慢性心力衰竭患者运动峰值时的肺功能

Pulmonary function at peak exercise in patients with chronic heart failure.

作者信息

Papazachou Ourania, Anastasiou-Nana Maria, Sakellariou Dimitrios, Tassiou Antonia, Dimopoulos Stavros, Venetsanakos John, Maroulidis George, Drakos Stavros, Roussos Charis, Nanas Serafim

机构信息

Pulmonary and Critical Care Medicine Department, Cardiopulmonary Exercise Testing Laboratory and Rehabilitation Center, National and Kapodestrian University of Athens, Evgenidio Hospital, 20, Papadiamantopoulou str, Athens 115 28, Greece.

出版信息

Int J Cardiol. 2007 May 16;118(1):28-35. doi: 10.1016/j.ijcard.2006.04.091. Epub 2006 Aug 8.

DOI:10.1016/j.ijcard.2006.04.091

PMID:16893579

Abstract

BACKGROUND

Various respiratory abnormalities are associated with chronic heart failure (CHF). However, changes in inspiratory capacity (IC) and breathing pattern from rest to exercise in patients with CHF have not been thoroughly investigated in these patients.

MATERIALS AND METHODS

Seventy seven (66 male/11 female) patients with clinical stable CHF (age: 52+/-11 years) were studied. All the patients underwent pulmonary function tests, including measurements of IC and maximal inspiratory pressure (Pimax) at rest and then a maximal cardiopulmonary exercise testing (CPET) on a treadmill. During the CPET, IC was measured every 2 min. Pimax was measured again after the end of CPET.

RESULTS

Percent predicted forced expiratory volume in 1 s (FEV1) was 91+/-12, %predicted forced vital capacity (FVC) was 92+/-13, %FEV1/FVC was 81+/-4, and %predicted IC was 85+/-18. Peak exercise IC was lower than resting (2.4+/-0.6 vs. 2.6+/-0.6 l, p<0.001). Analysis of variance between Weber's groups revealed statistically significant differences in peak exercise IC (p<0.001), VE/VCO2slope (p<0.001), resting Pimax (p=0.005) and post-exercise Pimax (p<0.001). At rest, there was a statistically significant difference in end-tidal CO2 (P(ETCO2)) (p=0.002), in breathing frequency (p=0.004), in inspiratory time (Ti) (p=0.04) and in total respiratory time (T(Tot)) (p=0.004) among Weber's groups. At peak exercise there was a statistically significant decrease in minute ventilation (VE) (p<0.001), tidal volume (VT) (p<0.001), respiratory cycle (VT/TI) (p<0.001) and P(ETCO2) (p<0.001). Peak IC was correlated with peak VO2 (r=0.72, p<0.001), anaerobic threshold (r=0.71, p<0.001), VO2/t slope (r=0.54, p<0.0001), and post-exercise Pimax (r=0.62, p<0.001).

CONCLUSIONS

In patients with CHF, peak exercise IC is reduced in parallel with disease severity, which is probably due to respiratory muscle dysfunction.

摘要

背景

多种呼吸异常与慢性心力衰竭（CHF）相关。然而，CHF患者从静息到运动时吸气容量（IC）和呼吸模式的变化尚未在这些患者中得到充分研究。

材料与方法

对77例（66例男性/11例女性）临床稳定的CHF患者（年龄：52±11岁）进行了研究。所有患者均接受了肺功能测试，包括静息时IC和最大吸气压力（Pimax）的测量，然后在跑步机上进行最大心肺运动测试（CPET）。在CPET期间，每2分钟测量一次IC。CPET结束后再次测量Pimax。

结果

预测的1秒用力呼气量（FEV1）百分比为91±12，预测的用力肺活量（FVC）百分比为92±13，FEV1/FVC百分比为81±4，预测的IC百分比为85±18。运动峰值IC低于静息值（2.4±0.6 vs. 2.6±0.6 l，p<0.001）。Weber组之间的方差分析显示，运动峰值IC（p<0.001）、VE/VCO2斜率（p<0.001）、静息Pimax（p=0.005）和运动后Pimax（p<0.001）存在统计学显著差异。静息时，Weber组之间的呼气末二氧化碳（P(ETCO2)）（p=0.002）、呼吸频率（p=0.004）、吸气时间（Ti）（p=0.04）和总呼吸时间（T(Tot)）（p=0.004）存在统计学显著差异。在运动峰值时，分钟通气量（VE）（p<0.001）、潮气量（VT）（p<0.001）、呼吸周期（VT/TI）（p<0.001）和P(ETCO2)（p<0.001）有统计学显著下降。运动峰值IC与运动峰值VO2（r=0.72，p<0.001）、无氧阈值（r=0.71，p<0.001）、VO2/t斜率（r=0.54，p<0.0001）和运动后Pimax（r=0.62，p<0.001）相关。