肺动脉高压患者在最大运动时全身氧摄取受损。
Impaired systemic oxygen extraction at maximum exercise in pulmonary hypertension.
作者信息
Tolle James, Waxman Aaron, Systrom David
机构信息
Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
出版信息
Med Sci Sports Exerc. 2008 Jan;40(1):3-8. doi: 10.1249/mss.0b013e318159d1b8.
PURPOSE
To determine the relative contributions of the Fick principle variables to impaired exercise tolerance in pulmonary arterial hypertension compared with pulmonary venous hypertension.
METHODS
One hundred forty-seven consecutive, complete, clinically indicated cardiopulmonary exercise tests done with radial and pulmonary arterial catheters and radionuclide ventriculographic scanning were screened for an exercise limit attributable to 1) pulmonary arterial hypertension (N = 34), 2) left ventricular systolic (N = 23), or 3) diastolic dysfunction (N = 36), defined by mean pulmonary artery pressure, pulmonary capillary wedge pressure, and left ventricular ejection fraction. Systolic and diastolic dysfunction are together referred to as pulmonary venous hypertension. Patients with other limits were excluded, including those with a pulmonary mechanical limit. For the resulting 93 exercise tests, the Fick principle variables' contributions to a depressed maximum oxygen consumption were compared by ANOVA and ANCOVA.
RESULTS
Maximum oxygen consumption (54.5 +/- 15.5 vs 73.2 +/- 20.1 vs 66.0 +/- 15.7% predicted) and oxygen delivery (1457 +/- 456 vs 2161 +/- 824 vs 2007 +/- 665 mL x min(-1)) were reduced in systolic dysfunction versus both diastolic dysfunction and pulmonary arterial hypertension, respectively (P < 0.05 by ANOVA). Maximum systemic oxygen extraction ratio was highest in systolic dysfunction, intermediate in diastolic dysfunction, and lowest in pulmonary arterial hypertension (0.744 +/- 0.091 vs 0.680 +/- 0.091 vs 0.619 +/- 0.113, respectively, P < 0.05 among all groups). Systemic oxygen extraction at peak exercise was inversely related to maximum cardiac output in pulmonary arterial hypertension, but it was blunted versus systolic dysfunction throughout the range of peak cardiac outputs (P < 0.05 by ANCOVA).
CONCLUSIONS
Maximum systemic oxygen extraction is impaired in pulmonary arterial versus pulmonary venous hypertension and contributes to the exercise limit.
目的
确定与肺静脉高压相比，菲克原理变量对肺动脉高压患者运动耐量受损的相对贡献。
方法
对147例连续、完整、有临床指征且使用桡动脉和肺动脉导管及放射性核素心室造影扫描进行的心肺运动试验进行筛查，找出由以下原因导致的运动极限：1）肺动脉高压（N = 34），2）左心室收缩功能障碍（N = 23），或3）舒张功能障碍（N = 36），这些由平均肺动脉压、肺毛细血管楔压和左心室射血分数定义。收缩功能障碍和舒张功能障碍统称为肺静脉高压。排除有其他运动极限的患者，包括有肺机械性运动极限的患者。对于最终的93例运动试验，通过方差分析（ANOVA）和协方差分析（ANCOVA）比较菲克原理变量对最大耗氧量降低的贡献。
结果
与舒张功能障碍和肺动脉高压相比，收缩功能障碍患者的最大耗氧量（分别为预测值的54.5±15.5% vs 73.2±20.1% vs 66.0±15.7%）和氧输送量（1457±456 vs 2161±824 vs 2007±665 mL·min⁻¹）均降低（方差分析，P < 0.05）。最大全身氧摄取率在收缩功能障碍患者中最高，在舒张功能障碍患者中居中，在肺动脉高压患者中最低（分别为0.744±0.091 vs 0.680±0.091 vs 0.619±0.113，所有组间P < 0.05）。在肺动脉高压患者中，运动峰值时的全身氧摄取与最大心输出量呈负相关，但在整个运动峰值心输出量范围内，与收缩功能障碍相比有所减弱（协方差分析，P < 0.05）。
结论
与肺静脉高压相比，肺动脉高压患者的最大全身氧摄取受损，并导致运动极限。
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