中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2014年
12期
1022-1028
,共7页
孙兴国%王桂芝%吕婧%谭晓越%William W.Stringer%Karlman Wasserman
孫興國%王桂芝%呂婧%譚曉越%William W.Stringer%Karlman Wasserman
손흥국%왕계지%려청%담효월%William W.Stringer%Karlman Wasserman
心脏功能试验%呼吸功能试验%肺通气%血液动力学现象
心髒功能試驗%呼吸功能試驗%肺通氣%血液動力學現象
심장공능시험%호흡공능시험%폐통기%혈액동역학현상
Heart function tests%Respiratory function tests%Pulmonary ventilation%Hemodynamic phenormena
目的 观察正常人运动期间心肺代谢等多系统功能的连续动态变化,从整体整合角度探讨摄氧效率平台(OUEP)和CO2排出通气效率((V)E/(V)CO2最低值)在循环系统中的生理意义.方法 选正常志愿者5名,在美国洛杉矶加大Harbor-UCLA医学中心分别在动脉和中心静脉置管后完成症状限制性最大极限心肺运动试验(CPET),每分钟动、静脉取样进行血气分析,计算血液动力学指标、肺通换气指标、摄氧通气效率(OUE,即(V)O2/(V)E)和(V)E/(V)CO2等连续变化.结果 CPET期间随着功率逐步递增,心排出量、心率、混合静脉血氧浓度、动静脉氧差、分钟通气量、分钟肺泡通气量、潮气量、肺泡通气量与肺通气血流比值均呈现近于线性渐进性递增(与静息状态比较,P＜0.05 ～0.01);动脉血氧浓度一直维持高水平无明显变化(P＞0.05);每搏输出量、呼吸频率、动脉血PCO2、动脉血氢离子浓度和死腔通气比值运动中均有明显变化(与静息状态比较,P＜0.05 ～0.01),但变化非单一方向线性模式.运动中OUE先从静息状态的30.9±3.3明显升高(与静息和上个运动状态比较,P均＜0.05),大约无氧阈水平数分钟达到最高平台为46.0±4.7(与上个运动状态比较,P＞0.05),无氧阈后开始显著下降(与上个运动状态比较,P＜0.05),到峰值运动时的36.6±4.4.而(V)E/(V)CO2先从静息状态的39.2±6.5显著下降(与静息和上个运动状态比较,P均＜0.05),约在无氧阈接近最低值,随后持续数分钟形成低值平台为24.2 ±2.4(与上个运动状态比较,P＞0.05),过呼吸代偿点后再显著上升(与上个运动状态比较,P＜ 0.05),到达峰值运动时的25.9 ±2.7.结论 CPET中人体心肺代谢功能同时变化,在无肺通气受限前提下,无氧阈前的OUEP和无氧阈后的(V)E/(V)CO2最低值是反映血液循环功能的指标.
目的 觀察正常人運動期間心肺代謝等多繫統功能的連續動態變化,從整體整閤角度探討攝氧效率平檯(OUEP)和CO2排齣通氣效率((V)E/(V)CO2最低值)在循環繫統中的生理意義.方法 選正常誌願者5名,在美國洛杉磯加大Harbor-UCLA醫學中心分彆在動脈和中心靜脈置管後完成癥狀限製性最大極限心肺運動試驗(CPET),每分鐘動、靜脈取樣進行血氣分析,計算血液動力學指標、肺通換氣指標、攝氧通氣效率(OUE,即(V)O2/(V)E)和(V)E/(V)CO2等連續變化.結果 CPET期間隨著功率逐步遞增,心排齣量、心率、混閤靜脈血氧濃度、動靜脈氧差、分鐘通氣量、分鐘肺泡通氣量、潮氣量、肺泡通氣量與肺通氣血流比值均呈現近于線性漸進性遞增(與靜息狀態比較,P＜0.05 ～0.01);動脈血氧濃度一直維持高水平無明顯變化(P＞0.05);每搏輸齣量、呼吸頻率、動脈血PCO2、動脈血氫離子濃度和死腔通氣比值運動中均有明顯變化(與靜息狀態比較,P＜0.05 ～0.01),但變化非單一方嚮線性模式.運動中OUE先從靜息狀態的30.9±3.3明顯升高(與靜息和上箇運動狀態比較,P均＜0.05),大約無氧閾水平數分鐘達到最高平檯為46.0±4.7(與上箇運動狀態比較,P＞0.05),無氧閾後開始顯著下降(與上箇運動狀態比較,P＜0.05),到峰值運動時的36.6±4.4.而(V)E/(V)CO2先從靜息狀態的39.2±6.5顯著下降(與靜息和上箇運動狀態比較,P均＜0.05),約在無氧閾接近最低值,隨後持續數分鐘形成低值平檯為24.2 ±2.4(與上箇運動狀態比較,P＞0.05),過呼吸代償點後再顯著上升(與上箇運動狀態比較,P＜ 0.05),到達峰值運動時的25.9 ±2.7.結論 CPET中人體心肺代謝功能同時變化,在無肺通氣受限前提下,無氧閾前的OUEP和無氧閾後的(V)E/(V)CO2最低值是反映血液循環功能的指標.
