THE ISCHEMIC WINDOW - A METHOD FOR THE OBJECTIVE QUANTITATION OF THE TRAINING EFFECT IN EXERCISE THERAPY FOR INTERMITTENT CLAUDICATION
THE ISCHEMIC WINDOW - A METHOD FOR THE OBJECTIVE QUANTITATION OF THE TRAINING EFFECT IN EXERCISE THERAPY FOR INTERMITTENT CLAUDICATION
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DOI：
10.1016/0741-5214(92)90114-n
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发表时间：
1992-08-01
影响因子：
4.3
通讯作者：
PATTERSON, RB
中科院分区：
文献类型：
--
作者：
FEINBERG, RL;GREGORY, RT;PATTERSON, RB
22例间歇性跛行患者前瞻性地参加了为期12周的有监督的分级踏车运动疗法。动脉闭塞性疾病的严重程度和分布通过无创测定下肢节段性血压和波形来确定。没有试图改变动脉粥样硬化闭塞性疾病的危险因素。记录运动引起的踝关节压力的降低及其随时间的恢复，该曲线下的面积，即“缺血窗”，代表缺血缺陷的严重程度。在所有受试者运动训练前后测量踝关节绝对收缩压、踝臂指数、最大步行时间、跛行疼痛时间和缺血窗。在完成12周计划的19例患者中，最大步行时间和跛行疼痛时间分别增加了659%和846%（p = 0.001; p = 0.0002）。标准化工作量后，这些患者的缺血窗口平均减少了58.7%（p < 0.05），这与症状改善程度相关。踝关节绝对压力和踝臂指数在运动训练后没有变化。这项研究证实了监督运动疗法在间歇性跛行治疗中的实用性。缺血窗是量化运动引起的缺血性缺损的有用方法，并提供了记录运动训练患者功能改善的可重复方法。
Twenty-two patients with intermittent claudication were prospectively enrolled in a 12-week program of supervised, graded treadmill exercise therapy. Severity and distribution of arterial occlusive disease were ascertained by noninvasive determination of segmental lower extremity blood pressures and waveforms. No attempt was made to modify risk factors for atherosclerotic occlusive disease. The exercise-induced reduction of the ankle pressure and its recovery were recorded over time, and the area under this curve, the "ischemic window," represents the severity of the ischemic deficit. Absolute systolic ankle pressure, ankle-brachial index, maximum walking time, claudication pain time, and the ischemic window were measured before and after exercise training in all subjects. Maximum walking time and claudication pain time increased 659% and 846%, respectively, among the 19 patients completing the 12-week program (p = 0.001; p = 0.0002). These patients underwent a mean reduction of 58.7% in the ischemic window after a standardized workload (p < 0.05), and this correlated with the degree of symptomatic improvement. Absolute ankle pressure and ankle-brachial index were unchanged after exercise training. This study confirms the utility of supervised exercise therapy in the treatment of intermittent claudication. The ischemic window is a useful method for quantifying the ischemic deficit produced by exercise and provides a reproducible means of documenting functional improvement in patients undergoing exercise training.