心肺运动试验评估心脏瓣膜置换术治疗心脏瓣膜疾病患者整体功能变化的临床研究

发布时间：2018-04-27 19:29

本文选题：心脏瓣膜疾病 + 心脏瓣膜假体植入　；参考：《中国全科医学》2016年17期

【摘要】：目的探讨心肺运动试验(CPET)对心脏瓣膜置换术治疗心脏瓣膜疾病患者整体功能变化的评估作用。方法选取2011—2014年度威海市立医院进行心脏瓣膜置换术的心脏瓣膜疾病患者10例,分别在治疗前后进行CPET检查,按照美国加州大学洛杉矶分校医学中心标准连续递增功率方案完成症状限制性极限运动,通过对数据标准化分析计算其核心指标,从系统软件导出静息状态、热身状态、无氧阈状态、极限状态时的循环指标及呼吸指标。结果10例心脏瓣膜疾病患者心脏瓣膜置换术后,7例患者整体功能显著改善,3例患者整体功能降低。心脏瓣膜置换术前后峰值摄氧量(L/min、ml·min-1·kg~(-1))、无氧阈(L/min、ml·min-1·kg~(-1)、%pred)、峰值氧脉搏(ml/次)、峰值负荷功率(W)比较,差异均无统计学意义(P0.05);术后峰值摄氧量(%pred)、峰值氧脉搏(%pred)、摄氧效率平台(比值、%pred)、递增功率运动时间(min)较术前升高,二氧化碳通气当量斜率(slope、%pred)、二氧化碳通气当量最低值(比值、%pred)较术前降低(P0.05)。心脏瓣膜置换术后极限状态时收缩压较术前升高(P0.05);热身状态时氧脉搏较术前升高(P0.05);静息状态、热身状态、无氧阈状态时其他3个状态摄氧通气效率较术前升高(P0.05);无氧阈状态、极限状态时二氧化碳通气当量较术前降低(P0.05)。心脏瓣膜置换术后静息状态、热身状态时分钟通气量较术前降低(P0.05);静息状态、无氧阈状态时潮气量较术前降低(P0.05);极限状态时呼吸频率较术前升高(P0.05);静息状态、热身状态、无氧阈状态时呼吸交换比值、潮气末氧分压较术前降低(P0.05);4个状态时潮气末二氧化碳分压较术前升高(P0.05)。结论 CPET是一项可以安全、无创、客观、定量、可重复地评估心脏瓣膜置换术患者整体功能的临床检查方法。CPET检查结果提示,心脏瓣膜置换术治疗心脏瓣膜疾病后大多数患者循环系统、呼吸系统、循环系统和呼吸系统匹配整体功能明显改善,是心脏瓣膜疾病的有效治疗方法。
[Abstract]:Objective to evaluate the effect of cardiopulmonary exercise test (CPET) on the global function of patients with valvular disease treated by cardiac valve replacement. Methods Ten patients with heart valve disease who underwent heart valve replacement in Weihai City Hospital from 2011 to 2014 were examined with CPET before and after treatment. According to the standard continuous incremental power program of UCLA Medical Center, the symptomatic limiting exercise is completed. The core indexes are calculated through the standardized analysis of the data, and the rest state and warm-up state are derived from the system software. Anaerobic threshold state, cycle index and respiratory index in limit state. Results after valve replacement in 10 patients with valvular disease, the overall function of 7 patients was significantly improved. Before and after cardiac valve replacement, the peak oxygen uptake was L / min / ml min-1 / kg ~ (-1), and the anaerobic threshold / L / min / ml min-1 / kg ~ (-1) / L ~ (-1) / L ~ (-1) / L ~ (-1) / L ~ (-1) / L ~ (-1). There was no significant difference between the two groups (P 0.05), but the peak oxygen intake was significantly higher than that before operation, and the peak oxygen pulse and oxygen uptake efficiency (P < 0.05) were higher than those before the operation, and the oxygen uptake efficiency (P < 0.05) was higher than that before the operation. The slope of carbon dioxide ventilation equivalent was slopetrol, and the lowest value of carbon dioxide ventilation equivalent was lower than that before operation (P 0.05). The systolic pressure after cardiac valve replacement was higher than that before operation (P 0.05); the pulse of oxygen in warm up state was higher than that before operation (P 0.05); the ventilation efficiency of oxygen uptake in rest state, warm up state, anaerobic threshold state was higher than that before operation (P 0.05); in anaerobic threshold state, the oxygen uptake efficiency of the other three states was higher than that before operation. The carbon dioxide ventilation equivalent at the limit state was lower than that before operation (P 0.05). In resting state after cardiac valve replacement, minute ventilation volume in warm up state was lower than that before operation (P0.05%); tidal volume in resting state and anaerobic threshold state was lower than that in preoperation; respiratory frequency in limit state was higher than that before operation (P0.05%); resting state, warm up state, The ratio of respiratory exchange at anaerobic threshold state, the partial pressure of oxygen at the end of tidal air was lower than that before operation (P 0.05), and the partial pressure of carbon dioxide at the end of tidal air at 4 states was higher than that before operation (P 0.05). Conclusion CPET is a safe, noninvasive, objective, quantitative and repeatable method for evaluating the global function of patients undergoing cardiac valve replacement. The matching function of circulatory system, respiratory system, circulatory system and respiratory system in most patients with valvular disease after heart valve replacement has been improved obviously, which is an effective method for the treatment of valvular disease.
【作者单位】：国家心血管病中心中国医学科学院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协和医学院;威海市立医院心脏中心;昆明医科大学第二附属医院心内科;宁夏医科大学总医院呼吸与危重症医学科肺功能室;
【基金】：国家高技术研究发展计划(863计划)课题(2012AA021009) 国家自然科学基金医学科学部面上项目(81470204) 中国医学科学院国家心血管病中心科研开发启动基金(2012-YJR02)
【分类号】：R654.2

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