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中华肾病研究电子杂志 ›› 2024, Vol. 13 ›› Issue (04) : 219 -225. doi: 10.3877/cma.j.issn.2095-3216.2024.04.007

综述

终末期肾脏病患者运动干预的作用研究进展
刘俊1, 陈客宏1,()   
  1. 1. 400042 重庆,陆军特色医学中心肾内科血净中心
  • 收稿日期:2024-02-01 出版日期:2024-08-28
  • 通信作者: 陈客宏

Research progress on the effect of exercise intervention in patients with end-stage renal disease

Jun Liu1, Kehong Chen1,()   

  1. 1. Blood Purification Center, Department of Nephrology, Daping Hospital of Army Medical University, Chongqing 400042, China
  • Received:2024-02-01 Published:2024-08-28
  • Corresponding author: Kehong Chen
引用本文:

刘俊, 陈客宏. 终末期肾脏病患者运动干预的作用研究进展[J]. 中华肾病研究电子杂志, 2024, 13(04): 219-225.

Jun Liu, Kehong Chen. Research progress on the effect of exercise intervention in patients with end-stage renal disease[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2024, 13(04): 219-225.

终末期肾脏病(ESRD)指慢性肾脏病(CKD)的终末阶段,发病率与死亡率均较高。运动干预被证明是CKD患者的保护因素,近期研究发现有氧运动、抗阻力训练、血流阻断训练以及肌肉电刺激训练可显著改善ESRD患者的临床症状与预后。考虑到运动方案制定和运动干预效果的相关影响因素,应实施个性化运动干预,以提高患者的生活质量。

End-stage renal disease (ESRD) refers to the end-stage of chronic kidney disease (CKD), with high incidence rate and mortality. Exercise intervention has been proven to be a protective factor for CKD patients, and recent studies have found that aerobic training, resistance training, blood flow restriction training, and muscle electrical stimulation training could significantly improve the clinical symptoms and prognosis of ESRD patients. Considering the factors affecting the exercise program and the effect of exercise intervention, personalized exercise intervention should be implemented to improve the quality of life of the patients.

