心肺运动试验评估心脏瓣膜置换术治疗心脏瓣膜疾病患者整体功能变化的临床研究  

Clinical Study of Cardiopulmonary Exercise Testing in the Evaluation of the Changes of Holistic Function of Patient With Heart Valve Disease After Heart Valve Replacement

作　　者：孙兴国[1] 郭志勇[2] 刘方[1] 葛万刚 周娜[1,3] 周萍[1,4] 董文涛[2] 滕志涛[2] 孙杏云[2] 毕艳梅[2] 王小康[2] 曲大鹏[2] 

机构地区：[1]国家心血管病中心,中国医学科学院阜外医院,心血管疾病国家重点实验室,国家心血管疾病临床医学研究中心,北京协和医学院,北京市100037 [2]威海市立医院心脏中心 [3]昆明医科大学第二附属医院心内科 [4]宁夏医科大学总医院呼吸与危重症医学科肺功能室

出　　处：《中国全科医学》2016年第17期2038-2045,共8页Chinese General Practice

基　　金：国家高技术研究发展计划(863计划)课题(2012AA021009);国家自然科学基金医学科学部面上项目(81470204);中国医学科学院国家心血管病中心科研开发启动基金(2012-YJR02)

摘　　要：目的探讨心肺运动试验(CPET)对心脏瓣膜置换术治疗心脏瓣膜疾病患者整体功能变化的评估作用。方法选取2011—2014年度威海市立医院进行心脏瓣膜置换术的心脏瓣膜疾病患者10例,分别在治疗前后进行CPET检查,按照美国加州大学洛杉矶分校医学中心标准连续递增功率方案完成症状限制性极限运动,通过对数据标准化分析计算其核心指标,从系统软件导出静息状态、热身状态、无氧阈状态、极限状态时的循环指标及呼吸指标。结果10例心脏瓣膜疾病患者心脏瓣膜置换术后,7例患者整体功能显著改善,3例患者整体功能降低。心脏瓣膜置换术前后峰值摄氧量(L/min、ml·min-1·kg^(-1))、无氧阈(L/min、ml·min-1·kg^(-1)、%pred)、峰值氧脉搏(ml/次)、峰值负荷功率(W)比较,差异均无统计学意义(P>0.05);术后峰值摄氧量(%pred)、峰值氧脉搏(%pred)、摄氧效率平台(比值、%pred)、递增功率运动时间(min)较术前升高,二氧化碳通气当量斜率(slope、%pred)、二氧化碳通气当量最低值(比值、%pred)较术前降低(P<0.05)。心脏瓣膜置换术后极限状态时收缩压较术前升高(P<0.05);热身状态时氧脉搏较术前升高(P<0.05);静息状态、热身状态、无氧阈状态时其他3个状态摄氧通气效率较术前升高(P<0.05);无氧阈状态、极限状态时二氧化碳通气当量较术前降低(P<0.05)。心脏瓣膜置换术后静息状态、热身状态时分钟通气量较术前降低(P<0.05);静息状态、无氧阈状态时潮气量较术前降低(P<0.05);极限状态时呼吸频率较术前升高(P<0.05);静息状态、热身状态、无氧阈状态时呼吸交换比值、潮气末氧分压较术前降低(P<0.05);4个状态时潮气末二氧化碳分压较术前升高(P<0.05)。结论 CPET是一项可以安全、无创、客观、定量、可重复地评估心脏瓣膜置换术患者整体功能的临床检查方法。CPET检查结果提示,心脏瓣膜置换术治疗心脏Objective To investigate the role of cardiopulmonary exercise testing（ CPET）in the evaluation of the changes of the holistic function of patients with heart valve disease after heart valve replacement. Methods From 2011 to 2014, we enrolled 10 patients with heart valve disease who underwent heart valve replacement in Weihai Municipal Hospital and conducted CPET examinations on them before and after surgery. According to standard continuously increasing power scheme of UCLA Medical Center,we completed symptom - limited extreme sports and calculated the core indexes by standardized data analysis. The circulation indexes and respiration indexes in a quiescent state,a warm - up state,an anaerobic threshold（AT） state and an extreme state were derived by system software. Results Of the 10 patients,7 patients saw obvious improvement in the holistic function and 3 patients saw obvious decrease in the holistic function after heart valve replacement. The peak VO2 （L/ min,ml·min - 1 ·kg - 1 ）,AT（L/ min,ml·min - 1 ·kg - 1 ,% pred）,peak oxygen pulse（ml/ time）and peak load power （W）of the 10 patients after surgery were not significantly different from those before surgery（ P ＆gt; 0. 05）;the peak VO2 （% pred）,peak oxygen pulse（% pred）,oxygen uptake efficiency plateau（ ratio,% pred）and increasing power movement time（min）were higher than those before surgery,while the slope of ventilatory equivalent for carbon dioxide（slope,% pred） and minimum ventilatory equivalent for carbon dioxide（ratio,% pred）were lower than those before surgery（P 〈 0. 05）. After heart valve replacement,the systolic pressure in an extreme state was higher than that before surgery（P 〈 0. 05）;the oxygen pulse in a warm - up state was higher than that before surgery（P 〈 0. 05）;the oxygen uptake efficiency in a quiescent state,a warm - up state,and an AT state after surgery were higher than those before surgery（P 〈 0. 05）;the ventilatory equivalent for carbon dioxide in an AT state

关 键 词：心脏瓣膜疾病 心脏瓣膜假体植入 心肺运动试验 

分 类 号：R542.5[医药卫生—心血管疾病]