心肺运动试验期间周期性呼吸对摄氧量和呼吸交换率测量的影响。

Impact of periodic breathing on measurement of oxygen uptake and respiratory exchange ratio during cardiopulmonary exercise testing.

作者信息

Francis Darrel P, Davies L Ceri, Willson Keith, Wensel Roland, Ponikowski Piotr, Coats Andrew J S, Piepoli Massimo

机构信息

National Heart & Lung Institute, London SW3 6LY, UK.

出版信息

Clin Sci (Lond). 2002 Dec;103(6):543-52. doi: 10.1042/cs1030543.

DOI:10.1042/cs1030543

PMID:12444906

Abstract

Metabolic exercise testing is valuable in patients with chronic heart failure (CHF), but periodic breathing may confound the measurements. We aimed to examine the effects of periodic breathing on the measurement of oxygen uptake ( VO(2)) and respiratory exchange ratio (RER). First, we measured the effects of different averaging procedures on peak VO(2) and RER values in 122 patients with CHF undergoing cardiopulmonary exercise testing. Secondly, we studied the effects of periodic breathing on VO2) and RER in healthy volunteers performing computer-guided periodic breathing. Thirdly, we used a Fourier analysis to study the effects of periodic breathing on gas exchange measurements. The first part of the study showed that 1 min moving window gave a mean peak VO(2) of 13.8 ml.min(-1).kg(-1) for the CHF patients. A 15 s window gave significantly higher values. The difference averaged 1.0 ml.min(-1).kg(-1) ( P <0.0001), but varied widely: 41% of subjects showed a difference greater than 1.0 ml.min(-1).kg(-1). RER values were also higher by an average of 0.09 ( P <0.0001); in 20% of subjects the difference was greater than 0.10. In the second part of the study, we found artefactual elevations of peak VO(2) (without averaging) of 2.9 ml.min(-1).kg(-1) ( P <0.01) and of peak RER of 0.13 ( P <0.001), which were still significant when 30 s averaging was applied [delta(peak VO(2))=1.8 ml.min(-1).kg(-1), P <0.01; deltaRER=0.08, P <0.001]. The third, theoretical, part of the study showed that values of carbon dioxide output and VO(2) oscillate with different phases and amplitudes, resulting in oscillations in their ratio, RER. Averaging over 15 s or 30 s can be expected to give only 10% or 36% attenuation respectively. Thus periodic breathing causes variable artefactual elevations of measured peak VO(2) and RER, which can be attenuated by using longer averaging periods. Clinical reports and research publications describing peak V*O(2) in CHF should be accompanied by details of the averaging technique used.

摘要

代谢运动测试对慢性心力衰竭（CHF）患者很有价值，但周期性呼吸可能会干扰测量结果。我们旨在研究周期性呼吸对摄氧量（V̇O₂）和呼吸交换率（RER）测量的影响。首先，我们测量了不同平均程序对122例接受心肺运动测试的CHF患者的峰值V̇O₂和RER值的影响。其次，我们研究了周期性呼吸对进行计算机引导的周期性呼吸的健康志愿者的V̇O₂和RER的影响。第三，我们使用傅里叶分析来研究周期性呼吸对气体交换测量的影响。研究的第一部分表明，对于CHF患者，1分钟移动窗口得出的平均峰值V̇O₂为13.8 ml·min⁻¹·kg⁻¹。15秒窗口得出的值明显更高。差异平均为1.0 ml·min⁻¹·kg⁻¹（P<0.0001），但差异很大：41%的受试者差异大于1.0 ml·min⁻¹·kg⁻¹。RER值平均也高出0.09（P<0.0001）；20%的受试者差异大于0.10。在研究的第二部分中，我们发现（不进行平均时）峰值V̇O₂的人为升高为2.9 ml·min⁻¹·kg⁻¹（P<0.01），峰值RER的人为升高为0.13（P<0.001），当应用30秒平均时这些差异仍然显著[δ（峰值V̇O₂）=1.8 ml·min⁻¹·kg⁻¹，P<0.01；δRER=0.08，P<0.001]。研究的第三部分，即理论部分表明，二氧化碳排出量和V̇O₂的值以不同的相位和幅度振荡，导致它们的比值RER振荡。预计15秒或30秒的平均分别只会使振荡衰减10%或36%。因此，周期性呼吸会导致测量的峰值V̇O₂和RER出现可变的人为升高，通过使用更长的平均周期可以使其衰减。描述CHF中峰值V̇O₂的临床报告和研究出版物应附带所使用平均技术的详细信息。