편측 하지 절단자들의 운동부하에 따른 에너지소모에 대한 고찰

Abstract

[한글]

하지절단자들이 의지를 착용한 후 보행을 할 때 에너지소모가 정상인에 비하여 많다는 것은 널리 알려진 사실이며 에너지소모량 즉, 산소요구량은 환자의 연령, 절단원인, 보행속도, 절단부위 및 절단단의 길이, 의지의 무게 등에 의해 영향을 받게 된다

이에 본 연구는 1990년 3월부터 연세대학교 세브란스병원 재활의학과로 내원하였던 남자 편측 하지절단자 17명과 정상대조군 20명을 대상으로 연령과 절단부위에 따라 5군으로 분류하여 폐기능을 검사한 후, 에너지소모량을 Treadmill을 이용한 최대하 운동(submaxi

mal exercise)부하검사를 통해 알아보고 운동부하 검사 동안의 심혈관계의 반응을 심박동수 및 혈압의 변화를 통해 관찰하여 절단군과 정상 대조군의 차이를 비교하여 보았다.

그 결과를 요약하면 다음과 같다.

1. 대상군을 연령 및 절단부위에 따라 5군으로 분류하였을 때 평균연령 및 피검자수는 45세 미만의 대조군이 35.7세로 10명, 45세 이상의 대조군이 50.7세로 10명, 45세 미만의 대퇴절단군이 27.3세로 6명, 45세미만의 하퇴절단군이 29.7세로 6명, 45세 이상의 하퇴 절단군이 53.8세로 5명이었고 전체 피검자수는 37명이었다.

2. 폐기능검사 결과는 폐활량, 폐활량 1초량, 최대환기량이 모두 고연령군에서 통계학적으로 의의있게 감소되어 있었고 대조군과 절단군 간의 차이 및 절단부위에 따른 차이는 없었으며, 폐기능은 연령과 의의있는 역상관관계를 보여 연령이 증가함에 따라 폐기능이

감소함을 알 수 있었다.

3. 안정시 산소소모량(VO^^2)은 5군 간에 의의있는 차이는 없었으며 운동부하 동안의 산소소모량은 하퇴절단군이 대조군에 비하여 고연령군은 평균 13%, 저연령군은 평균 8% 높개 나타난다.

4. 안정시 심박동수도 5군 간에 의의있는 차이는 없었으며 운동부하 동안에는 하퇴절단군이 대조군에 비하여 고연령군은 평균 l8%, 저연령군은 평균 10% 높게 나타났다.

5. 안정시 혈압도 5군 간에 의의있는 차이는 없었으며 운동부하 동안에는 하퇴절단군이 대조군에 비하여 고연령군은 평균 29%, 저연령군은 평군 12% 높게 나타났다.

6. 최대 산소소모량(VO^^2 max)은 저연령 대조군이 46.2ml/kg/min, 고연령 대조군이 40.Oml/kg/min, 저연령 대퇴절단군이 28.9ml/kg/min, 저연령 하퇴절단군이 45.8ml/kg/min, 고연령 하퇴절단군이 34.9ml/kg/min로 대퇴절단군이 의의있게 가장 낮았으며, 고연령 하

퇴절단군도 고연령 대조군에 비하여 낮았으나 통계학적인 의의는 없었다.

7. 절단단의 길이는 대퇴절단군이 평균 24.5cm, 하퇴절단군이 17.7cm이었으며 최대 산소소모량은 각각 28.9, 43.6ml/kg/min로 두 군간에 통계학적으로 의의있는 차이가 있었고, 대퇴절단군에서 절단단의 길이와 최대 산소소모량과는 의의있는 순상관관계가 있었다.

8. 운동부하 후 회복기 동안의 심박동수의 변화는 5군 모두 회복기 1분과 2분까지 감소하는 정도가 컸으며, 2분 이후에는 완만한 변화를 보였다.

9. 운동부하 후 회복기 동안의 혈압의 변화는 회복기 3분까지도 감소하는 정도가 컸으며, 3분 이후에는 완만한 변화를 보였다.

Energy expenditure of the unilateral lower extremity amputees by submaximal

treadmill exercise

Hee Cheong

Department of Medical Science, The Graduate School, Yonsei University

(Directed by Professor Kyoung Ja Cho, M.D.)

It is well known that energy expenditure of lower extremity amputee during

ambulation is greater than that of normal persons. Also the energy expenditure, so

called oxygen consumption, depends on various factors such as age, cause of

amputation, level of amputation, stump length and weight of prosthesis etc.

