张剑,孙毅,贺靖斐,张伊,梁延春,韩雅玲

• 1:北部战区总医院全军心血管病研究所心内科

摘要(Abstract)：

目的回顾性分析心电图运动负荷试验阳性患者心肺运动试验(CPET)的相关数据,探讨此类患者CPET的临床特点。方法入选2017年8月至2018年7月在北部战区总医院心内科住院诊断为冠心病并进行CPET测试的连续患者共2552例,同时进行心电图运动负荷试验,阳性患者215例作为阳性组,进行1︰1匹配选取与阳性患者同期进行CPET的心电图运动负荷试验阴性患者215例作为阴性组。全部受试者均使用瑞士Schiller CS-200CPET系统进行测试,在静息状态下测定人体的肺功能、心电图,继之连续动态监测记录进出气流、摄氧量(VO2)、二氧化碳排出量(VCO2)、十二导联心电图、血压和血氧饱和度的实时变化。结果两组患者年龄、体重指数、高血压病、糖尿病、高脂血症和陈旧性心肌梗死等方面比较,差异均无统计学意义(均P>0.05)。阳性组男性比例(85.6%比74.4%,P=0.003)、吸烟比例(34.9%比26.0%, P=0.047)显著高于阴性组,但左心室射血分数(LVEF)[(51.9±3.8)%比(55.2±4.7)%,P=0.037]显著低于阴性组,差异均有统计学意义。两组患者在运动递增功率、峰值Borg评分、运动持续时间、峰值功率、峰值代谢当量、呼吸储备、每分通气量/每分二氧化碳排出量(VE/VCO2)、静息心率、静息血压、静息和峰值指脉血氧饱和度比较,差异均无统计学意义(均P>0.05)。阳性组因疲劳终止比例(40.5%比62.8%,P<0.001)和心率储备[(34.6±17.6)次/分比(38.8±21.0)次/分,P=0.026]显著低于阴性组。阳性组峰值心率达预计值比例[(87.1±11.8)%比(84.4±14.3)%,P=0.031]及峰值收缩压[(179.1±25.5)mm Hg比(173.6±26.6)mm Hg,P=0.029]显著高于阴性组,差异均有统计学意义。两组患者无氧阈(AT)摄氧量、AT对应心率、峰值摄氧量、峰值千克摄氧量、峰值负荷、峰值氧脉搏、最大呼吸频率、用力肺活量(FVC)、最大肺活量(VCmax)、第一秒用力呼气量(FEV1)、FEV1/FVC比较,差异均无统计学意义(均P>0.05)。阳性组AT千克摄氧量[(11.9±2.4)ml/(kg·min)比(11.5±2.3)ml/(kg·min),P=0.040]、AT负荷[(3.4±0.7)Mets比(3.3±0.6)Mets,P=0.037]、最大通气量(MVV)[(113.9±30.1)L/min比(107.3±30.0)L/min,P=0.022]和MVV达预计值比例[(107±24)%比(102±24)%,P=0.030]显著高于阴性组,差异均有统计学意义。结论心电图运动负荷试验阳性患者可能因为男性比例较高,运动中峰值心率及峰值收缩压较高,AT负荷及MVV较高,表现出较强的心肺运动耐量。在进行CPET检查中,遵循症状限制性运动试验方法同时,建议根据患者的运动能力及状态,鼓励患者进行较强的或更接近靶心率的运动负荷测试,以得到更准确的测试结果。

关键词(KeyWords)： 心电图运动负荷试验;冠状动脉疾病;心肺运动试验;心脏康复

Abstract:

Keywords:

基金项目(Foundation): 军事科技领域青年人才托举工程项目(17-JCJQ-QT-028)

作者(Author): 张剑,孙毅,贺靖斐,张伊,梁延春,韩雅玲

参考文献(References)：

• [1]McKavanagh P,Lusk L,Ball PA,et al.A comparison of cardiac computerized tomography and exercise stress electrocardiogram test for the investigation of stable chest pain:the clinical results of the CAPP randomized prospective trial.Eur Heart J Cardiovasc Imaging,2015,16(4):441-448.
• [2]Albouaini K,Egred M,Alahmar A,et al.Cardiopulmonary exercise testing and its application.Postgrad Med J,2007,83(985):675-682.
• [3]Al-Khalili F,Malmberg K.Exercise testing,still the method of choice when evaluating patients with chronic stable angina pectoris.Eur Heart J,2000,21(11):875-877.
• [4]Master AM.The two-step exercise electrocardiogram:a test for coronary insuffi ciency.Ann Intern Med,1950,32(5):842-863.
• [5]Maron BA,Cockrill BA,Waxman AB,et al.The invasive cardiopulmonary exercise test.Circulation,2013,127(10):1157-1164.
• [6]Milani RV,Lavie CJ,Mehra MR,et al.Understanding the basics of cardiopulmonary exercise testing.Mayo Clin Proc,2006,81(12):1603-1611.
• [7]Piepoli MF,Capucci A.Cardiopulmonary exercise testing(CPET)in the identification of candidate for cardiac resynchronisation therapy(CRT).J Mole Cellu Cardio,2007,42(6):S157.
• [8]Sue DY,Wasserman K.Impact of integrative cardiopulmonary exercise testing on clinical decision making.Chest,1991,99(4):981-992.
• [9]Balady GJ,Arena R,Sietsema K,et al.Clinician's Guide to cardiopulmonary exercise testing in adults:a scientific statement from the American Heart Association.Circulation,2010,122(2):191-225.
• [10]Cordo Mollar JC.Exercise treadmill test in patients with unstable angina.Rev Esp Cardiol,2000,53(10):1414-1415.
• [11]Jian-ling S,Ying Z,Yu-lian G,et al.Coronary heart disease diagnosis bases on the change of diff erent parts in treadmill exercise test ECG.Cell Biochem Biophys,2013,67(3):969-975.
• [12]Stallones RA.The association between tobacco smoking and coronary heart disease.Int J Epidemiol,2015,44(3):735-743.
• [13]Keteyian SJ,Isaac D,Thadani U,et al.Safety of symptom-limited cardiopulmonary exercise testing in patients with chronic heart failure due to severe left ventricular systolic dysfunction.Am Heart J,2009,158(4 Suppl):S72-S77.
• [14]Guazzi M,Adams V,Conraads V,et al.EACPR/AHA Joint Scientifi c Statement.Clinical recommendations for cardiopulmonary exercise testing data assessment in specifi c patient populations.Eur Heart J,2012,33(23):2917-2927.
• [15]Schmid A,Schilter D,Fengels I,et al.Design and validation of an interpretative strategy for cardiopulmonary exercise tests.Respirology,2007,12(6):916-923.
• [16]Jain M,Nkonde C,Lin BA,et al.85%of maximal age-predicted heart rate is not a valid endpoint for exercise treadmill testing.J Nucl Cardiol,2011,18(6):1026-1035.
• [17]陈纪言,陈韵岱,韩雅玲,等.经皮冠状动脉介入治疗术后运动康复专家共识.中国介入心脏病学杂志,2016,24(7):361-369.