先天性心臟病童之攝氧效率斜率

The oxygen uptake efficiency slope in children with congenital heart disease

王思涵(Sih-Han Wang)

指導教授 ： 朱奕華

高雄醫學大學/醫學院/運動醫學系碩士在職專班/碩士(2016年)

摘要

研究背景:最大攝氧量常用來評估心肺適能，而先天性心臟病童的心肺適能普遍偏差，常因動機不足或體能較差，無法在心肺運動測試中達到最大攝氧量，因此近年來有許多次大運動參數(submaximal parameter)的出現，如:無氧閾值，換氣量/二氧化碳產生量的關係等，但兩者皆會受到受試者的努力程度及運動測試程序的不同而有所影響。攝氧效率斜率(oxygen uptake efficiency slope, OUES)為目前廣泛使用之次大運動參數，因其不受運動強度及受試者的動機或施測者的經驗所影響，攝氧效率斜率為一個客觀且能夠評估受試者心肺適能的新參數，此參數近年來常用於評估心衰竭患者、健康人及肥胖者的心肺適能等，但目前應用於先天性心臟疾病病童的相關研究鮮少。
目的:本研究目的為探討先天性心臟病童的攝氧效率斜率是否能夠評估心肺適能，並觀察不同攝氧效率斜率百分比與最大攝氧量之相關性，
方法：此研究為回顧性探索研究，蒐集自2006年到2014年診斷為先天性心臟病並在過去已有手術矯正的病童。實驗收集9名法洛氏四重症病童及25名心室中膈缺損病童，選用之運動測試方法為Modified Ramp Bruce protocol，分析運動測試資料並計算出OUES100、OUES90、OUES80、OUES70、OUES60、OUES50、OUESAT，並分析其與最大攝氧量的相關性。
結果:研究結果顯示先天性心臟病童之最大攝氧量(VO2peak)與攝氧效率斜率(OUES)各百分比皆有顯著相關性；而心室中膈缺損病童之最大攝氧量(VO2peak)與攝氧效率斜率(OUES)各百分比也皆有顯著相關性；然而法洛氏四重症病童之最大攝氧量(VO2peak)與攝氧效率斜率(OUES)各百分比則皆無相關性。
結論：本研究結果顯示，對於心室中膈缺損的病童，可以用攝氧效率斜率評估其心肺適能，然而法洛氏四重症之病童的心肺適能可能無法利用攝氧效率斜率來評估。

關鍵字

先天性心臟病 ； 攝氧效率斜率 ； 最大攝氧量 ； 次大運動參數

並列摘要

Background: Maximal oxygen consumption is commonly used to evaluate cardiorespiratory fitness. However, children with congenital heart disease often cannot reach the maximum oxygen uptake during the graded exercise testing. This may be due to poor cardiorespiratory fitness and lack of motivation. Therefore, in recent years several submaximal parameters, such as anaerobic threshold, ventilation / carbon dioxide generation relations, are used to evaluate cardiorespiratory fitness. Yet, both parameters can be affected by subjects’ efforts and different testing procedures. The oxygen uptake efficiency slope (OUES) is a promising submaximal index of exercise capacity. OUES is not affected by subjects’ efforts, exercise intensity, and testing protocols, thus can be an objective measure for cardiorespiratory fitness. This parameter has been used in heart failure patients, healthy adults, and individuals with obesity. Very few studies have used OUES to assess cardiorespiratory fitness in children with congenital heart disease.
Objective: This study aimed to investigate whether the OUES can be used to assess cardiorespiratory fitness in children with congenital heart disease.
Methods: This is a retrospective research in which data from 2006 to 2014 were gathered and analyzed. All participants in this study were children with a diagnosis of congenital heart disease and have undergone surgeries. This study collected 9 children with Tetralogy of Fallot and 25 children with ventricular septal defect. The exercise testing protocol used was Modified Ramp Bruce protocol. Peak oxygen uptake (VO2peak) was measured and OUES100, OUES90, OUES80, OUES70 , OUES60, OUES50, OUESAT were calculated. Pearson correlation analysis was used to examine the associations between VO2peak and each percentage of OUES.
Results: Overall, OUES100, OUES90, OUES80, OUES70, OUESAT, OUES60 and OUES50 were all significantly correlated with VO2peak. In children with ventricular septal defect, all OUESs were also significantly correlated with VO2peak. However, in children with Tetralogy of Fallot, none of the OUES was correlated with VO2peak.
Conclusion: The results of this study suggested that OUES may provide a valid evaluation of cardiorespiratory fitness in children with ventricular septal defect, but may not be used to assess cardiorespiratory fitness in children with Tetralogy of Fallot.

並列關鍵字

congenital heart disease ； oxygen uptake efficiency slope ； VO2peak ； submaximal parameter

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