心肺运动试验终止指征:85%最大预计心率及特定收缩压界值的探讨  

How to Stop Symptom-limited Maximal Cardiopulmonary Exercise Testing:a Discussion of Termination by 85% of Maximal Age-predicted Heart Rate and a Specific Systolic Blood Pressure

作　　者：孙兴国[1] 代雅琪 张也 慈政 朱嘉宝 葛万刚[1] 李浩 刘琴[1,5] 郝璐 Walliam W.Stringer[7] SUN Xingguo;DAI Yaqi;ZHANG Ye;CI Zheng;ZHU Jiabao;GE Wangang;LI Hao;LIU Qin;HAO Lu;STRINGER W W(National Center for Cardiovascular Diseases/Fuwai Hospital,Chinese Academy of Medical Sciences/State Key Laboratory of Cardiovascular Disease/National Clinical Research Center of Cardiovascular Diseases/Peking Union Medical College,Beijing 100037,China;Renmin Hospital of Wuhan University,Wuhan 430060,China;Weifang Medical University,Weifang 261053,China;The Second Hospital of Hebei Medical University,Shijiazhuang 050005,China;Taihe Hospital,Shiyan 442000,China;Chongqing Medical University,Chongqing 400016,China;Ronald Reagan UCLA Medical Center,Los Angeles Biomedical Research Institute,St.John's Cardiovascular Research Center,Torrance CA 90502,USA)

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]武汉大学人民医院,湖北省武汉市430060 [3]潍坊医学院,山东省潍坊市261053 [4]河北医科大学附属第二医院,河北省石家庄市050005 [5]湖北省十堰市太和医院,442000 [6]重庆医科大学,重庆市400016 [7]加州大学洛杉矶分校医学中心,洛杉矶生物医学研究院,圣约翰心血管研究中心,美国加利福尼亚州托伦斯市CA90502

出　　处：《中国全科医学》2018年第30期3672-3679,共8页Chinese General Practice

基　　金：国家自然科学基金医学科学部面上项目(81470204);国家高技术研究发展计划(863计划)(2012AA021009);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：目的对完成症状限制性最大极限心肺运动试验(CPET)者收缩压及心率数据进行再分析,以期探讨CPET终止指征之85%最大预计心率(MPHR)及收缩压的最佳界值作为终止试验标准的依据是否可行。方法对第4版Principles of Exercise Testing and Interpretation一书中于1974年1月—2004年1月在美国加州大学洛杉矶分校医学中心CPET实验室按照标准连续递增功率方案完成症状限制性最大极限CPET的精选85例受试者共112例次CPET进行分析。除1例次无心率记录外共有111例次CPET记录了心率;除15例次没有进行直接动脉测压外共有97例次直接动脉测定收缩压值的CPET。计算峰值心率≥85%MPHR的CPET例次及其所占百分数、峰值运动时和达到85%MPHR时CPET测定指标的差值及百分差值,收缩压≥210、220、250 mm Hg的CPET例次及其所占百分数、峰值运动时和收缩压≥该特定值时CPET测定指标的差值及百分差值。结果 CPET的峰值心率≥85%MPHR的有64例次,占58%。该64例次CPET峰值运动时与达到85%MPHR时的运动时间、功率、心率、呼吸频率、分钟通气量、二氧化碳排出量、摄氧量、氧脉搏和呼吸交换率比较,差异有统计学意义(P<0.001)。所有97例次直接动脉测压的CPET中,收缩压≥210、220、250 mm Hg的分别是39、28、9例次。峰值运动与达到210、220 mm Hg时的运动时间、功率、心率、呼吸频率、分钟通气量、二氧化碳排出量、摄氧量、氧脉搏和呼吸交换率比较,差异有统计学意义(P<0.05)。但是当收缩压≥250 mm Hg时与峰值运动时的所有测定指标比较,差异无统计学意义(P>0.05)。结论大多数CPET患者峰值心率≥85%MPHR,但也有很多患者没有达到此值;所以即不能以85%MPHR作为停止运动的标准,也不能以未达到85%MPHR而否定CPET患者的极限努力。大多数CPET患者收缩压没有达到210 mm Hg,所以不能以收缩压不够高来否定患者的极限努力,也不能以210、Objective To analyze the data concerning systolic blood pressure(SBP)and heart rate(HR)in symptom-limited maximal cardiopulmonary exercise tests(CPETs),in order to explore whether it is right or not to use 85%of maximal age-predicted heart rate(85%MPHR)and a specific SBP level to terminate the CPET.Methods Data of 112 symptom-limited maximal CPETs completed with incremental protocols by 85 participants in the cardiopulmonary exercise laboratory of Ronald Reagan UCLA Medical Center,between January 1974 and January 2004 were collected from the Principles of Exercise Testing and Interpretation(Fourth Edition).We analyzed 111 CPETs with HR data(the other one was excluded due to lack of corresponding data)and 97 CPETs with intra-arterial blood pressure(the other 15 were excluded due to lack of corresponding data).We calculated and counted the number and percentage of the CPETs with recorded maximum HR≥85%MPHR,and compared the differences and percentage differences of exercise duration(time),work rate(WR),HR,breath frequency(f),minute ventilation(V·E),carbon dioxide output(V·CO2),oxygen uptake(V·O2),oxygen pulse(O2P),and respiratory exchange ratio(RER)at peak exercise and while HR reached 85%MPHR using paired t test.We also did the similar calculation and count of the number and percentage of the CPETs with recorded SBP≥210,220 and 250 mmHg,and the comparisons of the differences and percentage differences of the aforementioned parameters between the peak exercise and while SBP≥210,220 and 250 mm Hg.Results There were 64(58%)CPETs during which the maximum HR≥85%MPHR,in all of 111 CPETs with recorded HR.There were significant differences for all measurements of time,WR,HR,f,V·E,V·CO2,V·O2,O2P and RER(P<0.001)between the peak and HR≥85%MPHR in these 64 CPETs.There were 39,28 and 9 CPETs during which the peak SBP≥210,220 and 250 mm Hg,respectively,in all of 97 CPETs with recorded intra-arterial BP.There were significant differences for all measurements of 9 parameters(time,WR,HR,f,V·E,V·CO2,V·O2,O2P,an

关 键 词：血压 心率 症状限制性极限运动 心肺运动试验 终止运动标准 安全与风险 

分 类 号：R544[医药卫生—心血管疾病]