心电图运动负荷试验阳性患者心肺运动试验分析  

Analysis of cardiopulmonary exercise test in patients with positive electrocardiogram exercise test

作　　者：张剑 孙毅 贺靖斐 张伊 梁延春 韩雅玲 ZHANG Jian;SUN Yi;HE Jing-fei;ZHANG Yi;LIANG Yan-chun;HAN Ya-ling(Department of Cardiology,General Hospital of Northern Theater Command,Cardiovascular Research Institute of PLA,Shenyang 110016,China)

机构地区：[1]北部战区总医院全军心血管病研究所心内科

出　　处：《中国介入心脏病学杂志》2019年第6期334-339,共6页Chinese Journal of Interventional Cardiology

基　　金：军事科技领域青年人才托举工程项目(17-JCJQ-QT-028)

摘　　要：目的回顾性分析心电图运动负荷试验阳性患者心肺运动试验(CPET)的相关数据,探讨此类患者CPET的临床特点。方法入选2017年8月至2018年7月在北部战区总医院心内科住院诊断为冠心病并进行CPET测试的连续患者共2552例,同时进行心电图运动负荷试验,阳性患者215例作为阳性组,进行1︰1匹配选取与阳性患者同期进行CPET的心电图运动负荷试验阴性患者215例作为阴性组。全部受试者均使用瑞士Schiller CS-200CPET系统进行测试,在静息状态下测定人体的肺功能、心电图,继之连续动态监测记录进出气流、摄氧量(VO2)、二氧化碳排出量(VCO2)、十二导联心电图、血压和血氧饱和度的实时变化。结果两组患者年龄、体重指数、高血压病、糖尿病、高脂血症和陈旧性心肌梗死等方面比较,差异均无统计学意义(均P>0.05)。阳性组男性比例(85.6%比74.4%,P=0.003)、吸烟比例(34.9%比26.0%,P=0.047)显著高于阴性组,但左心室射血分数(LVEF)[(51.9±3.8)%比(55.2±4.7)%,P=0.037]显著低于阴性组,差异均有统计学意义。两组患者在运动递增功率、峰值Borg评分、运动持续时间、峰值功率、峰值代谢当量、呼吸储备、每分通气量/每分二氧化碳排出量(VE/VCO2)、静息心率、静息血压、静息和峰值指脉血氧饱和度比较,差异均无统计学意义(均P>0.05)。阳性组因疲劳终止比例(40.5%比62.8%,P<0.001)和心率储备[(34.6±17.6)次/分比(38.8±21.0)次/分,P=0.026]显著低于阴性组。阳性组峰值心率达预计值比例[(87.1±11.8)%比(84.4±14.3)%,P=0.031]及峰值收缩压[(179.1±25.5)mm Hg比(173.6±26.6)mm Hg,P=0.029]显著高于阴性组,差异均有统计学意义。两组患者无氧阈(AT)摄氧量、AT对应心率、峰值摄氧量、峰值千克摄氧量、峰值负荷、峰值氧脉搏、最大呼吸频率、用力肺活量(FVC)、最大肺活量(VCmax)、第一秒用力呼气量(FEV1)、FEV1/FVC比较,差异均无统计学意义Objective The data of cardiopulmonary exercise test(CPET)in patients with positive ECG exercise stress test were retrospectively analyzed to explore the clinical characteristics of CPET in these patients.Methods From August 2017 to July 2018,2552 consecutive patients with coronary heart disease were enrolled in the Department of Cardiology of Shenyang Military Region General Hospital.215 patients with positive electrocardiogram exercise stress test were selected as the case group.A total of 215 patients with negative CPET exercise stress test on the same day were matched 1﹕1 as the control group.All of the subjects were tested with the Swiss Schiller cs-200 cardiopulmonary exercise testing system,in the resting state determination of human lung function and electrocardiogram were recorded,followed by continuous dynamic monitoring and recording of import and output flow,O2 concentration,CO2 concentration,12-lead ECG,blood pressure and oxygen saturated degree changes in real time.Results There was no significant difference in age,body mass index(BMI),hypertension,diabetes mellitus,hyperlipidemia and old myocardial infarction between the positive group and the negative group,and the positive group was signifi cantly higher than the negative group in male proportion and smoking rate(85.6%vs.74.4%,P=0.003)(34.9%vs.26.0%,P=0.047).The left ventricular ejection fraction in positive group was lower than that in the negative group(51.9±3.8)%vs.(55.2±4.7)%,P=0.037.There was no signifi cant dif ference between the positive group and the negative group in incremental exercise power,peak Borg score,duration of exercise,peak power,peak metabolic equivalent,respiratory reserve,VE/VCO2 slope,resting HR,resting blood pressure,resting or peak finger blood pressure saturation.However,the fatigue termination rate and heart rate reserve were signifi cantly lower than those in the negative group(40.5%vs.62.8%,P<0.001),[(34.6±17.6)bpm vs.(38.8±21.0)bpm,P=0.026].The percentage of peak HR reaching the predicted value and the peak SB

关 键 词：心电图运动负荷试验 冠状动脉疾病 心肺运动试验 心脏康复 

分 类 号：R540.47[医药卫生—心血管疾病]