| 肺动脉高压及其合并心脏内右向左分流患者的心肺运动试验特征性变化的临床研究* |
| |
| 引用本文： | 王冬,孙兴国,张也,邹昱馨,冯云红,陈荣,李浩,杨戈.肺动脉高压及其合并心脏内右向左分流患者的心肺运动试验特征性变化的临床研究*[J].中国应用生理学杂志,2021,37(1):51-58. |
| |
| 作者姓名： | 王冬 孙兴国 张也 邹昱馨 冯云红 陈荣 李浩 杨戈 |
| |
| 作者单位： | 1.中国医学科学院 北京协和医学院 国家心血管病中心阜外医院 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.江苏省如皋市人民医院心功能科,如皋 226500;3.山东省聊城市立医院儿童医院,聊城 252000 4.辽宁省大连儿童医院,大连 116000;5.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: 明确肺动脉高压及合并心脏内右向左分流（R-L）患者的心肺运动试验（CPET）气体交换变化。方法: 本文通过回顾性分析阜外医院从2016-10至2017-08签署知情同意书后完成CPET的73例肺动脉高压病人CPET数据,采取双盲方式抽取四位医生作为判读者分别独立识别R-L后,结果分为四组：①分流阳性组（n=20）、②分流可疑组（n=9）、③无分流组（n=37）、④分流延迟开放组（n=6）。选择同期完成CPET正常人14例作为对照。结果: 分流阳性组在运动开始时分钟通气量、二氧化碳排出通气效率、氧气通气效率和呼气末氧分压相对于静息期的改变值骤升,分别为（7.36±2.72） L/min、（1.84±3.59）、（5.02±4.34）、（3.75±2.64） mmHg）,明显高于对照组的（（4.26±2.59） L/min、（2.22±2.08）、（-1.46±4.68）、（-3.96±2.82） mmHg）;而呼气末二氧化碳分压相对于静息期的改变值骤降（-1.63±1.66） mmHg,明显低于对照组的（2.22±2.08） mmHg（P均<0.01）。分流延迟开放组在运动后期呼吸商（RER）、二氧化碳排出通气效率、氧气通气效率和呼气末氧分压相对于静息期的改变值骤升,分别为（0.40±0.08）、（11.07±5.60）、（30.55±7.89）、（13.72±2.21） mmHg,明显高于对照组的（0.38±0.12）、（5.67±4.6）、（4.54±3.83）、（5.51±4.24） mmHg;而呼气末二氧化碳分压相对于静息期的改变值骤降（-6.82±1.96） mmHg,明显区别于对照组的（5.67±4.6） mmHg,在恢复期分流延迟开放组二氧化碳排出通气效率、氧气通气效率相对于峰值功率时的改变值（分别为-8.38±3.24、-13.14±6.47）,明显低于对照组（6.22±2.87、16.56±4.2）（P均<0.01）。结论: 肺动脉高压患者较正常人CPET的整体功能和通气效率指标降低;肺动脉高压合并右向左分流患者不仅在静息通气效率受限更剧;且特征性地运动初始时出现PETO2明显上升、PETCO2明显下降,RER跳升到1.0左右,VE/VCO2 不降反升与VO2/VE不升反降, 常有SpO2显著下降,还有VE更大幅度上升;延迟开放型上述特征性变化发生在运动接近峰值的1~3 min而非运动初始,且运动停止后迅速反向变回以示重新关闭。
|
| 关 键 词： | 肺动脉高压 心肺运动试验 气体交换 右向左分流 延迟开放右向左分流 |
| 收稿时间： | 2020-08-12 |
Primary clinical investigation of cardiopulmonary exercise gas exchange in pulmonary hypertension patients with and without right-to-left shunt |
| |
| WANG Dong,SUN Xing-guo,ZHANG Ye,ZOU Yu-xin,FENG Yun-hong,CHEN Rong,LI Hao,YANG Ge.Primary clinical investigation of cardiopulmonary exercise gas exchange in pulmonary hypertension patients with and without right-to-left shunt[J].Chinese Journal of Applied Physiology,2021,37(1):51-58. |
| |
| Authors: | WANG Dong SUN Xing-guo ZHANG Ye ZOU Yu-xin FENG Yun-hong CHEN Rong LI Hao YANG Ge |
| |
| Affiliation: | 1. National Center for Cardiovascular Disease,Fuwai Hospital,Chinese Academy of Medical Sciences, State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Disease Clinical Medicine Research, Peking Union Medical College, Beijing 100037;2. Department of Cardiac Function,Rugao People's Hospital, Rugao 226500;3. Liaocheng People's Hospital, Liaocheng 252000;4. Dalian Children's Hospital, Dalian 116000;5. Nanyang Central Hospital, Nanyang 473000, China |
| |