表1 不同类型终末期肾脏病患者的运动干预策略研究
文献 研究对象基线特征 研究方案 研究结果 安全性
年龄[(±s)岁] 性别 人种/所在地区 治疗方式 对照组 干预组
Mortazavi等(2013)[5] 41.5±12.1 男(18例)、女(8例) 伊朗 HD 13例患者不进行干预 13例患者进行为期16周的床旁脚踏车运动干预(30 min/次,3次/周,感知运动强度10~12分,HD的第2~3 h开始) 有氧运动能够改善ESRD患者的不宁腿综合征,提高患者的生活质量
Dashtidehkordi等(2019)[6] 男(6例)、女(46例) 伊朗 HD 25例患者进行简单的拉伸运动(5 min/次) 27例患者进行为期8周的床旁脚踏车运动干预(3次/周,HD开始后0.5~2 h内完成) 有氧运动能够促进患者的健康行为,提高患者的营养评分、身体活动能力、责任感,改善患者的人际关系、心理/精神健康
Sheshadri等(2020)[9] 男(41例)、女(13例) 白人(17%)
黑人(39%)
其他(44%)
HD(44例)、PD(10例) 28例患者每日佩戴计步器记录3个月的步数 26例患者在第一周的步行距离基础上每周增加10%的步数,直至3个月 有氧运动能够增加ESRD患者的步行距离 23.1%的患者报告有不良事件,包括呼吸急促、疼痛、痉挛、疲劳等
Gadelha等(2021)[11] 65.4±3.7 HD 50例患者进行常规身体活动 57例患者进行为期24周的抗阻力训练干预(40 min/次,3次/周,前12周的感知运动强度为5~6分,后12周的感知运动强度为7~8分,HD前1 h开始) 抗阻力训练能够改善晚期CKD患者的炎症,增加患者肌肉质量
Tapia González等(2020)[13] 68.6±13.0 男(41例)、女(19例) HD、PD 30例患者不进行干预 30例患者进行为期4~8周的等长抗阻力训练干预(第一阶段捏橡皮球、挤压指尖等,第二阶段增加重量开展屈伸运动) 等长抗阻力训练能够促进晚期CKD患者的动静脉内瘘成熟
Moura等(2020)[16] 66.8±3.6 男(n=86)女(n=71) HD、PD 76例患者不进行任何运动干预 81例患者进行为期24周的抗阻力训练干预(3次/周,3组动作,每组动作重复8~12次,前12周感知运动强度5~6分,后12周感知运动强度7~8分,在透析前1 h完成) 抗阻力训练能够改善老年ESRD患者的贫血症状和炎症 未见任何不良事件
Cheema等(2007)[17] 62.6±14.2 男(34例)、女(15例) 澳大利亚 HD 24和25例患者分别进行为期12、24周的渐进式抗阻力训练干预(3次/周,2组动作,每组动作重复8次,感知运动强度为15~17分) 渐进式抗阻力训练能够改善老年ESRD患者的肌肉质量和力量、生活质量;运动周期对患者的疗效没有影响
Junqué-Jiménez等(2023)[18] 67.4±14.9 男(32例)、女(21例) 西班牙 HD(29例)、PD(17例)、未接受肾脏替代疗法(7例) 所有患者进行为期12周的渐进式抗阻力训练干预(45 min/次,3次/周,感知运动强度4~7分),HD患者的渐进式抗阻力训练干预在非透析日开始,其余患者的渐进式抗阻力训练干预时间自由安排 渐进式抗阻力训练能够改善晚期CKD患者的步行能力,提高患者的肌肉力量
Rosa等(2018)[19] 55.7±14.0 男(35例)、女(17例) 巴西 HD 24例患者接受非常低强度的渐进式抗阻力训练干预(5~10 min/次,3次/周) 28例患者进行为期12周的渐进式抗阻力训练干预(40~50 min/次,3次/周,设置11项运动,分两组进行,每组动作重复15~20次,于HD前或HD过程中开始) 渐进式抗阻力训练能够增加老年ESRD患者的骨矿物质含量
Rosa等(2021)[20] HD 65例患者不进行运动干预 65例患者、67例患者分别进行为期24周的等长抗阻力训练、渐进式抗阻力训练干预 渐进式抗阻力训练能够改善ESRD患者的血糖稳态、血脂水平以及一氧化氮含量
Lorenz等(2023)[21] 男(14例)、女(11例) 非西班牙裔白人(n=22)其他(n=3) HD(12例)、PD(4例) 25例患者进行为期4周的联合训练干预(60 min/次,2次/周,感知运动强度4~6分) 联合训练能够改善晚期CKD患者的衰弱、疲劳症状
Huang等(2020)[22] 男(23例)、女(9例) 中国西安 HD 16例患者进行常规护理 16例患者进行为期24周的联合训练干预(35 min/次,感知运动强度12~14分,于HD的前2 h内完成,4周/阶段) 联合训练能够改善ESRD患者的透析效率,增加患者的步行距离
Clarkson等(2020)[24] 61.0±13.0 男(7例)、女(3例) HD 血流阻断训练于10例患者开展其他运动期间实施(20 min/次,10次/周),血流阻断训练的袖带压力设定为肢体闭塞压力的50% 血流阻断训练能够增加ESRD患者的肌肉力量 1例患者出现运动相关晕厥,1例患者出现轻微头晕
Esteve等(2017)[29] 男(11例)、女(9例) 西班牙 HD 7例患者不进行运动干预 13例患者进行为期12周的肌肉电刺激训练干预(30~45 min/次,2~3次/周,于HD前2 h开始) 肌肉电刺激训练能够提高ESRD患者的肌肉适能
Lorenz等(2020)[30] 男(12例)、女(9例) 美国 HD(11例)、PD(3例)、其他(7例) 21例患者进行为期8周的联合训练干预(60 min/次,2次/周) 联合训练能够改善晚期CKD患者的衰弱、疲劳症状
Watson等(2018)[31] 男(18例)、女(23例) 英国 非肾脏替代疗法 21例患者进行为期12周的有氧运动干预(20 min/次,3次/周,感知运动强度为12~14分) 20例患者开展进行为期12周的联合训练干预(20 min/次,3次/周,设置3组动作,每组动作重复12~15次) 与有氧运动相比,联合训练能够增加非肾脏替代疗法治疗的晚期CKD患者的肌肉质量和力量
Hellberg等(2019)[32] 66.0±14.0 男(53例)、女(98例) 瑞典 非肾脏替代疗法 所有患者在每周进行长达60 min以上、感知运动强度为13~15分的有氧运动,76和75例患者分别在有氧运动的基础上进行为期12周的力量训练(30 min/次,3次/周,感知运动强度为13~17分,设置2~3组动作,每组动作重复10次)和平衡训练(与力量训练相同,但运动项目不同) 联合训练能够改善晚期CKD患者的肾脏功能  
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