递增心肺运动试验的风险与防控

Risk of progressive exercise testing and management

目的探讨递增心肺运动试验中的危险信号及应采取的应对措施。方法198例受试者进行心肺运动至症状自限，同步实时测定摄氧量、二氧化碳排出量，监测血氧饱和度、心电图和血压，慢性阻塞性肺疾病（COPD）患者于运动前后测定血气分析。结果155例受试者运动至最大耐受量，43例因出现危险信号而终止运动。危险信号包括：血氧饱和度低于88％（14例）；收缩压升高或降低（3例）；心律失常（16例）；缺血性STT改变（10例）。COPD患者运动高峰时Paq轻度降低，从（91．58±9．46）mmHg降至（88．92±13．66）mmHg，但差异无统计学意义，运动时的PaCO2较静态时轻度增高，分别为（43．05±3．16）mmHg和（40．64±4．26）mmHg，差异有统计学意义（P=0．003）。结论只要我们在运动试验中进行监测，出现危险信号时及时终止运动，运动试验对于多数患者还是一个安全的检查。

Objective To investigate risk signals appeared in subjects performing progressive maximal exercise testing and measures to be taken. Methods Progressive symptom limited exercise testing was performed in 198 patients. Oxygen uptake（VO2） and carbon dioxide output（VCO2） were measured breath-by-breath. Arterial oxygen saturation, ECG and blood pressure were monitored during the testing. Arterial blood samples were drawn both at rest and maximal exercise in patients with chronic obstructive pulmonary disease （COPD）. Results 155 subjects reached their maximal exercise, 43 were terminated exercising because of risk signals which included desaturation （14 cases）, higher or lower systolic blood pressure（3 cases）, arrhythmia（ 16 cases）, and isehaemic ST segment changes（ 10 cases）. In patients with COPD,there was a little decrease in PaO2 from （91.58±9.46） mm Hg at rest to （88.92± 13.66） mm Hg at exercise,but the PaCO2 increased significantly from （40.64±4.26） mm Hg at rest to （43.05±3.16） mm Hg at peak exercise. Conclusions Exercise testing is safe for most patients only if we monitor throughout the test, terminate the test when abnormal signs appear.