心肺运动试验在心血管疾病中的应用

心肺运动试验(cardiopulmonary exercise testing,CPET)是在一定负荷下测出摄氧量和二氧化碳排出量等代谢、通气指标及心电图变化,反映细胞呼吸功能的变化[1]。1975年呼吸疾病学者Wasserman提出:单独给心脏或肺脏增加负荷是不可能的,所有的运动均需要心肺的协调,以及周围循环与     

心肺运动试验在慢性心力衰竭预后评估中的价值

心肺运动试验通过测定机体对运动的反应，可以评估包括心血管、肺、骨骼肌等多系统的功能和储备，显示出其独特的优势，特别是对于慢性心力衰竭患者的功能状态及预后能够进行客观定量的评估，具有极其重要的价值和意义。本文重点阐述心肺运动试验主要指标的意义及其在慢性心力衰竭预后评估中的价值。     

心肺运动试验在心力衰竭患者中的应用及进展

心肺运动试验是目前广泛应用的一种无创检查方法,可通过对运动状态下外呼吸与内呼吸的异常,来评估肺、心血管、骨骼肌的一种无创方法,是目前评估运动耐量的"金标准",在心力衰竭领域得到了可靠的科学证据支持,现综述心肺运动试验在心力衰竭患者中的应用及进展.     

心肺运动试验在心肺疾病中的应用进展

许多心肺疾病在静息状态下往往处于代偿状态,在运动状态下才会出现一系列病理生理学改变。目前临床广泛应用的彩色超声、肺功能仪、心电图、冠状动脉造影等方法多数只能反映静态下心肺及血管功能情况,易导致疾病诊断、治疗延误。心肺运动试验是通过检测人体静息和运动状态时氧和二氧化碳变化趋势分析心肺协调性及功能状态的一种方法,其理论基础是气体交换。     

冠心病患者心肺运动试验结果分析

目的 分析冠心病患者心肺运动试验(cardiopulmonary exercise testing, CPET)相关指标,探讨其CPET临床特点。方法 本研究为回顾性研究,选择2021年5月至2023年8月于中日友好医院中西医结合心内科门诊进行随访的冠心病患者103例。按年龄分为60岁以下组(n=37)与60岁及以上组(n=66);60岁及以上按性别分为男性组(n=37)与女性组(n=29);患者均接受CPET检测,比较不同年龄男性组、同一年龄不同性别组CPET指标特点,采用Spearman或Pearson相关性分析法分析性别、年龄与CPET试验指标相关性。结果 60岁及以上男性组最大心率(Maximum Heart Rate, MHR)、峰值摄氧量(VO₂peak)、峰值氧脉搏(peak O₂pulse)、二氧化碳通气当量(EQCO₂)、代谢当量(METs)均低于60岁以下男性组,差异均有统计学意义(P<0.05);60岁及以上女性组无氧阈下摄氧量(VO₂AT)、VO₂...     

Bruce—Q运动方案枯心肺运动试验中的临床研究

采用心肺运动试验评定心脏起搏和其他吕质性心脏病患者的全身耐力和心力储备，综合Ｂｒｕｃｅ方案和Ｎａｕｇｈｔｏｎ方案，在Ｂｒｕｃｅ的基础上增加１ｍｐｈ平板速度，５％斜率的运动负荷 第一级运动，其余各级按照Ｂｒｕｃｅ方案进行，对１４７人进行了最大症状限制性心肺运动试验。其中正常人４０人，ＶＶＩＲ直搏２６例，其他器质性心脏病患者４１例。结果，正常人运动时间１２ｍｉｎ左右，非起搏心脏病患者和心脏起搏患者地运     

