長期血液透析尿毒症患者之運動心肺功能研究

Cardiopulmonary Function in the Long Term Hemodialysis Patients during Bicycle Exercise

楊百嘉(Baii-Jia Yang) ； 陳漢湘(Han-Shiang Chen) ； 賴金鑫(Jin-Shin Lai) ； 黃佩蘭(Pui-Lan Wong) ； 蔡敦仁(Tun-Jun Tsai)

《中華民國復健醫學會雜誌》 15期 (1987/12) Pp. 59-64

摘要

長期血液透析之尿毒症患者，雖然病情穩定，仍有貧血、動脈硬化及心肺功能降低等問題。本文就19位男性，及11位女性尿毒症患者在血液透析後18至36小時，給予漸增性踏車運動測驗，直接測量其最大運動心肺功能，並與43位男性及9位女性正常年輕人作比較。其結果顯示尿毒症患者不論男女，其最大攝氧量或單位體重最大攝氧量皆明顯小於正常人。男性患者之單位體重最大攝氧量平均值為21.4ml/kg/min，僅及正常男性平均值之42.6%，而女性患者之平值為16.6ml/kg/min為正常女性平均值之55.5％，此種現象和最高心跳率及最大氧脈皆降低有關，而最大呼吸交換系數（R）與正常人相似，顯示這些患者已盡力運動到非常喘的程度。最高心跳率的降低可能與年齡及自主神經病變有關。至於最大氧脈及最高血液乳酸濃度仍顯著低於正常人，可能和貧血，肌肉量，肌肉內細胞酵素，心臟收縮功能不佳因素有關。因此如何改進尿毒症症患者之心肺功能值得更深入研究。

並列摘要

Long term hemodialysis of uremic patients can keep on their living, but they still have many problems like severe anemia, atherosclerosis, and decreasing physical fitness, etc.
In this report, a symptomatic maximum bicycle execise test was given to 19 male and 11 female unremic patients who were in stable condition. This test was administered some 18-36 hours after hemodialysis. The patients experienced a progressive increase of resistance on the bicycle until the patient couldn't tolerate it. During exercise, oxygen uptake (VO2), pulmonary ventilation (VE), respiratory exchange ratio (R) and heart rate (HR) were measured breath-by-breath with a MGC-2000 system and lactate level was detemined by the enzymatic method in the venous blood sampled 5 minutes after maximal exercise. The results were compared with the data of 43 male and 19 female healthy adults who had similar physical characteristics.
The mean values (±S.D.) of maximum O2 consumption per Kg body weight in male & female uremic patients were 21.4 (±5.5) and 16.0(±2.8) ml/kg/min, which were significantly lower than those respective values in normal males and females (48.3±7.9 & 29.9±4.3ml/kg/min). This was due to the decrease in the maximum heart rate and maximum O2 pulse.
The cause of decreased maximal heart rate in uremic patients may be due to the dysfunction of the sympathetic nerous system. Also the abnormal lower O2 pulse may be due to anemia & the decreases in myocardial contractility & oxygen extaction in skeletal muscle.
In each case the uremic patients achieved a near normal respiratory exchange ratio which indicated that they had worded up to their maximum physical capacity. But they still had a marked decrease in physical fitness. So, how to improve the physical fitness of uremic patient is worthy of further study.

並列關鍵字

hemodialysis ； bicycle exercise ； maximum O2 consumption