| Abstract: | Objective: The aim of this study is to determine the changes of gas exchange parameters during ramp incremental cardiopulmonary exercise test (CPET) in patients with pulmonary hypertension (PH) could identify the right to left shunt (R-L Shunt). Methods: We did a retrospective analysis of exercise gas exchange parameters for 73 PH patients and 14 normal subjects as control, in Fuwai Hospital from October 2016 to August 2017, who did CPET with signature on content form. The gas exchange data of CPET were double-blindly independently interpreted by four export-doctors. According to the reading results of CPET, the PH patients were divided into four groups: ① R-L shunt positive group, ② R-L shunt suspicious group, ③R-L shunt negative group, ④late open R-L Shunt positive group. Results: Minute ventilation (VE), ventilatory equivalents for carbon dioxide and oxygen (VE/VCO2, VE/VO2), end-tidal partial pressure of oxygen (PETO2)in R-L shunt positive group were significantly increased ((7.36 ± 2.72) L/min, (1.84± 3.59), (5.02 ±4.34), (3.75±2.64) mmHg) at the beginning of exercise, and were also significantly higher than the control ((4.26 ± 2.59) L/min, (2.22± 2.08), (1.46 ±4.68), (3.96 ± 2.82) mmHg); Partial pressure of carbon dioxide in end expiratory gas (PETCO2) was decreased (-1.63 ±1.66) mmHg, and was significantly lower than control (2.22 ± 2.08) mmHg (P<0.01). Respiratory quotient (RER), carbon dioxide, VE/VCO2, VE/VO2, PETO2 in late open R-L Shunt positive group were suddenly increased ((0.40 ± 0.08), (11.07 ± 5.60),(30.55 ±7.89), (13.72 ±2.21) mmHg) at the end of exercise near the peak, significantly higher than control too ((0.38± 0.12), (5.67± 4.60), (4.54 ± 3.83), (5.51± 4.24) mmHg); PETCO2 was suddenly decreased at the end of the exercise compared to the resting stage (-6.82 ± 1.96) mmHg, and was significantly different from the control (5.67 ±4.60) mmHg. Carbon dioxide ventilatory efficiency, oxygen uptake ventilatory efficiency relative to the peak power (-8.38 ±3.24, -13.14 ± 6.47) at the recovery stage in late open R-L shunt positive group are significantly lower than control (6.22 ±2.87, 16.56± 4.20) (P<0.01). Conclusion: Cardiopulmonary function and ventilation efficiency of patients withpulmonary hypertension are significantly decreased; pulmonary hypertension and right to left shunt in patients not only resting ventilation efficiency is limited more serious; The characteristics of R-L shunt are the sudden increase of PETO2, VE/ VCO2, VE, RER and sudden decrease of PETCO2 and VO2/ VE at the beginning of exercise, and commonly companied with decreased SpO2. For the delay open R-L shunt, these changes occurred near the peak exercise rather than the beginning, and these characteristic changes quickly reversed after stopping exercise. |
| |
| Keywords: | pulmonary hypertension cardiopulmonary exercise testing gas exchange right-left shunt (R-L shunt) late open R-L shunt |
|
| 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 |
|
