中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2015年
1期
44-50
,共7页
卢志南%黄洁%孙兴国%谭晓越%李子煦%胡盛寿
盧誌南%黃潔%孫興國%譚曉越%李子煦%鬍盛壽
로지남%황길%손흥국%담효월%리자후%호성수
心力衰竭,充血性%运动试验%超声心动描记术%血液动力学过程%摄氧通气效率
心力衰竭,充血性%運動試驗%超聲心動描記術%血液動力學過程%攝氧通氣效率
심력쇠갈,충혈성%운동시험%초성심동묘기술%혈액동역학과정%섭양통기효솔
Heart failure,congestive%Exercise test%Echocardiography%Hemodynamic processes%Oxygen uptake efficiency
目的 评估心肺运动试验(CPET)摄氧通气效率指标摄氧效率平台(OUEP)、摄氧效率斜率(OUES)、通气量((V) E)/二氧化碳排出量((V)CO2)最低值和(V)E/(V)CO2斜率在监测终末期慢性心力衰竭(CHF)患者心功能和血液动力学状态中的意义.方法 入选2012年10月至2013年9月阜外心血管病医院住院行心脏移植的CHF患者26例.收集临床资料和CPET参数.在行CPET的2周内,进行超声心动图和Swan-Ganz导管检查监测血液动力学参数,并对CPET中摄氧通气效率指标与超声心动图参数和血液动力学参数进行相关性分析.结果 CPET摄氧效率指标OUEP、OUES与传统指标峰值氧耗量(峰值(V)O2)之间相关性好(r=0.535、P＜0.01;r=0.840、P＜0.001).在终末期CHF患者中OUEP相对峰值(V)O2的变化斜率约为32,而OUES相对峰值(V)O2的变化斜率仅约为2,两者相差约16倍,OUEP改变比OUES、峰值(V)O2更加敏感和显著(P＜0.05).OUEP、峰值(V)O2测定值占预测值百分比(％ pred)、(V)E/(V)CO2斜率和(V)E/(V)CO2最低值与无创血液动力学参数峰值心输出量(r =0.535,P＜0.01; r=0.652,P＜0.001; r=-0.640,P＜0.001; r=-0.606,P=0.001)和峰值心脏指数(r=0.556,P＜0.01;r=0.772,P＜0.001; r=-0.641,P＜0.001;r=-0.620,P＜0.001)均显著相关,但与静息状态下有创血液动力学参数心输出量和心脏指数不相关(P＞0.05).峰值(V)O2(％pred)和(V)E/(V)CO2斜率与肺动脉收缩压(r=-0.424,P＜0.05; r=0.509,P＜0.01)和平均肺动脉压力(r=-0.479,P＜0.05;r=0.405,P＜0.05)均显著相关,峰值(V)O2(％pred)还与肺毛细血管楔压显著相关(r=-0.415,P＜0.05),(V)E/(V)CO2斜率与肺血管阻力亦呈显著相关(r=0.429,P＜0.05).结论 CPET摄氧通气效率指标OUEP,可配合传统指标峰值(V)O2、(V)E/(V)CO2最低值、(V)E/(V)CO2斜率等,对CHF患者心功能和血液动力学状态的变化进行更好地监测和评估,以指导终末期CHF患者的临床管理.
目的 評估心肺運動試驗(CPET)攝氧通氣效率指標攝氧效率平檯(OUEP)、攝氧效率斜率(OUES)、通氣量((V) E)/二氧化碳排齣量((V)CO2)最低值和(V)E/(V)CO2斜率在鑑測終末期慢性心力衰竭(CHF)患者心功能和血液動力學狀態中的意義.方法 入選2012年10月至2013年9月阜外心血管病醫院住院行心髒移植的CHF患者26例.收集臨床資料和CPET參數.在行CPET的2週內,進行超聲心動圖和Swan-Ganz導管檢查鑑測血液動力學參數,併對CPET中攝氧通氣效率指標與超聲心動圖參數和血液動力學參數進行相關性分析.結果 CPET攝氧效率指標OUEP、OUES與傳統指標峰值氧耗量(峰值(V)O2)之間相關性好(r=0.535、P＜0.01;r=0.840、P＜0.001).在終末期CHF患者中OUEP相對峰值(V)O2的變化斜率約為32,而OUES相對峰值(V)O2的變化斜率僅約為2,兩者相差約16倍,OUEP改變比OUES、峰值(V)O2更加敏感和顯著(P＜0.05).OUEP、峰值(V)O2測定值佔預測值百分比(％ pred)、(V)E/(V)CO2斜率和(V)E/(V)CO2最低值與無創血液動力學參數峰值心輸齣量(r =0.535,P＜0.01; r=0.652,P＜0.001; r=-0.640,P＜0.001; r=-0.606,P=0.001)和峰值心髒指數(r=0.556,P＜0.01;r=0.772,P＜0.001; r=-0.641,P＜0.001;r=-0.620,P＜0.001)均顯著相關,但與靜息狀態下有創血液動力學參數心輸齣量和心髒指數不相關(P＞0.05).峰值(V)O2(％pred)和(V)E/(V)CO2斜率與肺動脈收縮壓(r=-0.424,P＜0.05; r=0.509,P＜0.01)和平均肺動脈壓力(r=-0.479,P＜0.05;r=0.405,P＜0.05)均顯著相關,峰值(V)O2(％pred)還與肺毛細血管楔壓顯著相關(r=-0.415,P＜0.05),(V)E/(V)CO2斜率與肺血管阻力亦呈顯著相關(r=0.429,P＜0.05).結論 CPET攝氧通氣效率指標OUEP,可配閤傳統指標峰值(V)O2、(V)E/(V)CO2最低值、(V)E/(V)CO2斜率等,對CHF患者心功能和血液動力學狀態的變化進行更好地鑑測和評估,以指導終末期CHF患者的臨床管理.
