基本資料 33
第二節 運動訓練計畫之執行 34
第三節 運動訓練後測量參數的改變 35
身體組成 35
肌力與肌耐力 35
心肺耐力 36
健康相關生活品質 37
每日活動量與飲食攝取熱量 38
第五章 討論 39
第一節 身體組成 40
第二節 肌力與肌耐力 43
第三節 心肺耐力 45
第四節 健康相關生活品質 51
第五節 每日活動量與飲食攝取熱量 53
第六節 本研究之限制與未來研究方向 55
第六章 結論 56
第七章 參考文獻 57
圖表與附件
表1 心臟移植患者的運動耐力研究 69
表2 心臟移植患者運動訓練的結果 71
表3-A 上肢的阻力訓練 73
表4. 受試者的基本資料 74
表5. 休息時的心跳與血壓 75
表6. 身體組成測量結果 76
表7. 肌力與肌耐力測量結果 77
表8. 心肺耐力測量結果 78
表9. 健康相關生活品質評估結果-生理、心理、社會關係與環境四大範疇分數 79
表10. 運動訓練組與控制組的日常活動量及單日飲食攝取熱量評估結果 80
表11. 未完成研究之受試者資料 81
圖1. 日常活動量評估結果 83
圖2. 單日飲食攝取熱量 84
附件一 國立臺灣大學醫學院暨附設醫院臨床試驗受試者說明及同意書 85
附件二 受試者的基本資料 88
附件三 台灣簡明版世界衛生組織生活品質問卷 90
附件四 日常活動量評估- 七日回憶問卷 93
附件五 單日飲食紀錄表 95
附件六 運動訓練組受試者的自我運動紀錄表 96
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