心肺运动试验在肺癌患者放疗前后心肺功能变化评估中的应用  

Application of cardiopulmonary exercise testing in the assessment of cardiopulmonary functional changes in lung cancer patients before and after radiotherapy

作　　者：任梦怡 姜效韦[2,3] 张杨梅 李瑾 REN Mengyi;JIANG Xiaowei;ZHANG Yangmei;LI Jin(Department of Rehabilitation Medicine,Northern Jiangsu People's Hospital,Yangzhou 225001,Jiangsu Province,China;Department of Rehabilitation Medicine,Xuzhou Central Hospital,Xuzhou 221009,Jiangsu Province,China;Department of Rehabilitation Medicine,Xuzhou Rehabilitation Hospital Affiliated to Xuzhou Medical University,Xuzhou 221010,Jiangsu Province,China;Xuzhou Institute of Medical Sciences,Xuzhou 221006,Jiangsu Province,China)

机构地区：[1]江苏省苏北人民医院康复科,江苏扬州225001 [2]徐州市中心医院康复科,江苏徐州221009 [3]徐州医科大学附属徐州康复医院康复科,江苏徐州221010 [4]徐州市医学科学研究所,江苏徐州221006

出　　处：《医学新知》2024年第10期1130-1139,共10页New Medicine

基　　金：江苏省自然科学基金(BK20201153);徐州市科技计划项目(KC20136)。

摘　　要：目的探讨心肺运动试验(cardiopulmonary exercise testing,CPET)在肺癌患者放疗前后心肺功能评估中的应用价值。方法选择2020年7月至2022年12月在徐州市中心医院放疗科拟行放疗的肺癌患者为研究对象,在行放疗前一天和放疗结束后一周进行CPET检查(含静态肺功能),收集静息阶段、热身阶段、无氧阈阶段、极限阶段及恢复3 min阶段的核心指标、循环指标、呼吸指标和静态肺功能指标,以评估肺癌患者放疗前后的心肺功能变化。结果共纳入45例放疗的肺癌患者。核心指标方面,肺癌患者放疗后无氧阈占预计值百分比、峰值氧脉搏(VO_(2)/HRpeak)较放疗前降低(P<0.05),二氧化碳通气当量斜率(VE/VCO_(2)slope)较放疗前升高,差异有统计学意义(P<0.05);循环指标方面,肺癌患者静息、热身、无氧阈、极限、恢复3 min状态时的心率(HR)和静息、无氧阈、极限和恢复3 min状态时的二氧化碳通气当量(VE/VCO_(2))均较放疗前显著升高(P<0.05),无氧阈、极限状态时的收缩压(SBP)和静息、热身、无氧阈和极限状态时的氧脉搏(VO_(2)/HR)均较放疗前显著降低(P<0.05);呼吸指标方面,静息、热身、无氧阈、极限状态时的二氧化碳分压(PCO_(2))均较放疗前显著降低(P<0.05),热身、无氧阈状态时的氧分压(PO_(2))较放疗前显著升高(P<0.05);患者在放疗前后静态肺功能指标变化差异无统计学意义(P>0.05)。结论肺癌患者放疗后心肺功能较放疗前下降,尤其是患者循环功能和细胞代谢功能的损害,针对此类患者制定并实施肺康复计划十分必要,而CPET作为一项诊察手段,可用于肺癌患者放疗前后心肺功能的评估。Objective To investigate the value of cardiopulmonary exercise testing(CPET)in the cardiopulmonary functional assessment of lung cancer patients before and after radiotherapy.Methods Lung cancer patients who were to undergo radiotherapy in the radiotherapy department of Xuzhou Central Hospital from July 2020 to December 2022 were included,and CPET(including static lung function)were performed one day before and one week after radiotherapy.The core indexes,circulatory indexes,respiratory indexes and static lung function indexes in the resting phase,warm-up phase,anaerobic threshold phase,limiting phase and recovery 3 min phase were derived from the test system.The results of data analysis were used to assess the overall functional changes of lung cancer patients before and after radiotherapy.Results A total of 45 patients with lung cancer were enrolled.After radiotherapy,among the core indexes,the anaerobic threshold as a percentage of predicted value(AT%pred),and peak oxygen pulse were lower(P<0.05)and the carbon dioxide ventilation equivalent slope was higher in lung cancer patients after radiotherapy than those before radiotherapy,with statistically significant differences(P<0.05).Among the circulatory indexes,heart rate at rest,warm-up,anaerobic threshold,limit,and recovery 3 min states and carbon dioxide ventilation equivalent at rest,anaerobic threshold,limit,and recovery 3 min states were significantly higher in patients with lung cancer compared with those prior to radiotherapy(P<0.05),and oxygen pulse at rest,warm-up,anaerobic threshold and limit state were significantly lower than before radiotherapy(P<0.05).Among the respiratory indexes,the partial pressure of carbon dioxide at rest,warm-up,anaerobic threshold,and limit states was lower(P<0.05)and the partial pressure of oxygen at warm-up and anaerobic threshold states was higher(P<0.05)than those before radiotherapy.There was no statistically significant difference in the changes of static lung function indexes before and after radiotherapy.Conclusion

关 键 词：肺癌 放疗 心肺运动试验 心肺功能 

分 类 号：R493[医药卫生—康复医学] R734.2[医药卫生—临床医学]