Bruce-Q运动方案在心肺运动试验中的临床研究

采用心肺运动试验评定心脏起搏和其他器质性心脏病患者的全身耐力和心力储备,综合Ｂｒｕｃｅ方案和Ｎａｕｇｈｔｏｎ方案,在Ｂｒｕｃｅ方案的基础上增加１ｍｐｈ平板速度、５％斜率的运动负荷做为第一级运动,其余各级按照Ｂｒｕｃｅ方案进行。对１４７人进行了最大症状限制性心肺运动试验。其中正常人４０人、ＶＶＩＲ起搏２６例、其他器质性心脏病患者４１例。结果：正常人运动时间１２ｍｉｎ左右,非起搏心脏病患者和心脏起搏患者的运动时间６ｍｉｎ左右。窦房结对运动的反应呈频率应变的方式,其心率与做功的关系为Ｙ＝７５＋０．４１Ｘ;体动式频率应变性起搏频率和做功的关系为Ｙ＝８３．３９＋０．１８Ｘ。此外根据本方案运动试验的结果可进行心功能分级：能完成本方案的四、三、二、一级运动的心功能分级分别为一、二、三、四级。结论：本方案适宜正常人、非起搏心脏病患者和起搏患者的心肺运动试验。     

冠心病合并非酒精性脂肪肝患者心肺运动试验特点

目的:比较冠心病和冠心病合并非酒精性脂肪肝(NAFLD)患者心肺运动试验指标的特点,探讨NAFLD对冠心病患者心肺耐力的影响。方法:选取2018年3月—2022年3月于重庆医科大学附属第一医院心内科住院行心肺运动试验的慢性稳定期冠心病患者122例,其中61例合并NAFLD为NAFLD组,61例无脂肪肝为对照组,比较两组患者运动心肺核心指标的差异。结果:122例冠心病患者平均峰值公斤摄氧量(Peak VO₂/kg)为(17.89±3.82) mL·kg^-1·min^-1,102例(83.6%)患者无氧阈下代谢当量(AT-METs)<5 MET。其中NAFLD组Peak VO₂/kg、无氧阈(AT)、AT-METs均低于对照组(均P<0.05)。Spearman相关检验分析提示,NAFLD与Peak VO₂/kg、AT、AT-MET均呈显著负相关(r=-0.331、-0.274、-0.266,均P<0.01)。多元线性回归分析显示,NAFLD是冠心病患者心肺耐力下降...     

基于心肺运动试验评价心血管疾病的临床康复优势

通过心肺运动试验（CPET）对心血管疾病（CVD）患者进行临床诊断和疗效评估已成为心脏康复（CR）领域的研究热点。本文基于CPET诊断和疗效评估优势,对核心指标如峰值耗氧量、无氧阈、心率储备、氧脉搏、代谢当量、二氧化碳通气斜率、吸氧效率斜率等的优势和特点进行总结,通过CPET相关随机对照临床试验,深入评估CPET在冠心病患者的心脏康复处方制定与调整、心脏康复疗效评价中的作用,为临床运用CPET辅助冠心病患者进行心脏康复提供依据和参考。     

慢性阻塞性肺疾病合并抑郁症患者心肺运动试验研究

目的观察稳定期慢性阻塞性肺疾病(简称慢阻肺)合并抑郁症患者心肺运动试验(CPET)各参数变化,研究抑郁症对慢性阻塞性肺疾病的影响。方法入选了稳定期慢阻肺患者85例,根据Zung抑郁自评量表(SDS)分成抑郁组和对照组,并分别进行CPET。结果 (1)合并抑郁症患者共26例,占慢阻肺总人数30.6%。(2)与非抑郁组相比,抑郁组具有相似水平的肺功能损害,但表现出更加明显的呼吸困难(P0.05)。(3)共4例患者未能完成试验,完成试验的患者结果显示抑郁组在峰值摄氧量(VO2peak)、无氧阈占预估峰值摄氧量百分比(AT%pred)低于非抑郁组、而二氧化碳通气当量斜率(VE/VCO2 slope)高于非抑郁组,差异有统计学意义(P0.05)。结论超过30%的稳定期慢阻肺患者合并存在抑郁症,且其对患者通气功能和运动能力产生负面影响。     

