心肺运动试验在老年急性冠状动脉综合征患者心脏康复的应用

The application of cardiopulmonary exercise testing in treatment of elderly patients with acute coronary syndrome

目的回顾性分析老年（≥65岁）冠心病患者心肺运动试验（CPET）的相关数据,探讨老年急性冠状动脉综合征（ACS）患者CPET的临床特点。方法选取2015年4月-2016年4月在沈阳军区总医院心内科住院诊断冠心病并进行CPET测试的老年（≥65岁）患者共356例,均使用Schiller CS-200心肺运动试验系统进行测试,在静息状态下测定人体的肺功能、心电图,继之连续动态监测记录进出气流、O2浓度、CO2浓度、全导联心电图、血压和血氧饱和度的实时变化。结果 ACS组与稳定型冠心病（SCHD）组比较,在年龄、性别比例、体质量指数（BMI）及吸烟、高血压、糖尿病、高脂血症等方面差异无统计学意义,但陈旧心肌梗死发生率ACS组高于SCHD组（31.8%vs 6.4%,P〈0.05）,ACS组左室射血分数（LVEF）值低于SCHD组[（52.6±4.3）vs（56.9±5.1）,P〈0.05]。ACS组危险分层中高危患者比例、运动终止Borg评分高于SCHD组[43.5%vs 5.9%,（16.0±1.4）vs（15.5±1.3）,P〈0.001],而运动持续时间[（7.32±0.68）min vs（9.09±0.93）min,P〈0.001]低于SCHD组。不论ACS组还是SCHD组,无氧阈（AT）负荷及峰值负荷均明显降低,ACS组AT摄氧量、AT公斤摄氧量、AT负荷（Mets）、呼吸频率、呼吸储备、FVC%和FEV1%均低于SCHD组（P〈0.001）。结论老年ACS患者因心功能较差、高危患者比例较高,导致在CPET中运动持续时间缩短、运动耐量明显下降,呼吸储备和呼吸功能也明显下降,需高度重视。

Objective To analyze the cardiopulmonary exercise testing（CPET） data of elderly patients（≥ 65）with coronary heart disease and to summarize the clinical characteristics of patients with acute coronary syndrome. Methods Data of 356 elderly patients with CHD verified by coronary angiography who underwent CPET between April 2015 and April 2016 were analyzed retrospectively. Among them 239 patients were ACS（67.1%） and 117 patients were stable CHD（32.9%）. All subjects were tested using Swiss Schiller cs-200 cardiopulmonary exercise testing system. Data on determination of human lung function and electrocardiogram were collected in the resting state,followed by continuous dynamic monitoring and recording of air flows,O2 concentration,CO2concentration,lead ECG,blood pressure and oxygen saturated degree changes in real time. Results Compared with SCHD group,ACS group showed no significant difference in age,sex ratio,BMI,smoking,hypertension,diabetes,hyperlipidemia or other aspects. The ACS group had higher rate of myocardial infarcton（31.8% vs 6.4%,P〈0.05）and lower rate of LVEF（52.6 ±4.3 vs 56.9 ± 5.1,P〈0.05）. ACS group had higher percentage of patients with high risk according to risk stratification,higher score of Brog at end of CPET（43.5% vs 5.9%,16.0 ± 1.4 vs 15.5 ± 1.3,P〈0.001,respectively）,and lower exercise duration than the control group（7.32 ± 0.68 min vs 9.09 ± 0.93 min,P〈0.001）. AT load and peak load were significantly lower in both the ACS group and the control group. The oxygen uptake of AT,AT kg,AT load（Mets）,respiratory rate,respiratory reserve,FVC% and FEV1% in ACS group were lower than those in control group（P〈0.001）. Conclusion Elderly ACS patients suffer from poor cardiac function and have higher probability of being high-risk patients,resulting in shortened total exercise time in CPET and significantly decreased exercise tolerance, respiratory reserve and respiratory function. This is an issue that demands urgent attention.