终末期慢性心力衰竭患者运动中摄氧通气效率指标的临床应用  

Clinical value of cardiopulmonary exercise testing derived oxygen uptake efficiency parameters in patients with end-stage chronic heart failure

作　　者：卢志南[1] 黄洁[1] 孙兴国[1] 谭晓越[1] 李子煦[1] 胡盛寿[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院心血管疾病国家重点实验室,100037

出　　处：《中华心血管病杂志》2015年第1期44-50,共7页Chinese Journal of Cardiology

基　　金：国家高技术研究发展计划（863计划）课题（2012AA021009）

摘　　要：目的 评估心肺运动试验（CPET）摄氧通气效率指标摄氧效率平台（OUEP）、摄氧效率斜率（OUES）、通气量（（V） E）/二氧化碳排出量（（V）CO2）最低值和（V）E/（V）CO2斜率在监测终末期慢性心力衰竭（CHF）患者心功能和血液动力学状态中的意义.方法 入选2012年10月至2013年9月阜外心血管病医院住院行心脏移植的CHF患者26例.收集临床资料和CPET参数.在行CPET的2周内,进行超声心动图和Swan-Ganz导管检查监测血液动力学参数,并对CPET中摄氧通气效率指标与超声心动图参数和血液动力学参数进行相关性分析.结果 CPET摄氧效率指标OUEP、OUES与传统指标峰值氧耗量（峰值（V）O2）之间相关性好（r=0.535、P＜0.01;r=0.840、P＜0.001）.在终末期CHF患者中OUEP相对峰值（V）O2的变化斜率约为32,而OUES相对峰值（V）O2的变化斜率仅约为2,两者相差约16倍,OUEP改变比OUES、峰值（V）O2更加敏感和显著（P＜0.05）.OUEP、峰值（V）O2测定值占预测值百分比（％ pred）、（V）E/（V）CO2斜率和（V）E/（V）CO2最低值与无创血液动力学参数峰值心输出量（r =0.535,P＜0.01; r=0.652,P＜0.001; r=-0.640,P＜0.001; r=-0.606,P=0.001）和峰值心脏指数（r=0.556,P＜0.01;r=0.772,P＜0.001; r=-0.641,P＜0.001;r=-0.620,P＜0.001）均显著相关,但与静息状态下有创血液动力学参数心输出量和心脏指数不相关（P＞0.05）.峰值（V）O2（％pred）和（V）E/（V）CO2斜率与肺动脉收缩压（r=-0.424,P＜0.05; r=0.509,P＜0.01）和平均肺动脉压力（r=-0.479,P＜0.05;r=0.405,P＜0.05）均显著相关,峰值（V）O2（％pred）还与肺毛细血管楔压显著相关（r=-0.415,P＜0.05）,（V）E/（V）CO2斜率与肺血管阻力亦呈显著相关（r=0.429,P＜0.05）.结论 CPET摄氧通气效率指标OUEP,可配合传统指标峰值（V）O2、（V）E/（V）CO2最低值、（V）E/（V）CO2斜率等,对CHF患者心功能和血液动力�Objective To assess the cardiopulmonary exercise testing （CPET） derived performance of oxygen uptake and ventilation efficiency parameters,including oxygen uptake efficiency plateau （OUEP）,oxygen uptake efficiency slope （OUES）,（V）E/（V）CO2 slope and lowest （V）E/（V）CO2,in patients with end-stage chronic heart failure（CHF） and evaluate their clinical value on monitoring cardiac function and hemodynamic status.Methods A total of 26 end-stage CHF patients considered for heart transplantation were enrolled in this study.CPET,echocardiography and invasive hemodynamic examinations with Swan-Ganz flowing balloon catheter were performed.Correlation analysis was made between oxygen uptake and ventilation efficiency parameters from CPET and echocardiographic and hemodynamic parameters.Results OUEP and OUES showed good correlation with peak oxygen consumption （peak （V）O2） （r =0.535,P 〈 0.01 ; r =0.840,P 〈 0.001）.In end-stage CHF patients,the slope of OUEP with respect to peak （V）O2 is about 32,but the slope of OUES with respect to peak （V）O2 is only about 2.The difference was 16 times.The change of OUEP was more sensitive and significant than those of OUES and peak （V）O2 （P 〈 0.05）.OUEP,peak （V）O2 （% pred）,（V）E/（V）CO2 slope and lowest （V）E/（V）CO2 were all correlated well with non-invasive hemodynamic parameters peak cardiac output （r=0.535,P〈0.01; r=0.652,P〈0.001; r=-0.640,P〈0.001 ; r=-0.606,P=0.001 respectively） and peak cardiac index （r =0.556,P〈0.01;r =0.772,P 〈0.001; r =-0.641,P 〈 0.001 ; r =-0.620,P 〈 0.001 respectively） derived from CPET,but not correlated with invasive hemodynamic parameters cardiac output and cardiac index at rest （P 〉0.05）.Both peak （V）O2 （% pred） and （V）E/（V）CO2 slope were significantly correlated with invasive hemodynamic parameters systolic pulmonary arterial pressure （r =-0.424,P 〈 0.05 ; r =0.509,P 〈 0.01） and mean pulmonary arterial pressure （r=-0.479,P

关 键 词：心力衰竭 充血性 运动试验 超声心动描记术 血液动力学过程 摄氧通气效率 

分 类 号：R541.6[医药卫生—心血管疾病]