上肢精准电磁功率计(臂力计)用于心肺代谢等整体功能评估的临床观察研究

Clinical observation and research on the use of precise electromagnetic power meter(arm dynamometer)for upper limbs to evaluate the holistic function of cardiopulmonary metabolism

目的:受试者分别用上肢(臂力计)和下肢精准电磁功率计(自行车)进行症状限制性极限心肺运动试验(CPET),分析探讨上肢CPET的临床价值。方法:15例受试者(正常人6例和慢病患者9例)签署知情同意书后在不同的2 d里分别完成上肢和下肢精准电磁功率计CPET,分析CPET数据、计算相关核心指标,探究上肢和下肢CPET的异同及其相关性。结果:①全体15例受试者男8女7,其中6例正常人和9例慢病患者亚组相比仅年龄((33.2±12.7)比(53.6±8.5)岁)和无诊断疾病有显著差异(P<0.05)。②全体受试者上肢CPET峰值心率((131.0±19.0)比(153.0±22.0)bpm,P<0.05)和血压均低于下肢CPET,但血压差异无统计学意义(P>0.05);上肢CPET的峰值潮气量((1.3±0.4)比(1.8±0.4)L)和分钟通气量((51.4±21.1)比(67.9±22.1)L/min)均显著低于下肢(P均<0.05),而峰值呼吸频率无显著差异;采用上肢CPET时,运动时间((6.4±0.6)比(8.5±1.2)min)要短于下肢CPET;峰值负荷功率((73.2±19.6)比(158.5±40.3)W/min)、峰值摄氧量((1.1±0.4)比(1.7±0.4)L/min)、无氧阈((0.6±0.2)比(0.9±0.2)L/min)、峰值氧脉搏((8.6±2.3)比(10.9±2.6)ml/beat)、摄氧通气效率峰值平台(34.7±4.3比39.8±5.3)均较低,而二氧化碳排出通气效率最小值(32.6±3.8比28.7±4.9)及斜率(33.9±4.3比28.3±6.2)高于下肢CPET(P均<0.05)。正常人和慢病两亚组各自的比较结果与整体比较结果无显著差异。③上肢CPET的运动时间,峰值心率,峰值呼吸频率、潮气量、分钟通气量,峰值负荷功率实测值及百分预计值,峰值摄氧量实测值、公斤体重值和百分预计值,无氧阈实测值、公斤体重值,峰值氧脉搏的实测值,摄氧通气效率峰值平台、二氧化碳排出通气效率最小值和斜率的实测值及百分预计值与下肢CPET的结果相关性较好,其余指标无显著相关性。结论:作为下肢CPET的补充,上肢CPET用于整体功能状态评估具有极高的可行性和更高的安全性,对于指导安全有效个体化精准运动整体方案的实施提供了重要补充,值得进一步深入探究。

Objective:Subjects used upper limb(arm dynamometer)and lower limb precision electromagnetic power meter(cycle ergometer)to perform symptom-restricted limit cardiopulmonary exercise testing(CPET).Then we analyzed the clinical value of arm ergometer CPET.Methods:The upper limb and lower limb precision electromagnetic power meters were used to complete the CPET in two different days for 6 normal people and 9 chronic patients.We analyzed CPET data,calculated related core indicators,and compared normal subjects and chronic patients to analyze the similarities and differences between upper and lower extremities and their correlations.Results:①Compared with 9 patients with chronic diseases,there were significant differences in age((33.2±12.7)vs(53.6±8.5)years)and diagnosis in 6 normal people.②The Peak HR((131.0±19.0)vs(153.0±22.0)bpm,P<0.05)of upper limb CPET of 15 subjects were lower than lower limb CPET,but the difference in blood pressure was not statistically significant(P>0.05).The Peak VT((1.3±0.4)vs(1.8±0.4)L)and Peak V 4 E((51.4±21.1)vs(67.9±22.1)L/min)of lower limb CPET were significantly higher than that of upper limb(all P<0.05),and there was no significant difference in Peak BF When upper limb CPET was used,EX-time((6.4±0.6)vs(8.5±1.2)min)was shorter than lower limb CPET;Peak Work Rate((73.2±19.6)vs(158.5±40.3)W/min),Peak V 4 O_(2)((1.1±0.4)vs(1.7±0.4)L/min),AT((0.6±0.2)vs(0.9±0.2)L/min),Peak V 4 O_(2)/HR((8.6±2.3)vs(10.9±2.6)ml/beat),OUEP(34.7±4.3 vs 39.8±5.3)were lower,and the Lowest V 4 E/V 4 CO_(2)(32.6±3.8 vs 28.7±4.9),V 4 E/V 4 CO_(2) Slope(33.9±4.3 vs 28.3±6.2)were higher than those of lower limb CPET(all P<0.05).The comparison results of the two subgroups of normal and chronic patients were the same as the holistic comparison results.③EX-time,Peak HR,Peak BF,Peak VT and Peak V 4 E of upper limb CPET had good correlation with the results of lower limb CPET.Besides,the measured value and percentage of the projected value of Peak Work Rate,the measured value,kilogram weight value of Peak V 4 O_(2) and AT,and percentage of the projected value of Peak V 4 O_(2),the measured value of Peak V 4 O_(2)/HR also had good correlation.The measured value of OUEP,the measured value and percentage of the projected value of Lowest V 4 E/V 4 CO_(2) and V 4 E/V 4 CO_(2) Slope were also the same,when the other indicators had no significant correlation.Conclusion:As a supplement to lower limb CPET,upper limb CPET is highly feasible and safe for holistic functional status assessment.It provides an important supplement to guide the implementation of the holistic plan of individualized precision exercise,which is worthy of our further exploration.