儿童心肺运动试验生理指标医学参考值的初步研究

Preliminary study on the medical reference value of physiological indexes for cardiopulmonary exercise testing in children

目的研究儿童心肺运动试验(CPET)生理指标及其变化规律,以期建立儿童心肺运动试验正常参考值范围。方法采用心肺运动测试系统按照标准CPET方案对450例健康儿童进行心肺运动试验,每1自然岁50例,男女各半。检测指标包括无氧阈(VO_2@AT)、峰值摄氧量(VO_2峰值)、峰值氧脉搏(峰值VO_2/HR)、二氧化碳通气当量最低值(VE/VCO_2最低值)、二氧化碳通气当量斜率(VE/VCO_2 slope)、摄氧效率斜率(OUES)、峰值负荷功率(Pmax)、峰值心率(HRmax)和最大分钟通气量(VEmax)。结果男童VO_2峰值为:4~6岁:(816.36±152.03)ml/min;7~9岁:(1 132.19±261.6)ml/min;10~12岁:(1 418.99±270.2)ml/min。女童VO2峰值为:4~6岁:(700.36±139.77)ml/min;7~9岁:(1 004.19±198.5)ml/min;10~12岁:(1 264.97±230.2)ml/min。VO_2@AT、VO_2峰值、峰值VO_2/HR、OUES、Pmax和VEmax均随年龄增长而增加(P均<0.001),而VE/VCO_2最低值及VE/VCO_2 slope随年龄增长而降低(P均<0.001)。并建立了各核心指标正常预计值公式,其中峰值VO_2/HR=-2.757+0.148×年龄(y)+0.049×身高(cm)+0.040×体重(kg)+0.892×性别("男"=1,"女"=0)。结论本研究是针对国内儿童心肺运动试验医学参考值的较大样本研究,在国内无儿童心肺运动试验医学参考值判断标准的情况下,可以参考本项研究结果。

Objective To study the physiological indexes of children receiving cardiopulmonary exercise testing(CPET)in order to establish the normal CPET reference value in Chinese children. Methods Four hundred and fifty healthy children underwent the CPET with the standard scheme using the cardiopulmonary testing system.There were fifty children per age,and the gender ratio was 1∶1.The indexes included oxygen uptake at anaerobic threshold(VO_2@AT),peak oxygen uptake(VO_2 peak),peak oxygen pulse(peak VO_2/HR),minimum of respiratory minute volume to CO2 production(VE/VCO_2minimum),slope of respiratory minute volume to CO2 production(VE/VCO_2slope),slope of oxygen uptake efficiency(OUES),peak tolerance power(Pmax),peak heart rate(HRmax)and maximal minute ventilation(VEmax). Results The VO_2 peak of boys was:4~6years old:(816.36±152.03)ml/min;7~9years old:(1 132.19±261.6)ml/min;10~12years old:(1 418.99±270.2)ml/min respectively.The VO_2 peak of girls was:4~6:(700.36±139.77)ml/min;7~9years old:(1 004.19±198.5)ml/min;10~12:(1 264.97±230.2)ml/min.VO_2@AT,VO_2 peak,Peak VO_2/HR,OUES,Pmax and VEmax all increased with age(P<0.001).VE/VCO_2 minimum and VE/VCO_2 slope decreased with age(P<0.001).The prediction equations for the above indexes were established by parameters of anthropometry.Peak VO_2/HR=-2.757+0.148×age(y)+0.049 × height(cm)+0.040× weight(kg)+0.892 × gender( ' boys' =1, 'girls' =0). Conclusions This study is to provide CPET medical reference value based on a large sample of Chinese children.The study can be used under the circumstances that there is no pediatric medical reference of CPET in China.