心臟衰竭病患運動復健訓練後中醫症狀之評估：先導性試驗

The Effect of Exercise on the Clinical Manifestation of Traditional Chinese Medicine Symptoms in the Heart Failure Patients: A Pilot Study

心臟衰竭有呼吸困難、疲勞、及運動不耐等症狀，係由心肌功能受損，心輸出量和組織器官的血液灌流減少所致。一般依紐約心臟學會功能性分級（NYHA FC）進行功能缺損之評估，而由中醫角度視之，應以「氣虛」為主要病機。二者之程度間是否相關，值得進一步觀察。心臟衰竭患者進行運動訓練，能改善心肌功能，促進運動能力，進而提升其生活品質，此等效果類似中醫「補氣」作用。本研究擬以中、西醫指標進行觀測，以評估運動復健對心臟衰竭患者氣虛症狀之效應。本研究邀請長庚醫院基隆院區心臟衰竭中心患者10名，進行有氧間歇強度運動訓練先導性試驗，每周3次，每次30分鐘，為期12週，並於訓練前後接受運動測試、中醫症狀及生活品質評估。經12週運動訓練後，10名受試者最大氧氣攝取量（peak oxygen consumption, VO2peak，1137.00±466.20 vs 1371.90±527.88 ml/kg/min, P<0.001）、絕對做功量（83.50±30.37 vs 106.50±39.73 Watt, P<0.001）、左心室射出分率（left ventricle ejection fraction, LVEF）（33.20±14.75 vs 51.30±16.26(%), P=0.05）、攝氧效率斜率oxygen uptake efficiency slope, OUES）（549.25±221.41 vs 708.77±283.71, P=0.007）、明尼蘇達心衰量表（28.4±20.7 vs 14.8±15.0, P=0.02）等指標皆有顯著改善，中醫問卷在四肢發冷、少氣等症狀有改善，與舌診、脈診之變化一致。心臟衰竭患者之生理功能參數與中醫症狀之部分指標有一致性表現，可作為臨床評估之參考。

Heart failure (HF) patients experienced dyspnea, fatigue, and exercise intolerance, resulted from myocardial pumping deficiency, which lead to reduced cardiac output and impaired blood perfusion in peripheral tissue, and further systemic dysfunction. The New York Heart Association (NYHA) Functional Classification provides a simple way of classifying the degree of HF. It places patients in one of the four categories based on how they are limited in their physical activity. The limitations of daily activity correspond to the clinical manifestations of “Qi-deficiency” in traditional Chinese medicine (TCM). Due to pathogenesis of HF is closely related to “Qi-deficiency”, the relationship of NYHA functional classification and the degree of “Qi-deficiency” is worthy of further observation. We recruit 10 HF patients from the department of cardiology in medial center. All patients received exercise training for 30 minutes, three times per week for 12 weeks, and receive another CPET、TCM and quality of life evaluation before and afterwards. We evaluate them by maximal oxygen uptake (peak VO2), cardiac output (CO), Minnesota Living With Heart Failure Questionnaire, SF-36, tongue diagnosis, pulse diagnosis, and TCM symptom questionnaire. The conclusion showed that the physical and body expression in HF patient are improved after exercise intervention, but poor correlated with the degree of “Qi-deficiency.”