慢性心力衰竭患者波浪呼吸的平均幅度和周期时长与运动能力的关系  

Relationship of characteristic duration and magnitude of the oscillatory breathing related with exercise functional capacity in patients with chronic heart failure

作　　者：吕婧 黎镇赐[1,2,3] 孙兴国 William Stringer[3] LYU Jing;LI Zhen-ci;SUN Xing-guo;William Stringer(National Center of Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences,State Key Laboratory of Cardiovascular Diseases,National Center for Cardiovascular Diseases Clinical Medical Research,Peking Union Medical College,Beijing 100037,China;Guangzhou First People’s Hospital,Guangzhou 510180,China;Harbor-UCLA Medical Center,Los Angel,California,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]广州市第一人民医院,广东广州510180 [3]Harbor-UCLA Medical Center,Los Angel,California,USA

出　　处：《中国应用生理学杂志》2021年第2期169-176,共8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:探讨心衰患者(CHF)波浪呼吸的周期长度、振幅与运动能力的关系。方法:237例心力衰竭患者进行症状限制性极限心肺运动试验(CPET)。将CPET每次呼吸的原始数据每秒切割,再进行单位时间的平均计算、分析。波浪式呼吸(OB)定义为CPET期间连续3次及其以上的呼吸波动,其中分钟通气量(V_(E))波动幅度超过同期均值的25%。存在OB的CHF患者(OB+)根据其峰值摄氧量(Peak VO_(2))分为3个亚组。第1亚组(轻度CHF)Peak VO_(2)≥16 ml/(min·kg),第2亚组(中度CHF)Peak VO_(2)为12~16 ml/(min·kg),第3亚组(重度CHF)Peak VO_(2)≤12 ml/(min·kg)。结果:237例CHF患者中,78例OB+患者(32.6%)出现波浪呼吸。在OB+的CHF患者中,OB周期时间长度与Peak VO_(2)(r=-0.82)、Peak VO_(2)%pred(r=-0.65)、AT(r=-0.78)呈负相关,与Lowest V_(E)/VCO_(2)呈正相关(r=0.61)。结论:心衰患者波浪呼吸的平均周期时间长度与整体运动能力呈负相关。Objective:To find out the relationship between the duration and amplitude of oscillatory breathing(OB)and their exercise capacity in patients with chronic heart failure(CHF)we did this study.Methods:Two hundred and thirty-seven CHF patients performed a maximum incremental upright cycle ergometry cardiopulmonary exercise testing(CPET).Respiratory gas exchange was measured on a breath-by-breath basis throughout the test.OB was defined as 3 or more continuous cycle fluctuations of ventilation during CPET,and the amplitude of V_(E) oscillations exceed 25%of concurrent mean value.The CHF patients with OB(OB+)were divided into 3 sub-groups according to their Peak VO_(2).Group1(mild OB+)Peak VO_(2)of≥16 ml/min/kg,group 2(moderate OB+)Peak VO_(2) is between 12~16 ml/min/kg,group 3(severe OB+)Peak VO_(2)≤12 ml/(min·kg).Results:There were 78(32.6%)patients detected as OB+in 237 CHF patients.Among OB+patients,OB duration in s related negatively to Peak VO_(2) in mL/min/kg(r=-0.82),Peak VO_(2) in%pred(r=-0.65),VO_(2) at AT(r=-0.78),and related positively to V_(E)/VCO_(2) at AT(r=0.61).Conclusion:OB duration is related negatively to exercise capacity of CHF patients.

关 键 词：心力衰竭 心肺运动试验 波浪呼吸 波浪呼吸周期时间长度 气体交换 

分 类 号：R332.3[医药卫生—人体生理学]