使用面罩行心肺运动试验(CPET)可能导致误诊的临床观察研究

The preliminary report of investigation:Using mask for cardiopulmonary exercise testing in Chinese children may result misinterpretation and misdiagnosis

目的:观察面罩增加解剖死腔,归纳总结CPET新9图结果中运动诱导的波浪式呼吸(EIOB)产生的规律,并分析出其发生率及易产生波浪式呼吸的年龄段。方法:本研究全部CPET实验数据结果来自2014年至今在聊城市儿童医院门诊完成CPET的3至14岁的501例儿童。通过严格质控,根据Harbor-UCLA标准操作流程在经过特殊座位处理的儿童精准功率计上完成症状限制极限运动的CPET,通过CPET数据的标准化计算分析判读,对不同年龄儿童的气体交换特征性表现的EIOB发生频率进行分析,同时分析高强度运动时漏气导致摄氧量和氧脉搏递增变缓的可能。结果:3~6岁组EIOB的发生率最高,为42%;7~10岁组EIOB的发生率为29.4%,11~14岁组EIOB的发生率为29.9%。三组经卡方检验(χ^(2)=7.512),差别具有统计学意义(P<0.05)。508例患儿中有14例在CPET过程中出现漏气情况,发生率为2.7%。结论:儿童出现波浪式呼吸(OB)现象可能因为面罩增加了解剖死腔,并非疾病所致。为提高CPET质控和减少临床误诊建议尽可能使用较少增加死腔的咬口器。

Objective:Observe the increased anatomical dead space of the mask,summarize the law of exercise induced oscillatory breathing(EIOB)in the results of CPET’s new 9 figure,and analyze its incidence and age groups that are prone to oscillatory breathing.Methods:After signed the informed consent form by guardian,501 children from pre-school to middle-school,aged 3~14 year,performed Harbor-UCLA standard protocol CPET with strict quality control in the CPET laboratory of Liaocheng Children’s Hospital since 2014.CPET data was interpreted second by second from the breath by breath collection,averaged by 10 s and then display by 9 plots.We analyzed the trends,pattern,incidence and age difference for EIOB and gas leakage.Results:The incidence of EIOB was the highest in the 3 to 6-year-old group,which was 42%.The 7 to 10-year-old group was 29.4%and the 11-to 14-year-old group was 29.9%.The three groups were tested by chi-square(χ^(2)=7.512),and the difference was statistically significant(P<0.05).14 out of 508 children had air leakage during CPET,the incidence rate was 2.7%.Conclusion:The phenomenon of oscillatory breathing(OB)in children may be caused by the increased anatomical dead space of the mask,and it is not caused by disease.To improve the quality of CPET and to reduce clinical misdiagnosis,it is recommended to use a mouthpiece to decrease the dead space rather than the musk.