心力衰竭患者心率变时功能的心肺联合运动试验评价

Evaluation of heart rate chronotropic function in patients with heart failure by cardiopulmonary exercise test

目的通过心肺运动试验(CPET)评价健康人和心力衰竭患者运动心率变时功能变化。方法75例健康人和199例心力衰竭患者,进行CPET。运动前、运动高峰和运动后分别测定心率、血压、运动时间、峰氧耗量(V O2)和无氧代谢阈(A T),每分钟通气量/二氧化碳产生量斜率(V E/VCO2斜率)。结果与健康组比较,心力衰竭组运动峰氧耗量(V O2)和无氧代谢阈(A T)明显下降。心力衰竭组运动峰心率与峰VO2呈正相关(r=0.47),年龄与静态心率到运动高峰实际心率变化幅度呈正相关(r=0.59)。与健康人组比较,心力衰竭患者心率变时性完全组和心率变时性不全组峰VO2和AT明显下降(P<0.01),VE/VCO2斜率明显上升。心率变时性不全组通气效能(V E/VCO2斜率)较心率变时性完全组明显下降。结论在心力衰竭患者中25%患者有心率变时性不全,这是其心肺储备力下降的主要原因。心肺运动试验有助于评价运动时心肺储备功能和窦房结变时功能。

Objective Cardiopulmonary exercise test(CPET)was used to evaluate the functional changes of exercise heart rate in healthy people and patients with heart failure.Methods 199 cases of heart failure patients and 75 cases of healthy people as the controls were tested with CPET.Heart rate,blood pressure,exercise time,peak oxygen consumption(VO2)and anaerobic metabolism valve(AT),ventilation/carbon dioxide production slope per minute(VE/VCO2 slope)were measured before,during and after the exercise respec tively.Results Compared with the healthy group,the peak oxygen consumption(VO2)and anaerobic metabolic valve(AT)in heart failure group decreased significantly.In the heart failure group,peak exercise heart rate was positively correlated with peak VO2(r=0.47),and age was positively correlated with the change range from static heart rate to peak exercise heart rate(r=0.59).Compared with the healthy group,the VO2 and AT of the complete group and the incomplete group decreased significantly when the heart rate changed(P<0.01),and the slope of VE/VCO2 increased significantly when the heart rate changed.Ventilatory efficiency(VE/VCO2 slope)of incomplete group decreased significantly when heart rate changed compared with complete group when heart rate changed.Conclusion 25%patients in the heart failure group have heart rate insufficiency,which is the main reason for the decrease of cardiopul monary reserve.Cardiopulmonary exercise test is helpful to evaluate cardiopulmonary reserve function and sinoatrial node chronotropic function during exercise.