Therefore the present study was designed to determine oxygen consumption in

unilateral lower extremity amputees(devided into 3 subgroups) by submaximal

exercise according to age and level of amputation: to observe the cardiovascular

response during exercise and to compare the results with a control group(2

subgroups).

The major results are as follows:

1. The pulmonary function test(vital capacity, forced expiratory volume in 1 sec

and maximum voluntary ventilation) showed significant decrease in older(45 and

over) persons regardless of group status, but no significant decrease in all the

remaining subjects. And the pulmonary function was significantly correlated wi th

age as opposed to amputee status.

2. Difference in oxygen consumption values was related to exercise with a

difference of 13%(higher in amputee group) between the below-knee amputee and

control over 45 yrs of age and a difference of 8%(higher in amputee group) between

the below-knee amputee and the control group under 45. There was no significant

difference in all groups during rest.

3. Difference in heart rate was related to exercise with a difference of

18%(higher in amputee group) between the below-knee amputee and control over 45 yrs

of age and a difference of 10%(higher in amputee group) between the below-knee

amputee and the control group under 45. There was no significant difference in all

groups during rest.

4. The resting blood pressure was only slightly higher in the older age

below-knee amputee group. During exercise, the older age below-knee amputee group

had more increase of 29% and younger age below-knee amputee group, 12% than control

group.

5. The maximum oxygen consumption of the younger age control group was

46.2ml/kg/min: older age control group. 40.0ml/kg/min: younger age above-knee

amputee group, 28.9ml/kg/min: younger age below-knee amputee group, 45.8ml/kg/min:

older age below-knee amputee group, 34.9ml/kg/min. The maximum oxygen consumption

in the above-knee amputee group was significantly lower than that of all other

groups.

6. The stump length of above-knee and below-knee amputee groups were 24.5 and

17.7cm, respectively, and was significantly correlated with maximum oxygen

comsumption in the above-knee amputee group.

7. The change of heart rate during the recovery period was marked at 1 and 2

minutes after exercise and was slight in all 5 groups thereafter.

8. The change of systolic blood pressure during the recovery period was marked at

1 and 2 minutes after exercise in some groups and in other groups, was marked at 3

minutes and was slight in all 5 groups thereafter.

[영문]

It is well known that energy expenditure of lower extremity amputee during ambulation is greater than that of normal persons. Also the energy expenditure, so called oxygen consumption, depends on various factors such as age, cause of

amputation, level of amputation, stump length and weight of prosthesis etc.

Therefore the present study was designed to determine oxygen consumption in unilateral lower extremity amputees(devided into 3 subgroups) by submaximal exercise according to age and level of amputation: to observe the cardiovascular response during exercise and to compare the results with a control group(2

subgroups).

The major results are as follows:

1. The pulmonary function test(vital capacity, forced expiratory volume in 1 se cand maximum voluntary ventilation) showed significant decrease in older(45 and over) persons regardless of group status, but no significant decrease in all the remaining subjects. And the pulmonary function was significantly correlated with age as opposed to amputee status.

2. Difference in oxygen consumption values was related to exercise with a difference of 13%(higher in amputee group) between the below-knee amputee and control over 45 yrs of age and a difference of 8%(higher in amputee group) between the below-knee amputee and the control group under 45. There was no significant difference in all groups during rest.

3. Difference in heart rate was related to exercise with a difference of 18%(higher in amputee group) between the below-knee amputee and control over 45 yrs of age and a difference of 10%(higher in amputee group) between the below-knee

amputee and the control group under 45. There was no significant difference in all groups during rest.

4. The resting blood pressure was only slightly higher in the older age below-knee amputee group. During exercise, the older age below-knee amputee group had more increase of 29% and younger age below-knee amputee group, 12% than control group.

5. The maximum oxygen consumption of the younger age control group was 46.2ml/kg/min: older age control group. 40.0ml/kg/min: younger age above-knee amputee group, 28.9ml/kg/min: younger age below-knee amputee group, 45.8ml/kg/min: older age below-knee amputee group, 34.9ml/kg/min. The maximum oxygen consumption

in the above-knee amputee group was significantly lower than that of all other groups.

6. The stump length of above-knee and below-knee amputee groups were 24.5 and 17.7cm, respectively, and was significantly correlated with maximum oxygen comsumption in the above-knee amputee group.

7. The change of heart rate during the recovery period was marked at 1 and 2 minutes after exercise and was slight in all 5 groups thereafter.

8. The change of systolic blood pressure during the recovery period was marked at 1 and 2 minutes after exercise in some groups and in other groups, was marked at 3 minutes and was slight in all 5 groups thereafter.