Max试验验证症状限制心肺运动试验为最大极限运动进一步临床研究

Max test verify further clinical research for whether individualized symptom-limited cardiopulmonary exercise testing is the maximum extreme exercise

目的:验证临床受试者所完成的心肺运动试验(CPET)为最大极限运动,进一步设计完善Max试验验证CPET结果客观定量功能评估的准确性及以某特定指标的特定数值作为停止运动的标准是否可行。方法:选择2017年9月至2019年1月在阜外医院签署知情同意书后进行CPET和Max试验受试者216例。其中正常受试者41例,因CPET峰值呼吸交换率(RER)≤1.10,或运动中心率和血压不上升,对CPET极限运动结果存在质疑的临床患者175例进行研究。其中60例已初步报告,本研究进一步扩大研究。Max试验方法:完成CPET测试后,先蹬车≥60r/min,再施加130%峰值功率的恒定功率,鼓励受试者运动至不能坚持的极限状态。计算分析Max试验30 s的最大心率和最大摄氧量、及其与峰值心率和峰值摄氧量之间的差值和百分差值。百分差值=(Max值-峰值值)/Max值×100%。评测标准:(1)若心率和摄氧量任一指标的差值百分比≤-10%(Max测试的数值低于CPET峰值数据)则定义Max试验操作失败,否则为成功;(2)若心率和摄氧量的差值百分比均在-10%~10%,则Max试验操作成功,证明CPET数据为极限运动,CPET峰值相关数据较为准确;(3)若心率和摄氧量差值任一指标差值百分比≥10%时,则Max试验操作成功,证明CPET结果为非极限运动。结果:病例组峰值摄氧量(L/min、ml/(min·kg)、%pred)、无氧阈(L/min、ml/(min·kg)、%pred)、峰值氧脉搏(ml/beat、%pred)、峰值RER、峰值收缩压(mm Hg)、峰值运动负荷(W/min)、峰值心率(bpm)、摄氧有效性峰值平台(OUEP)(比值、%pred)低于正常组,二氧化碳通气有效性平均90 s最低值(Lowest V_(E)/VCO_(2))(比值、%pred)、二氧化碳通气效率斜率(V_(E)/VCO_(2) Slope)(比值、%pred)高于正常组(P<0.05)。所有正常组与病例组均安全无任何事件完成CPET和Max试验。216例受试者中,Max试验成功198例(91.7%),其中证明CPET为极限运动182例,为非极限运动16例;失败18例(8.3%)。结论:在临床检查中,若对CPET结果是否为最大极限存在质疑,利用Max试验可验证CPET是否为极限运动。Max试验方法安全可行,值得进一步深入研究和临床推广应用。

Objective:To verify that the cardiopulmonary exercise testing(CPET)performed by clinical subjects is the maximum extreme exercise,we designed The Max test(Max)during clinical CPET.We used Max to verify the accuracy of the quantitative CPET evaluation result,and whether it is feasible and safe to use the specific value of a certain index as the standard for stopping CPET.Methods:Two hundred and sixteen cases from Fuwai Hospital were selected during June 2017 to January 2019,including 41 healthy person(control group)and 175 with cardiovascular diseases(patient group),The patients had a CPET peak RER≤1.10,or the peak heart rate and peak blood pressure were basically non-responsive.The Max was first attempted in 60 subjects,and this study is further expanded.When the CPET ended,they had a 5-minute break,then the Max,during which,they cycled with a velocity of≥60 r/min,at a constant intensity equivalent to to 130%of peak work,until exhausted.The difference and percentage difference between the peak heart rate and the peak oxygen uptake were calculated.(1)If the percentage difference of heart rate and oxygen uptake are all less than-10%,then the Max is defined as failure,otherwise it is succesful.(2)If the percentage difference is between-10%~10%,then the Max is successful,which proved that the CPET is precise.(3)If the difference is≥10%,the Max is successful,which proves that the CPET is non-extreme exercise.Results:Patient group’s Peak VO_(2)(L/min,ml/(min·kg)),anaerobic threshold(L/min,ml/(min·kg),%pred),Peak V4 O_(2)/HR(ml/beat,%pred),Peak RER,Peak SBP,Peak WR,peak heart rate,OUEP(ratio,%pred)were lower than those of the control group(P<0.05).The V_(E)/VCO_(2) Slope(ratio,%pred)and Lowest V_(E)/VCO_(2)(ratio,%pred)were higher in the patient group than in the control group(P<0.05).No adverse events occurred during the CPET and Max in all cases.Among the 216 cases,Max was successful in 198 cases(91.7%).CPET was proved to be maximum extreme exercise for 182 cases,non-maximum extreme exercise for 16 cases,and failed in 18 cases(8.3%).Conclusion:For CPET with a low peak RER and a maximum challenge,the Max can confirm the accuracy of the objective quantitative assessment of CPET.Max is safe and feasible,and that deserved further research and clinical application.