运动对Ⅱ型糖尿病患者血液动力学的影响

Abnormal hemodynamic response to exercise in patients with Ⅱtype diabetes mellitus

目的Ⅱ了解Ⅱ型糖尿病患者运动的血流动力学变化特点。方法 Ⅱ型糖尿病患者进行运动平板试验，记录其运动时的心率、血压变化，计算心率变时性反应指数、最大心率收缩压双乘积并与非糖尿病患者的对照组比较。结果 ６９例Ⅱ型糖尿病患者运动心率上升的绝对值低于对照组（６０±１６和 ６７±１５，Ｐ＜０．０１）．心率变时性反应指数也较对照组低（０．７４±０ ．１６和０．９０±０．１７；Ｐ＜０．００１）．峰值收缩压与对照组相似，但收缩压上升不足 ３０ｍｍＨｇ的患者多于对照组（２３和 ８，Ｐ＜０．０１），主要为合并陈旧性心梗的患者．最大心率收缩压双乘积小于对照组（２４５±５１．２１和２６４±４１．３３，Ｐ＜０．０５６）．结论Ⅱ型糖尿病患者运动时较普遍存在心率变时性功能不全，运动收缩压上升不足则见于合并陈旧性心肌梗死患者，同时存在冠状动脉血流储备下降。运动平板试验有助于发现糖尿病患者运动血液动力学的异常改变。

Objective To describe the characters of the dynamic response to exercise in patients with type diabetes mellitus(2-DM). Methods Patients with 2-DM and controls referred to perform treadmill exercise test. Heart rate and systolic blood pressure response were recorded and analyzed. Chronotropic response index and maximum double product (RPP) were calculated and compared. Results 69 patients with 2-DM had lower chronotropic response index than controls(0. 74 ± 0. l6 vs 0. 90 ± 0. l7, P < 0. 0001 ), which was considered to have chronotropic incompetence. The maximum systolic blood pressures were similar in two groups, but blunted response existed in 2-DM patients accompanied with old myocardial infarction (MI). RPP was lower than controls' (245±5l. 21 vs 264 ± 4l. 33, P- 0.0l6 ). Conclusions Patients with 2-DM tend to have chronotropic incompetence and blunted pressure response to exercise, especially when accompanied with MI. RPP is lower in 2-DM patients, which represents the reduced coronary flow reserve. Exercise test is helpful to find out the abnormal response.