心肺运动终止试验血压值的标准设定探讨

The exploration of the termination standard of blood pressure value in cardiopulmonary exercise test

目的通过症状限制最大极限心肺运动试验(CPET)的动脉导管有创直接测压的相关数据分析,以期为血压多高应该终止试验提供参考依据。方法受试者共80例,来自美国Harbor-UCLA心肺运动实验室,数据收集时间为1984年1月~2013年1月。血压测量采用动脉导管有创直接测压。按照美国Harbor-UCLA中心心肺运动实验室标准的连续递增功率方案完成症状限制性极限CPET。结果在本研究中,收缩压达到210、220、240、250mm Hg及以上者即停止心肺运动试验的受试者分别有20、19、7、4例,分别占全部研究对象(75例)的26.7%、25.3%、9.3%、5.3%,排除慢性心衰及肺血管病患者后,所占比例分别为32.8%、31.1%、11.5%、6.6%。本研究中实行的最大极限心肺运动相较在达到210、220、240、250 mm Hg即停止运动,其分钟摄氧量(VO2)分别增加了[(0.51±0.38)L/min](0.30±0.20)、[(0.30±0.28)L/min](0.20±0.20)、[(0.26±0.22)L/min](0.22±0.20)、[(0.26±0.22)L/min](0.22±0.20);其呼吸交换率(RER)分别增加了(0.26±0.22)(0.20±0.14)、(0.19±0.15)(0.14±0.11)、(0.15±0.16)(0.12±0.13)、(0.15±0.16)(0.12±0.13);其心率(HR)分别增加了[(30.40±22.13)次/min](0.19±0.13)、[(19.84±18.69)次/min](0.13±0.12)、[(20.71±22.19)次/min](0.14±0.14)、[(20.71±22.19)次/min](0.14±0.14);其运动功率分别增加了[(76.45±70.16)W](0.57±0.34)、[(60.37±67.61)W](0.47±0.36)、[(40.71±31.78)W](0.45±0.37)、[(40.71±31.78)W](0.45±0.37);其分钟通气量(VE)分别增加了[(35.14±28.42)L/min](0.44±0.23)、[(24.05±23.04)L/min](0.32±0.23)、[(24.37±22.30)L/min](0.34±0.25)、[(24.37±22.30)L/min](0.34±0.25)。结论心肺运动试验应为最大极限症状限制运动,不能以特定的血压值作为终止试验的标准。

Objective Through analyzing the related data of arterial catheter directly and invasive manometry of symptom and maximum limited cardiopulmonary exercise testing(CPET), so as to provide reference for how high blood pressure should CPET be terminated. Methods A total of 80 cases from the Harbor-UCLA Cardiopulmonary Exercise Laboratory in the United States were collected. Blood pressure was measured by invasive and directly arterial catheter manometry. According to the standard of continuous power program in the US Harbor-UCLA Cardiopulmonary Exercise Laboratory, the symptom-limited incremental CPET was completed. Results In this study, CPET was terminated when systolic blood pressure reached 210, 220, 240, 250 mm Hg, which had 20, 19, 7, 4cases respectively and accounted for 26.7%, 25.3%, 9.3%, 5.3% in the all research objects(75 cases) respectively. After excluding patients with chronic heart failure and pulmonary vascular diseases, the proportion was 32.8%, 31.1%,11.5%, 6.6% respectively. The symptom and maximum limited CPET was terminated when blood pressure reached210, 220, 240, 250 mm Hg, the VO2 was increased by [(0.51±0.38) L/min](0.30±0.20), [(0.30±0.28) L/min](0.20±0.20),[(0.26±0.22) L/min](0.22±0.20), [(0.26±0.22) L/min](0.22±0.20); RER was increased by(0.26±0.22)(0.20±0.14),(0.19±0.15)(0.14±0.11),(0.15±0.16)(0.12±0.13),(0.15±0.16)(0.12±0.13);HR was increased by [(30.40±22.13) times/min](0.19±0.13), [(19.84±18.69) times/min](0.13±0.12), [(20.71±22.19) times/min](0.14±0.14), [(20.71±22.19) times/min](0.14±0.14); the power was increased by [(76.45±70.16) W](0.57±0.34), [(60.37±67.61) W](0.47±0.36), [(40.71±31.78) W](0.45±0.37), [(40.71±31.78) W](0.45±0.37); VE was increased by [(35.14±28.42) L/min](0.44±0.23),[(24.05±23.04) L/min](0.32±0.23), [(24.37±22.30) L/min](0.34±0.25), [(24.37 ±22.30) L/min](0.34±0.25). Conclusion CPET should be symptom and maximum limited exercise. Using a specific blood pressure value as a standard to terminate test is wrong.