| 重症心力衰竭患者运动病理生理学特征的临床研究* |
| |
| 引用本文： | 陈荣,孙兴国,张也,邹昱馨,冯云红,马铭欣,夏蕊,王冬,黄燕,李浩,杨戈.重症心力衰竭患者运动病理生理学特征的临床研究*[J].中国应用生理学杂志,2021,37(2):162-168. |
| |
| 作者姓名： | 陈荣 孙兴国 张也 邹昱馨 冯云红 马铭欣 夏蕊 王冬 黄燕 李浩 杨戈 |
| |
| 作者单位： | 1.中国医学科学院阜外医院 国家心血管病中心 北京协和医学院心血管疾病国家重点实验室 国家心血管疾病临床医学研究中心,北京 100037; 2.辽宁省大连市妇女儿童医疗中心（集团）, 大连116000; 3.山东省聊城市立医院儿童医院, 聊城252000; 4.江苏省如皋市人民医院心功能科, 如皋 226500; 5.中国科学院大学医学院,北京 100049; 6.河南省南阳人民医院,南阳473000 |
| |
| 基金项目： | * 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: 通过症状限制性极限运动心肺运动试验（CPET）,从整体整合角度研究慢性心力衰竭患者（CHF）的运动病理生理学特征。方法: 选2016年10月至2017年10月就诊于中国医学科学院阜外医院签署知情同意书后的CHF 83例,并选同期12例正常人作为对照。在严格定标、规范化操作下按照美国加州大学洛杉矶分校医学中心标准完成连续递增功率方案的症状限制性CPET,并检测运动中呼吸循环代谢等功能指标。结果: CHF病人CPET核心指标中峰值摄氧量为（14.33±2.69） ml/（min·kg）, （44.25±14.74）%pred显著低于正常对照组（29.42±5.46） ml/（min·kg）, （83.88±6.28）%pred。此外,CHF组患者的无氧阈（AT）、峰值氧脉搏、摄氧通气效率峰值平台（OUEP）、二氧化碳通气当量最小值（Lowest VE/VCO2）、二氧化碳通气当量斜率（VE/VCO2 Slope）均与正常对照组有显著统计学差异（P<0.01）;CHF肺功能核心指标一秒用力呼气容积（FEV1）、用力肺活量（FVC）、一秒率（FEV1/FVC）、肺一氧化碳弥散量（DLCO）百分预计值均显著低于正常对照组（P<0.01）。CHF组收缩压的5个功能状态均显著低于正常对照组（P<0.05）,舒张压无统计学差异,心率在无氧阈、峰值和恢复2 min时均显著低于正常对照组（P<0.01）。分钟通气量、潮气量和呼吸频率在静息和热身状态下显著高于正常对照组（P<0.05）,在运动极限时显著低于正常对照组（P<0.05）,潮气量在恢复期显著高于正常对照组（P<0.05）。摄氧量在无氧阈、峰值和恢复2 min显著高于正常对照组（P<0.01）;氧脉搏在无氧阈、峰值显著高于正常对照组（P<0.01）;脉搏氧饱和在5个功能状态均显著低于正常对照组（P<0.01）。结论: 心源性疾病导致的CHF患者整体功能下降主要源于循环受限,同时呼吸和代谢也有受限。
|
| 关 键 词： | 慢性心力衰竭 心肺运动试验 运动病理生理 循环受限 呼吸受限 代谢受限 |
| 收稿时间： | 2020-08-12 |
Clinical study on the characteristics of exercise pathophysiological in patients with severe heart failure |
| |
| CHEN Rong,SUN Xing-guo,ZHANG Ye,ZOU Yu-xin,FENG Yun-hong,MA Ming-xin,XIA Rui,WANG Dong,HUANG Yan,LI Hao,YANG Ge.Clinical study on the characteristics of exercise pathophysiological in patients with severe heart failure[J].Chinese Journal of Applied Physiology,2021,37(2):162-168. |
| |
| Authors: | CHEN Rong SUN Xing-guo ZHANG Ye ZOU Yu-xin FENG Yun-hong MA Ming-xin XIA Rui WANG Dong HUANG Yan LI Hao YANG Ge |
| |
| Abstract: | Objective: The cardiopulmonary function of patients with chronic heart failure (CHF) was severely limited, but the holistic integrative exercise pathophysiology is still unclear. Methods: After signed the consent form, Eighty three patients with severe CHF from October 2016 to October 2017 in Fuwai Hospital were performed Ramp incremental loading program CardioPulmonary Exercise Testing (CPET), and 12 normal subjects served as control. CPET were performed according to standard of Harbor-UCLA MC and the circulatory, respiratory and metabolic parameters during CPET were measured and analyzed. Results: Peak oxygen uptake (Peak VO2) in CHF (14.33±2.69) ml/(min·kg), (44.25±14.74)%pred was significantly lower than control ((29.42±5.46) ml/(min·kg), (83.88±6.28)%pred). Other core parameters of CPET such as anaerobic threshold (AT), peak oxygen pulse, oxygen uptake efficiency platform (OUEP), the lowest of carbon dioxide output ventilation ratio (Lowest VE/VCO2), and carbon dioxide output ventilation slope (VE/VCO2 Slope) in CHF were significantly different with the control group(P<0.01). The core parameters of lung function, such as forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC, and carbon monoxide diffusion (DLCO) were significantly decreased (P<0.01). Systolic blood pressure during all stages of CPET in CHF was significantly lower than control group (P<0.05); Heart rate at AT, peak and recovery stages were significantly lower than control (P<0.01). Minute ventilation, tidal volume and respiratory frequency at rest, warm-up were significantly higher than control (P<0.05). Tidal volume at recovery was significantly higher than control (P<0.05). VO2 at AT, peak and recovery stages in CHF were significantly higher than control (P<0.01). Oxygen pulse at AT and peak were significantly higher than control (P<0.01). Pulse oxygen saturation during all stages of CPET in CHF were significantly lower than control (P<0.01). Conclusion: The decreased holistic functional capacity of cardiogenic CHF dominantly due to circulatory limitation, and secondly due to respiratory and metabolic limitation. |
| |
| Keywords: | chronic heart failure cardiopulmonary exercise testing exercise pathophysiology circulatory limitation respiratory limitation metabolic limitation |
|
| 点击此处可从《中国应用生理学杂志》浏览原始摘要信息 |
|
点击此处可从《中国应用生理学杂志》下载全文 |
|