목적 평고심폐운동시험(CPET)섭양통기효솔지표섭양효솔평태(OUEP)、섭양효솔사솔(OUES)、통기량((V) E)/이양화탄배출량((V)CO2)최저치화(V)E/(V)CO2사솔재감측종말기만성심력쇠갈(CHF)환자심공능화혈액동역학상태중적의의.방법 입선2012년10월지2013년9월부외심혈관병의원주원행심장이식적CHF환자26례.수집림상자료화CPET삼수.재행CPET적2주내,진행초성심동도화Swan-Ganz도관검사감측혈액동역학삼수,병대CPET중섭양통기효솔지표여초성심동도삼수화혈액동역학삼수진행상관성분석.결과 CPET섭양효솔지표OUEP、OUES여전통지표봉치양모량(봉치(V)O2)지간상관성호(r=0.535、P＜0.01;r=0.840、P＜0.001).재종말기CHF환자중OUEP상대봉치(V)O2적변화사솔약위32,이OUES상대봉치(V)O2적변화사솔부약위2,량자상차약16배,OUEP개변비OUES、봉치(V)O2경가민감화현저(P＜0.05).OUEP、봉치(V)O2측정치점예측치백분비(％ pred)、(V)E/(V)CO2사솔화(V)E/(V)CO2최저치여무창혈액동역학삼수봉치심수출량(r =0.535,P＜0.01; r=0.652,P＜0.001; r=-0.640,P＜0.001; r=-0.606,P=0.001)화봉치심장지수(r=0.556,P＜0.01;r=0.772,P＜0.001; r=-0.641,P＜0.001;r=-0.620,P＜0.001)균현저상관,단여정식상태하유창혈액동역학삼수심수출량화심장지수불상관(P＞0.05).봉치(V)O2(％pred)화(V)E/(V)CO2사솔여폐동맥수축압(r=-0.424,P＜0.05; r=0.509,P＜0.01)화평균폐동맥압력(r=-0.479,P＜0.05;r=0.405,P＜0.05)균현저상관,봉치(V)O2(％pred)환여폐모세혈관설압현저상관(r=-0.415,P＜0.05),(V)E/(V)CO2사솔여폐혈관조력역정현저상관(r=0.429,P＜0.05).결론 CPET섭양통기효솔지표OUEP,가배합전통지표봉치(V)O2、(V)E/(V)CO2최저치、(V)E/(V)CO2사솔등,대CHF환자심공능화혈액동역학상태적변화진행경호지감측화평고,이지도종말기CHF환자적림상관리.
Objective To assess the cardiopulmonary exercise testing (CPET) derived performance of oxygen uptake and ventilation efficiency parameters,including oxygen uptake efficiency plateau (OUEP),oxygen uptake efficiency slope (OUES),(V)E/(V)CO2 slope and lowest (V)E/(V)CO2,in patients with end-stage chronic heart failure(CHF) and evaluate their clinical value on monitoring cardiac function and hemodynamic status.Methods A total of 26 end-stage CHF patients considered for heart transplantation were enrolled in this study.CPET,echocardiography and invasive hemodynamic examinations with Swan-Ganz flowing balloon catheter were performed.Correlation analysis was made between oxygen uptake and ventilation efficiency parameters from CPET and echocardiographic and hemodynamic parameters.Results OUEP and OUES showed good correlation with peak oxygen consumption (peak (V)O2) (r =0.535,P ＜ 0.01 ; r =0.840,P ＜ 0.001).In end-stage CHF patients,the slope of OUEP with respect to peak (V)O2 is about 32,but the slope of OUES with respect to peak (V)O2 is only about 2.The difference was 16 times.The change of OUEP was more sensitive and significant than those of OUES and peak (V)O2 (P ＜ 0.05).OUEP,peak (V)O2 (％ pred),(V)E/(V)CO2 slope and lowest (V)E/(V)CO2 were all correlated well with non-invasive hemodynamic parameters peak cardiac output (r=0.535,P＜0.01; r=0.652,P＜0.001; r=-0.640,P＜0.001 ; r=-0.606,P=0.001 respectively) and peak cardiac index (r =0.556,P＜0.01;r =0.772,P ＜0.001; r =-0.641,P ＜ 0.001 ; r =-0.620,P ＜ 0.001 respectively) derived from CPET,but not correlated with invasive hemodynamic parameters cardiac output and cardiac index at rest (P ＞0.05).Both peak (V)O2 (％ pred) and (V)E/(V)CO2 slope were significantly correlated with invasive hemodynamic parameters systolic pulmonary arterial pressure (r =-0.424,P ＜ 0.05 ; r =0.509,P ＜ 0.01) and mean pulmonary arterial pressure (r=-0.479,P＜0.05; r=0.405,P＜0.05).Peak (V)O2(％pred)was also significantly correlated with pulmonary capillary wedge pressure (r =-0.415,P ＜ 0.05),and (V)E/(V)CO2 slope was significantly correlated with pulmonary vascular resistance (r =0.429,P ＜ 0.05).Conclusions The oxygen uptake and ventilation efficiency parameters derived from CPET,including peak (V)O2,OUEP,lowest (V)E/(V)CO2 and (V)E/(V)CO2 slope etc,are objectively monitoring and evaluating cardiac function and hemodynamic status.And they are useful for optimizing clinical management of patients with end-stage CHF.