목적 관찰정상인운동기간심폐대사등다계통공능적련속동태변화,종정체정합각도탐토섭양효솔평태(OUEP)화CO2배출통기효솔((V)E/(V)CO2최저치)재순배계통중적생리의의.방법 선정상지원자5명,재미국락삼기가대Harbor-UCLA의학중심분별재동맥화중심정맥치관후완성증상한제성최대겁한심폐운동시험(CPET),매분종동、정맥취양진행혈기분석,계산혈액동역학지표、폐통환기지표、섭양통기효솔(OUE,즉(V)O2/(V)E)화(V)E/(V)CO2등련속변화.결과 CPET기간수착공솔축보체증,심배출량、심솔、혼합정맥혈양농도、동정맥양차、분종통기량、분종폐포통기량、조기량、폐포통기량여폐통기혈류비치균정현근우선성점진성체증(여정식상태비교,P＜0.05 ～0.01);동맥혈양농도일직유지고수평무명현변화(P＞0.05);매박수출량、호흡빈솔、동맥혈PCO2、동맥혈경리자농도화사강통기비치운동중균유명현변화(여정식상태비교,P＜0.05 ～0.01),단변화비단일방향선성모식.운동중OUE선종정식상태적30.9±3.3명현승고(여정식화상개운동상태비교,P균＜0.05),대약무양역수평수분종체도최고평태위46.0±4.7(여상개운동상태비교,P＞0.05),무양역후개시현저하강(여상개운동상태비교,P＜0.05),도봉치운동시적36.6±4.4.이(V)E/(V)CO2선종정식상태적39.2±6.5현저하강(여정식화상개운동상태비교,P균＜0.05),약재무양역접근최저치,수후지속수분종형성저치평태위24.2 ±2.4(여상개운동상태비교,P＞0.05),과호흡대상점후재현저상승(여상개운동상태비교,P＜ 0.05),도체봉치운동시적25.9 ±2.7.결론 CPET중인체심폐대사공능동시변화,재무폐통기수한전제하,무양역전적OUEP화무양역후적(V)E/(V)CO2최저치시반영혈액순배공능적지표.
Objective To observe oxygen uptake efficiency plateau (OUEP,i.e.highest (V)O2/(V)E) and carbon dioxide output efficiency (lowest (V)E/(V)CO2) parameter changes during exercise in normal subjects.Methods Five healthy volunteers performed the symptom limited maximal cardiopulmonary exercise test (CPET) at Harbor-UCLA Medical Center.(V)O2/(V) E and (V) E/(V) CO2 were determined by both arterial and central venous catheters.After blood gas analysis of arterial and venous sampling at the last 30 seconds of every exercise stage and every minute of incremental loading,the continuous parameter changes of hemodynamics,pulmonary ventilation were monitored and oxygen uptake ventilatory efficiency ((V)O2/(V)E and (V) E/(V)CO2) was calculated.Results During CPET,as the loading gradually increased,cardiac output,heart rate,mixed venous oxygen saturation,arteriovenous oxygen difference,minute ventilation,minute alveolar ventilation,tidal volume,alveolar ventilation and pulmonary ventilation perfusion ratio increased near-linearly (P ＜0.05-0.01,vs.resting); arterial oxygen concentration maintained at a high level without significant change (P ＞ 0.05) ; stroke volume,respiratory rate,arterial partial pressure of carbon dioxide,arterial blood hydrogen ion concentration and dead space ventilation ratio significantly changed none-linearly (compare resting state P ＜ 0.05-0.01).OUE during exercise increased from 30.9 ± 3.3 at resting state to the highest plateau 46.0 ± 4.7 (P ＜ 0.05 vs.resting state),then,declined gradually after anaerobic threshold (P ＜ 0.05 -0.01,vs.OUEP) and reached 36.6 ±4.4 at peak exercise.The (V)E/(V)CO2 during exercise decreased from the resting state (39.2 ± 6.5) to the minimum value (24.2 ± 2.4) after AT for a few minutes (P ＞ 0.05 vs.earlier stage),then gradually increased after the ventilatory compensation point (P ＜ 0.05 vs.earlier stage) and reached to 25.9 ± 2.7 at peak exercise.Conclusions Cardiac and lung function as well as metabolism change during CPET is synchronous.In the absence of pulmonary limit,appearing before and after anaerobic threshold,OUEP and lowest (V) E/(V) CO2 could be used as reliable parameters representing the circulatory function.
