心脏外科术后患者早期运动能力的观察

Observation on early exercise capacity of patients after cardiac surgery

目的通过心肺运动试验观察心脏外科术后患者早期的运动能力特点。方法纳入安贞医院行心脏外科术后早期心肺运动试验的患者,接受心脏外科手术后3个月内行心肺运动试验的患者40例,以手术日至心肺运动试验检查日的天数将患者分为出院组(术后30天内,20例)、术后1月组(术后30~60天,10例)和术后2月组(术后60~90天,10例),探讨不同时段心脏外科术后患者的运动能力特点;另将20例出院组按手术类型又分为大血管组(9例)、搭桥组(6例)和瓣膜组(5例),并进一步观察不同手术类型患者出院时(术后30天内)的运动能力,即观察不同时段和不同手术类型的所有患者从静息开始运动到无氧阈强度时的心率变化、收缩压变化,以及心肺运动试验指标(无氧阈、峰值摄氧量及二氧化碳通气当量)。结果所有患者均完成无氧阈值以上的心肺运动试验,未发生运动意外等不良事件。(1)不同时段患者的运动能力:出院组达到无氧阈时的心率上升(8.8±7.1)次/分,显著低于术后1月组[(17.0±5.9)次/分]和术后2月组[(18.3±10.5)次/分],且差异有统计学意义(P<0.05);出院组的无氧阈和峰值摄氧量分别为(8.0±1.5)和(11.0±2.9)m L/(kg·min),显著低于术后1月组[(11.2±3.1)和(15.6±4.2)m L/(kg·min)]和术后2月组[(11.9±2.6)和(15.7±2.8)m L/(kg·min)],差异均有统计学意义(P<0.05),而术后1月组与术后2月组的无氧阈和峰值摄氧量组间比较,差异均无统计学意义(P>0.05);各组患者收缩压变化值及二氧化碳通气当量的组间差异均无统计学意义(P>0.05);(2)术后30天内不同手术类型患者的运动能力:大血管组和搭桥组术后患者的无氧阈[(7.2±1.3)和(7.8±0.7)m L/(kg·min)]及峰值摄氧量[(10.4±2.9)和(9.4±1.3)m L/(kg·min)],分别明显低于瓣膜组[(9.6±1.5)m L/(kg·min)及(14.2±2.3)m L/(kg·min)],且差异有统计学意义(P<0.05)。结论心脏外科术后患者的运动能力在术后30~60天显著提高,而大血管术和搭桥术患者术后30天内的运动能力明显低于瓣膜术后患者。

Objective To observe the early exercise capacity and characteristics of patients after cardiac surgery by cardiopulmonary exercise test.Methods In this retrospective study,the patients who underwent early cardiopulmonary exercise tests after cardiac surgery at Anzhen Hospital from June 2016 to February 2019 were included.Cardiopulmonary exercise test indexes(anaerobic threshold,peak oxygen uptake and carbon dioxide ventilation equivalent)were collected.To explore the exercise capacity in different periods,patients were divided into discharge group,1 month group,and 2 months group.In addition,to explore the exercise capacity of discharge group in different surgical types,the discharge group were divided into aortic surgery,bypass surgery and valve surgery.Results All patients completed the cardiopulmonary exercise test above the anaerobic threshold,and no adverse events such as exercise accidents occurred.①The difference in heart rate when discharge group reached the anaerobic threshold[(8.8±7.1)bpm]was statistically different from that of the other two groups[(17.0±5.9)bpm]、[(18.3±10.5)bpm](P<0.05);The anaerobic thresholds in 1 month group and 2 months group[(11.2±3.1)ml/(kg·min)]、[(11.9±2.6)ml/(kg·min)]were significantly higher than those in discharge group[(8.0±1.5)ml/(kg·min)];the results of peak oxygen uptake are consistent with the anaerobic threshold;the difference in the slope of the equivalent carbon dioxide ventilation of each group showed no statistically significant.②In discharge group,patients with aortic surgery[(7.2±1.3)ml/(kg·min)]and bypass surgery[(7.2±1.3)ml/(kg·min)]had lower postoperative anaerobic threshold than valve surgery[(9.6±1.5)ml/(kg·min)](P<0.05).Conclusions The early stage of cardiac surgery patients'exercise ability recovered significantly within 30 to 60 days after surgery;within 30 days after surgery,patients with aortic surgery and bypass surgery had lower exercise capacity than valve surgery.