不同功率递增速率对正常人心肺运动试验整体功能的影响Ⅰ——峰值运动相关指标及呼吸交换率的变化  

Effect of different work rate increasing rate on the overall function evaluation of cardiopulmonary exercise testingⅠ——peak parameters and changes in respiratory exchange rate

作　　者：郝璐 孙兴国[1,3] 宋雅 刘方 台文琦[1] 葛万刚 李浩 张也[1] 陈荣 邹昱馨 马铭欣 夏蕊 黄燕 谢友红 HAO Lu;SUN Xing-guo;SONG Ya;LIU Fang;TAI Wen-qi;GE Wan-gang;LI Hao;ZHANG Ye;CHEN Rong;ZOU Yu-xin;MA Ming-xin;XIA Rui;HUANG Yan;XIE You-hong(Fuwai Hospital,Chinese Academy of Medical Sciences/National Center for Cardiovascular Diseases/State Key Laboratory of Cardiovascular Diseases/Chinese Academy of Medical Sciences/Peking Union Medical College,Beijing 100037;Henan Provincial People’s Hospital,Henan 450003;The Affiliated Rehabilitation Hospital of Chongqing Medical University,Chongqing 400050;Dalian Children’s Hospital,Dalian 116000;Liaocheng People’s Hospital,Liaocheng 252000,China)

机构地区：[1]国家心血管病中心中国医学科学院阜外医院,北京协和医学院心血管疾病国家重点实验室心血管疾病国家临床医学研究中心,北京100037 [2]河南省人民医院,郑州450003 [3]重庆医科大学附属康复医院,重庆400050 [4]辽宁省大连儿童医院,大连116000 [5]聊城市立医院儿童医院,山东聊城252000

出　　处：《中国应用生理学杂志》2021年第2期113-119,共7页Chinese Journal of Applied Physiology

基　　金：国家高技术研究发展计划(863计划)课题资助项目(2012AA021009);国家自然科学基金医学科学部面上项目(81470204);中国康复医疗机构联合重大项目基金(20160102);中国医学科学院国家心血管病中心阜外医院科研开发启动基金(2012-YJR02);首都临床特色应用研究与成果推广(Z161100000516127);北京康复医院2019-2021科技发展专项(2019-003);北京协和医学院教学改革项目(2018E-JG07);北京协和医学院-国家外国专家局外国专家项目(2015,2016,T2017025,T2018046,G2019001660);重庆市卫计委医学科研计划项目(2017MSXM090);重庆市科委社会事业与民生保障科技创新专项项目(cstc2017shmsA130063)。

摘　　要：目的:观察健康志愿者不同功率递增速率完成症状限制性极限心肺运动试验(CPET)对CPET峰值运动相关核心指标的影响,及运动中呼吸交换率(RER)的变化。以探讨不同功率递增速率对CPET峰值运动相关指标的影响。方法:选择12名健康志愿者在一周内不同工作天随机完成中等适度程度(30 W/min)及比较低(10 W/min)和比较高(60 W/min)3种不同功率递增速率CPET。按标准方法比较CPET数据主要峰值运动核心指标:峰值运动时的摄氧量、二氧化碳排出量、负荷功率、呼吸频率、潮气量、分钟通气量、心率、血压和氧脉搏,运动持续时间和CPET各时段的RER。对三组不同功率递增速率下各个指标的差异进行组间两两比较。结果:与中等适度功率递增速率组比较,比较低和比较高功率递增速率组的峰值功率分别显著地降低和升高((162.04±41.59)W/min vs(132.92±34.55)W/min vs(197.42±46.14)W/min,P<0.01);运动时间显著延长和缩短((5.69±1.33)min vs(13.49±3.43)min vs(3.56±0.76)min,P<0.01);峰值RER(1.27±0.07 vs 1.18±0.06 vs 1.33±0.08,P<0.01~P<0.05)与恢复期RER最大值(1.72±0.16 vs 1.61±0.11 vs 1.81±0.14,P<0.01~P<0.05)均显著降低和升高。结论:不同功率递增速率CPET显著改变峰值运动时的功率、运动持续时间、峰值RER和恢复期最大RER。CPET规范化操作要选择个体化适合受试者的中等适度功率递增速率,而且也不能以某一固定的RER值作为保证安全、受试者达到极限运动和提前终止运动的依据。Objective:To observe the effect of healthy volunteers different work rate increasing rate cardiopulmonary exercise test(CPET)on the peak exercise core indicators and the changes of respiratory exchange rate(RER)during exercise,to explore the effect of different work rate increasing rate on CPET peak exercise related indicators.Methods:Twelve healthy volunteers were randomly assigned to a moderate(30 W/min),a relatively low(10 W/min)and relatively high(60 W/min)three different work rate increasing rate CPET on different working days in a week.The main peak exercise core indicators of CPET data:VO_(2),VCO_(2),work rate(WR),breathe frequency(Bf),tidal volume(V_(T)),ventilation(V_(E)),heart rate(HR),blood pressure(BP),Oxygen pulse(O_(2)P),exercise time and RER for each period of CPET were analyzed using standard methods.The ANOVA test and paired two-two comparison was performed on the difference of each index in the three groups of different work rate increasing rate.Results:Compared with the moderate work rate group,the peak work rate of the lower and higher work rate groups were relatively lower and higher,respectively((162.04±41.59)W/min vs(132.92±34.55)W/min vs(197.42±46.14)W/min,P<0.01);exercise time was significantly prolonged and shortened((5.69±1.33)min vs(13.49±3.43)min vs(3.56±0.76)min,P<0.01);peak RER(1.27±0.07 vs 1.18±0.06 vs 1.33±0.08,P<0.01~P<0.05)and the recovery RER maximum(1.72±0.16 vs 1.61±0.11 vs 1.81±0.14,P<0.01~P<0.05)were significantly decreased and increased.Conclusion:Different work rate increasing rate of CPET significantly change the Peak Work Rate,exercise time,Peak RER,and maximum RER during recovery.The CPET operator should choose an individualized work rate increasing rate that is appropriate for the subject,and also does not use a fixed RER value as a basis for ensuring safety,the subject’s extreme exercise,and early termination of exercise.

关 键 词：呼吸交换率 心肺运动试验 功率递增速率 停止运动标准 安全和风险 

分 类 号：R332[医药卫生—人体生理学]