Borg-评分与Weber心功能分级

BorgScale&WeberClassificationBorg评分与Weber心功能分级华中阜外医院（阜外华中心血管病医院）国家心血管病中心华中分中心河南心血管病中心林松Ratingofperceivedexertion:BorgscalesRatingofperceivedexertion(RPE)isawidelyusedandreliableindicatortomonitorandguideexerciseintensity.Thescaleallowsindividualstosubjectivelyratetheirlevelofexertionduringexerciseorexercisetesting(AmericanCollegeofSportsMedicine,2010).DevelopedbyGunnarBorg,itisoftenalsoreferredtoastheBorgScale.TwoRPEscalesarecommonlyused1.theoriginalBorgscaleorcategoryscale(6to20scale),and2.therevisedcategory-ratioscale(0to10scale).Theoriginalscalewasdevelopedinhealthyindividualstocorrelatewithexerciseheartrates(e.g.,RPE15wouldapproximateaHRof150bpm),andtoenablesubjectstobetterunderstandterminology(Borg,1982).Thecategoryratioscalewaslaterdevelopedandhassincealsobeenmodifiedtomorespecificallyrecordsymptomaticbreathlessness(ModifiedBorgDyspnoeaScale).RPEscalesareparticularlyvaluablewhenHRmeasuresofexerciseintensityareinaccurateordampened,suchasinpatientsonbetablockermedication.Thisisduetothescale’sabilitytocapturetheperceivedexertionfromcentralcardiovascular,respiratoryandcentralnervoussystemfunctions(Borg,1982).Boththe6-20and0-10scalesareusedinclinicalpracticetomeasureperceivedexertion;nocurrentrecommendationsexistregardinguseofonescaleinpreferencetoanother.TheModifiedBorgDyspnoeaScaleismostcommonlyusedtoassesssymptomsofbreathlessness.Despitebeingasubjectivemeasureofexerciseintensity,RPEscalesprovidevaluableinformationwhenusedcorrectly.Itisthereforeimportantthatclinicianstakesufficienttimetoeducatethepatientandensureappropriateunderstandingpriortouse(Whaleyetal.,1997;Borg1998,).PatientInstructionsforBorgDyspnoeaScale“Thisisascalethatasksyoutoratethedifficultyofyourbreathing.Itstartsatnumber0whereyourbreathingiscausingyounodifficultyatallandprogressesthroughtonumber10whereyourbreathingdifficultyismaximal.Howmuchdifficultyisyourbreathingcausingyourightnow?”WeberclassificationTheWeberclassificationstratifiespatientsbasedonpeakVO2andanaerobicthresholdtodefinefunctionalphysicalcapacity.OBJECTIVE:Uponbeginningcardiacrehabilitationafteracardiacevent,stationarycycleexerciseergometryiscommonlyperformedtodeterminemaximumexerciseaerobiccapacity(peakoxygenuptake[peakVO2])andanaerobicthreshold.TheWeberclassificationstratifiespatientsbasedonpeakVO2andanaerobicthresholdtodefinefunctionalphysicalcapacity.ThepurposeofthepresentstudywastoevaluatetheWeberclassificationinpatientsenteringcardiacrehabilitation.METHODSANDRESULTS:In275consecutivepatientsenteringcardiacrehabilitationfromJanuary2009toMarch2010,peakVO2,andanaerobicthresholdweremeasuredbeforeandaftercardiacrehabilitation.Consecutivepatientswithdifferentcardiacconditionswerecompared,includingpercutaneousintervention(PCI)withoutmyocardialinfarction,myocardialinfarction,coronaryarterybypassgraft(CABG),andheartfailure.TheWeberclassofmostpatientsenteringcardiacrehabilitationwaslow,usuallyWeberclassCforwomenandclassBformen(peakVO2was13+/-4ml/kg/mininwomenand15+/-3ml/kg/mininmen).BeforethecardiacrehabilitationthegreatestvaluesofpeakVO2wereassociatedwithPCIandthelowestvalueswithheartfailure,withsignificantlygreateraveragevaluesforpatientswithPCIthanheartfailurebeforecardiacrehabilitation(PCI,16+/-2ml/kg/minversusheartfailure,11+/-3ml/kg/min,P0.05).TherewasnostatisticaldifferencebetweentheCABGandheartfailuregroupsinmeanpeakVO2beforecardiacrehabilitation(CABG,13+/-2ml/kg/minversusheartfailure,11+/-3ml/kg/min,NS)andbetweenthePCIandmyocardialinfarctiongroups(PCI,16+/-2ml/kg/minversusmyocardialinfarction,15+/-4ml/kg/min,NS).Attheendofcardiacrehabilitation,theWeberclasswasimprovedofoneclassforpatientswithPCI,myocardialinfarction,CABG,andwomenwithheartfailurebutnotformenwithheartfailure.CONCLUSIONS:TheWeberclassificationwasusefultomonitorimprovementinfunctionalcapacityfromthebeginningtotheendofcardiacrehabilitation.Cardiacrehabilitationimprovedphysicalfunction.ButtheWeberclassificationinitselfbecauseofthelowclassesfoundamongmanypatientsafteracardiaceventandbeforeacardiacrehabilitationcouldunderestimatetheresultsofthisone.InthisstudyacorrelationwassoughtbetweentheNYHAclass,theresultsofcardiopulmonaryexercisetesting(CPX)andtheejectionfraction(EF)measuredbyechocardiographyandscintigraphy.Of36patientsenrolled,CHFin20patientswasduetoCADandin16patientsduetoDCM.TheNYHAclasswasdeterminedindependentlybytwocardiologistswhowereblindedtotheCPX,echocardiographyorscintigraphyresults.SixteenpatientswereclassifiedasclassIIand20asclassIII.Asacontrol,23patientswithoutcardiopulmonarydiseasewereexamined.TheCPXwasdoneaccordingtoarampprotocolwithcontinuousmeasurementofrespiratorygases,maximaloxygenconsumption(VO2-max)andoxygenconsumptionattheanaerobicthreshold(VO2-AT).Acorrelation(p=0.0425)betweentheNYHAclassificationandtheWeberclassificationforVO2-ATwasfound.TherewasnocorrelationforVO2-max.VO2-ATwassignificantlyhigherinNYHAIIpatientsascomparedtoNYHAIIIpatients.NosignificantdifferencewasseeninrelationtotheVO2-max.Incomparisontothenormalgroup,theVO2-ATandVO2-maxweresignificantly