PCI术后患者平板运动试验与心肺运动试验比较研究

目的 探讨平板运动试验与心肺运动试验的相互关系及临床应用价值。方法 选取解放军总医院心血管内科38例行经皮冠状动脉介入治疗（PCI）的冠心病患者,随机交替进行心肺运动试验及平板运动试验检查,比较各项试验参数情况。结果 患者行心肺运动试验检查时静息血压及运动中最大血压均高于平板运动试验（P＜0.01）,平板运动试验中患者的运动耐量（MET）大于心肺运动试验（P＜0.01）,且两者存在相关关系。患者在平板运动试中自我感知运动强度评分量表（Borg评分）低于心肺运动试验,差异有统计学意义（P＜0.01）。心肺运动试验各参数中,男性与女性相比,运动时间、运动耐量、最大耗氧量表现出统计学差异（P＜0.05）。结论 平板运动试验与心肺运动试验同为负荷试验,两者不可互相替代,因根据患者不同情况进行不同的选择。对于PCI术后的患者而言,心肺运动试验可以提供更多运动能力评价的客观指标。     

Patients with gastroesophageal reflux disease and respiratory manifestations do not present lung function disorders during cardiopulmonary exercise test

Gastroesophageal reflux disease (GERD) has been associated with a variety of pulmonary manifestations, but it is unclear if gastroesophageal reflux causes any abnormality in pulmonary function. Cardiopulmonary exercise test (CPET) is a specialized method that is used to evaluate respiratory function during exercise. The aim of this study was to reveal any abnormality of pulmonary function in patients with GERD and respiratory symptoms. We evaluated 34 patients with GERD (24 men and 10 women, aged 21–63) and extraesophageal respiratory symptoms (wheezing and/or cough) before therapy and after a 12‐week treatment with double dose of omeprazole. No patient presented abnormal spirometry. CPET was performed in all the patients at baseline and after completion of the 12‐week treatment. CPET parameters including VO₂rest, VO₂max, VCO₂rest, VCO₂max, O₂–puls rest, O₂–puls max, HR (heart rate) rest, HRmax, PETCO₂rest, PETCO₂max, and VE/VCO₂ slope were recorded pretreatment and posttreatment. Twenty‐four patients (70.6%) had esophagitis (grade A–D), 16 patients had hiatal hernia (47.1%), and 13 patients (38.2%) tested positive for Helicobacter pylori. All of the patients completed the CPET. No one presented shortness of breath or respiratory symptoms. CPET parameters were within normal limits in all of the patients. Twenty‐eight patients were reevaluated. No improvement in any CPET parameter posttreatment was observed despite remission of esophageal and extraesophageal respiratory symptoms in all patients. No statistically significant difference was observed pretreatment and posttreatment between the patients older and younger than 40 years, smokers and nonsmokers, Hp(+) and Hp(–) patients, and those with and without hiatal hernia and esophagitis. The patients with GERD and respiratory manifestations and normal spirometry present no pulmonary dysfunction during CPET. No alterations in CPET values posttreatment or differences in CPET values according to age, smoking, Hp status, presence of esophagitis, or hiatal hernia were observed.     

Diagnostic value of the cardiopulmonary exercise test in coronary artery disease

BackgroundCoronary angiography (CAG) is “gold standard” for the diagnosis of coronary heart disease (CHD). This study aimed to explore the diagnostic value of cardiopulmonary exercise testing (CPET) and the oxygen uptake kinetics indexes of CPET.MethodsOne hundred thirty-one patients with chest pain who underwent coronary angiography in the Department of Cardiology of our hospital from April to September 2021 were selected. According to the results of angiography, the patients were divided into an observation group (patients with coronary heart disease, n=80) and a control group (patients without coronary heart disease, n=75). Both groups underwent CPET before angiography. The differences of peak oxygen uptake, anaerobic threshold, peak kilogram oxygen uptake, peak oxygen pulse, maximum exercise load, maximum metabolic equivalent, and exercise time between the two groups were compared. Also, the correlation between the above indexes and the degree of coronary artery stenosis was analyzed, and the clinical value of the CPET in the diagnosis of CHD was evaluated.ResultsThe peak oxygen uptake, anaerobic threshold, peak kilogram oxygen uptake, peak oxygen pulse, maximum exercise load, maximum metabolic equivalent, and exercise time in the observation group were lower than those in the control group (P<0.01), and were negatively correlated with the Gensini score (P<0.01). The area under the receiver operating characteristic (ROC) curve of the above seven indexes in the combined diagnosis of CHD was 0.974, the sensitivity was 86.40%, and the specificity was 98.50%, which was better than the clinical value of any of the above indexes alone.ConclusionsCPET is an effective non-invasive examination in the diagnosis of CHD, and has a certain clinical value in the evaluation of the severity of coronary artery stenosis.     

