慢性心臟衰竭患者在漸增式運動測試中之心肺反應

Cardiopulmonary Response to Incremental Exercise Testing in chronic heart Failure Patients

黃文亞(Wen-Yat Huang) ； 陳明豐(Ming-Fong Chen) ； 賴金鑫(Jin-Shin Lai) ； 吳惠東(Huey-Dong Wu) ； 吳英黛(Ying-Tai Wu)

《台灣醫學》 8卷5期 (2004/09) Pp. 639-647

https://doi.org/10.6320/FJM.2004.8(5).04

摘要

Patients with chronic heart failure (CHF) often suffer from dyspnea and fatigue, thus limit their exercise capacity. The purpose of the study was to compare the differences in voluntary exhaustion exercise capacity, 02 consumption (V02) on-kinetics in early stage of exercise, expiratory flow limitation, and ventilatory response (VE/VC02) at voluntary exhaustion exercise between CHF patients and normal subjects, and to investigate the correlation between maximal exercise capacity and these variables of interest. Eighteen patients with CHF (14 men and 4 women, age averaged 63±13 yrs), and 16 normal subjects (11 men and 5 women with average age of 58±8 yrs) served as subjects of the study. The patients had an average of LVEF of 34.9±3.4% and in NYHA class II to III. All subjects received a voluntary exhaustion cardiopulmonary exercise test, body composition test, questionnaires of physical activity and diet-calories intake, and expiratory flow limitation test by negative expiratory pressure immediately after the exercise test. Breath-by-breath gas data of the fist three minutes of the exercise test were analysed to study the V02 time constant in early stage of exercise. Mann-Whitney U test was used to make group comparisons and Spearman correlation test to investigate the relationship between exercise capacity and those related variables in CHF group. Significantly lower values in maximal V02, heart rate, and oxygen pulse but higher V02 time constant were found in CHF patients (p＜0.05). As to pulmonary function at maximal exercise, the tidal volume, ratio of tidal volume and inspiratory time were lower, while the end-tidal CO2 partial pressure and VE/VCO2 were higher in patient group (p＜0.05). No difference in expiratory flow limitation between groups was found. In addition, a moderate negative correction was found between peak V02 and VE/VCO2 (r=-0.60, p=0.009), as well as with VU2 time constant (r=-0.51, p=0.042) in CHF group. CHF patients have lower values in exercise capacity that may be related to higher VE/VCO2 and V02 time constant.

關鍵字

最大攝氧量 ； 吐氣氣流限制 ； 換氣反應 ； 動態攝氣量

並列摘要

Patients with chronic heart failure (CHF) often suffer from dyspnea and fatigue, thus limit their exercise capacity. The purpose of the study was to compare the differences in voluntary exhaustion exercise capacity, 02 consumption (V02) on-kinetics in early stage of exercise, expiratory flow limitation, and ventilatory response (VE/VC02) at voluntary exhaustion exercise between CHF patients and normal subjects, and to investigate the correlation between maximal exercise capacity and these variables of interest. Eighteen patients with CHF (14 men and 4 women, age averaged 63±13 yrs), and 16 normal subjects (11 men and 5 women with average age of 58±8 yrs) served as subjects of the study. The patients had an average of LVEF of 34.9±3.4% and in NYHA class II to III. All subjects received a voluntary exhaustion cardiopulmonary exercise test, body composition test, questionnaires of physical activity and diet-calories intake, and expiratory flow limitation test by negative expiratory pressure immediately after the exercise test. Breath-by-breath gas data of the fist three minutes of the exercise test were analysed to study the V02 time constant in early stage of exercise. Mann-Whitney U test was used to make group comparisons and Spearman correlation test to investigate the relationship between exercise capacity and those related variables in CHF group. Significantly lower values in maximal V02, heart rate, and oxygen pulse but higher V02 time constant were found in CHF patients (p＜0.05). As to pulmonary function at maximal exercise, the tidal volume, ratio of tidal volume and inspiratory time were lower, while the end-tidal CO2 partial pressure and VE/VCO2 were higher in patient group (p＜0.05). No difference in expiratory flow limitation between groups was found. In addition, a moderate negative correction was found between peak V02 and VE/VCO2 (r=-0.60, p=0.009), as well as with VU2 time constant (r=-0.51, p=0.042) in CHF group. CHF patients have lower values in exercise capacity that may be related to higher VE/VCO2 and V02 time constant.

並列關鍵字

maximal oxygen conumption ； expiratory flow limitation ； ventilatory response ； oxygn consumption on-kinetics