冠状动脉旁路移植术后的心脏运动负荷试验

Cardiac load exercise test after coronary artery bypass graft

目的 分析评估冠状动脉旁路移植术 (CABG)后心脏运动负荷试验的临床意义。方法 以Bruce方案对 2 9例CABG患者进行了活动平板运动负荷试验 (ETT) ,同时随机取同时期非CABG且ETT阴性 2 5例健康者做对比研究。结果 CABG组平均运动耐量虽低于非CABG组但无统计学差异 (90 9%± 7 3%vs 97 0 %± 14 0 % ,P >0 0 5 ) ,运动耐量 >95 %者 ,在CABG组占 37 9% ,非CABG组占 84 0 %(P <0 0 0 1) ;最大做功当量≥ 8METS者两组有显著差异(31 0 %vs 4 4 .0 % ,P <0 0 0 1) ,在CABG组 ,最大做功当量≥8METS ,其中心肌缺血亚组与无心肌缺血亚组间无显著差异(35 3%vs 33 3% ,P >0 0 5 ) ;最大做功当量≥ 8METS或运动耐量 >95 %合计 ,在CABG组占 5 5 2 % ,非CABG组占10 0 0 % (P <0 0 0 1)。结论 CABG术后 2年患者仍能保持较好的运动耐量 ,ETT时 ,心肌缺血对最大做功当量不是一个影响因素 ;以最大做功当量≥ 8METS结合运动耐量 >95 %作指标也许能更全面地评估术后心功能状态 。

Objective To analyse and evaluate the clinical significance of exercise treadmill test (ETT) after coronary artery bypass graft (CABG). Methods 29 patients had CABG were undergone ETT by Bruce protocol and 25 subjects had no CABG as control group.Results Average exercise tolerance (ET) in CABG group was lower than non CABG group but, no statistic difference (90 09%±7 3% vs 97 0%±14 0%, P>0 05 ),exercise tolerance >95% in CABG group was 37.9%. Non CABG group was 84 0%( P <0 001), METS max ≥8 was difference between two groups (31 0% vs 44.0%, P<0.001 ). In CABG group, its myocardial ischemia subgroup and non myocardial ischemia subgroup were no difference (35.3% vs 33.3%, P>0.05 ). Total METS max≥8 or ET>95% was 55 2% in CABG group and 100.0% in non CABG group ( P<0.001 ). Conclusion Myocardial ischemia is not a influence factor for METS max. It may be more effective to evaluate cardiac function considering METS≥8 or ET>95% together, and it may be as an indication for deciding to perform angiography again after CABG.