中老年人症状限制性心电运动试验的心血管反应

Cardiovascular response to symptom limited exercise testing in the middle aged and elderly Chinese

目的：探讨症状限制性心电运动试验的心血管反应。方法：依Ｂｒｕｃｅ方案采用活动平板试验。检查者年龄平均５３９±１１３岁，男女比例为２∶１。结果：最大运动时间和最大代谢当量分别为９８９±２７８ｍｉｎ和１０７１±２９２Ｍｅｔｓ；最大心率１５９０±２０４次／ｍｉｎ；最大收缩压２２５±３２ｋＰａ；最大舒张压１１６±１８ｋＰａ。运动后血压均明显降低，以舒张压降低最为明显。可疑冠心病人和体检者的心血管反应类型相似，绝对数值有一定差异。最大运动时ＳＴ段下移最明显，可疑冠心病阳性组ＳＴ段下移大于体检阳性组，两组又都明显大于阴性组（Ｐ均＜０００１）。结论：应采用症状、体征和心电改变确定运动试验终点。运动有一定的降压作用。最大运动时ＳＴ段下移最为明显。运动后常见ＳＴＶ现象，值得进一步研究。

Objective:To report cardiovascular response to the symptom limited exercise testing in 1000 subjects .Method:Treadmill exercise test was used by Bruce protocol.Sujects were aged 53 9±11 3years and the ratio of male to female was 2∶1.Result:Maximal exercise time and MET max were 9 89±2 78min and 10 71±2 92Mets.Maximal heart rate was 159 0±20 4beat/min,maximal systolic blood pressure(BP) was 22 5±3 2kPa and maximal diastolic BP was 11 6±1 8kPa.BP was dropped significantly after exercise,especially the diastolic BP.Subjects with high risks of coronary artery disease(CAD) and apparent normal subjects had similar type of cardiovascular response,even though the absolute values were different.ST segment depression was the most significant sign at the maximal exercise.The ST depression was deeper in the subjects with high risk factors of CAD and positive exersice testing than the apparent normal subjects with positive exercise testing( P <0 001).Subjects with positive exercise testing had more significant ST depression than the subjects with the negative test( P <0 001).Conclusion:Chinese has similar heart rate and BP responses to the Westerners in symptom limited exercise.Symptoms ,signs and abnormal ECG changes could be used as indications of the end point of exersise testing.Significant decrease of BP implies effects of exercise training in patients with hypertension.ST segment depression is most significant at the maximal exercise. Author′s address\ Dept. of Rehabilitation Medicine,Nanjing Medical University,210029