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Ⅱ——亚极限运动相关指标的影响  

Effect of different work rate increasing rate on the overall function evaluation of cardiopulmonary exercise testingⅡ—sub-peak parameters

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120-124,134,共6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亚极限运动相关核心指标的影响。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12名志愿者CPET亚极限运动相关核心指标:无氧阈(AT)、单位功率摄氧量(ΔVO_(2)/ΔWR)、摄氧通气有效性峰值平台(OUEP)、二氧化碳通气当量平均90 s最低值(Lowest V_(E)/VCO_(2))、二氧化碳通气当量斜率(V_(E)/VCO_(2) Slope)及截距(intercept)和无氧阈时的摄氧通气效率值(VO_(2)/V_(E)@AT)和无氧阈时的二氧化碳通气当量值(V_(E)/VCO_(2) @AT)。对三组不同功率递增速率下各个指标的差异组间两两比较。结果:中等适度功率递增速率组与比较低和比较高功率递增速率组相比摄氧通气有效性峰值平台(42.22±4.76 vs 39.54±3.30 vs 39.29±4.29)和二氧化碳通气当量平均90 s最小值(24.13±2.88vs 25.60±2.08vs 26.06±3.05)明显好,差异有统计学意义(P<0.05);比较低、比较高功率递增速率组与中等适度功率递增速率组相比,单位功率摄氧量显著升高和降低((8.45±0.66 vs 10.04±0.58 vs 7.16±0.60)ml/(min·kg)),差异有统计学意义(P<0.05);无氧阈值没有发生明显改变((0.87±0.19 vs 0.87±0.19 vs 0.89±0.19)L/min),差异无统计学意义(P>0.05);结论:比较低、比较高功率递增速率可以明显改变摄氧通气有效性、二氧化碳排出通气有效性、单位功率摄氧量等CPET亚极限运动相关指标;选择比较低和比较高的功率递增速率和适度功率递增速率CPET相比明显降低了健康个体的摄氧通气有效性和二氧化碳排出通气有效性。CPET规范化操作要求选择适合受试者的功率递增速率,这样得到的CPET亚极限相关指标才最能反应受试者的真实功能状态。Objective:To observe the effect of healthy volunteers different work rate increasing rate cardiopulmonary exercise testing(CPET)on the sub-peak parameters.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 core indicators related to CPET sub-peak exercise of 12 volunteers were compared according to standard methods:anaerobic threshold(AT),oxygen uptake per unit power(ΔVO_(2)/ΔWR),oxygen uptake eficiency plateau,(OUEP),the lowest average of 90 s of carbon dioxide ventilation equivalent(Lowest V_(E)/VCO_(2)),the slope of carbon dioxide ventilation equivalent(V_(E)/VCO_(2) Slope)and intercept and anaerobic threshold oxygen uptake ventilation efficiency value(VO_(2)/V_(E)@AT)and the anaerobic threshold carbon dioxide ventilation equivalent value(V_(E)/VCO_(2) @AT).Paired t test was performed on the difference of each parameter in the three groups of different work rate increasing rate.Results:Compared with the relatively low and relatively high work rate increasing rate group,the moderate work rate increasing rate group uptake eficiency plateau,(42.22±4.76 vs 39.54±3.30 vs 39.29±4.29)and the lowest average of 90 s of carbon dioxide ventilation equivalent(24.13±2.88 vs 25.60±2.08 vs 26.06±3.05)was significantly better,and the difference was statistically significant(P<0.05);Compared with the moderate work rate increasing rate group,the oxygen uptake per unit work rate of the relatively low and relatively high work rate increasing rate group increased and decreased significantly((8.45±0.66 vs 10.04±0.58 vs 7.16±0.60)ml/(min·kg)),difference of which was statistically significant(P<0.05);the anaerobic threshold did not change significantly((0.87±0.19 vs 0.87±0.19 vs 0.89±0.19)L/min),the difference was not statistically significant(P>0.05).Conclusion:Relatively low and relatively high power increase rate can significantly change the CPET

关 键 词：心肺运动试验 功率递增速率 亚极限运动相关指标 通气效率 

分 类 号：R332[医药卫生—人体生理学]