运动锻炼对心血管和代谢性疾病影响的研究进展

心血管和代谢性疾病在全球的患病率日益增加,其引起的社会和经济负担日渐加重,是人类重大的公共卫生问题。近年来,大量证据表明,适当的运动锻炼能够预防和治疗心血管和代谢性疾病。本文对运动锻炼在病理性心肌肥厚、心肌梗死、心肌病、心力衰竭和动脉粥样硬化等心血管疾病以及肥胖、糖尿病、脂肪肝等代谢性疾病中调控的分子机制和治疗价值进行综述,以期为进一步基于运动锻炼开展防治心血管和代谢性疾病的研究提供证据与思路。     

Safety and feasibility of symptom-limited cardiopulmonary exercise test using the modified Naughton protocol in children with cerebral palsy: An observational study

Variables derived from the cardiopulmonary exercise test (CPX) provide objective information regarding the exercise capacity of children with cerebral palsy (CP), which can be used as the basis for exercise recommendations. Performing maximal CPX might not be appropriate, safe, or practical for children with CP. In the present study, the safety and feasibility of symptom-limited CPX using the modified Naughton protocol, a submaximal protocol, were investigated in children with CP, Gross Motor Function Classification System (GMFCS) level I or II. The present study included 40 children aged 6 to 12 years with CP who underwent symptom-limited CPX. CPX was performed to measure cardiopulmonary fitness using a treadmill with a modified Naughton protocol. Motor capacity was assessed using the Gross Motor Function Measure (GMFM), Pediatric Balance Scale (PBS), Timed Up and Go (TUG) test, and 6-minute walk test. Thirty-seven children with CP successfully completed testing without any adverse events during or immediately after CPX (dropout rate 7.5%). The reason for test termination was dyspnea (51.4%) or leg fatigue (48.6%). Based on the respiratory exchange ratio (RER), 21 of 37 (56.8%) children chose premature termination. The relationship between the reason for test termination and RER was not statistically significant (Spearman rho = 0.082, P = .631). CPX exercise time was strongly correlated with GMFM (Spearman rho = 0.714) and moderate correlation with PBS (Spearman rho = 0.690) and TUG (Spearman rho = 0.537). Peak oxygen uptake during CPX showed a weak correlation with GMFM and a moderate correlation with PBS. This study revealed that symptom-limited CPX using the modified Naughton protocol was safe and feasible for children with CP and GMFCS level I or II.     

冠状动脉CT成像和平板运动试验对冠心病的诊断价值

目的探讨冠状动脉CT成像(CTCA)和平板运动试验(TET)对冠心病的诊断价值。方法选择怀疑冠心病并于2周内分别行CTCA、TET及冠状动脉造影检查的患者共254例,以冠状动脉造影结果为对照指标,分析CTCA、TET及两者联合时对冠心病的诊断价值。结果 TET、CTCA及CTCA联合TET的敏感性、特异性、阳性预测值、阴性预测值和准确率分别为:60.8%、64.7%、82.5%、37.6%和61.8%;84.9%、80.9%、92.4%、66.3%和83.9%;88.3%、86.0%、94.2%、74.0%和87.7%。CTCA对左主干病变的检出率明显高于冠状动脉造影(P<0.01)。结论 CTCA和CTCA联合TET在诊断冠心病时的准确率比单独TET高,CTCA对左主干病变的检出更有一定优势。因此,临床上可将CTCA作为可疑冠心病患者的筛查方法之一。