Department of Cardiology, Tongji Hospital, Tongji University, Shanghai 200065, China.
Chin Med J (Engl). 2012 Feb;125(3):465-9.
There is no research, either at home or abroad, focusing on assessing the cardiopulmonary functional reserve and exercise tolerance in patients with pulmonary embolism (PE), but the benefits of early exercise are well recognized. The goals of this study were to assess cardiopulmonary functional reserve in treated PE patients using the inert gas rebreathing method of the cardiopulmonary exercise test (CPET), and to compare it with traditional methods.
CPET on the bicycle ergometer were performed in 40 patients with age, gender, body mass index, systolic blood pressure, and pulmonary function matched. The first group was the PE group composed of 16 PE patients (5 male, 11 female) who were given the standard antithrombotic therapy for two weeks. The second group was composed of 24 normal individuals (10 male, 14 female). Both groups were evaluated by cardiac ultrasound examination, 6-minute walking test (6MWT), and CPET.
(1) Right ventricular systolic pressure (RVSP) in the PE group increased significantly compared to the control group, (34.81 ± 8.15) mmHg to (19.75 ± 3.47) mmHg (P < 0.01). But neither right atrial end-systolic diameter (RASD) nor right ventricular end-diastolic diameter (RVDD) in the PE patients had changed when compared with the controls. The 6-minute walk distance was significantly reduced in the PE patients compared with normal subjects, (447.81 ± 79.20) m vs. (513.75 ± 31.45) m (P < 0.01). Both anaerobic threshold oxygen consumption (VO(2)AT) and peak oxygen consumption (VO(2)peak) were significantly lower in patients with PE, while CO(2) equivalent ventilation (VE/VCO(2) slope) was higher; VO(2)AT (9.44 ± 3.82) ml×kg(-1)×min(-1) vs. (14.62 ± 2.93) ml×kg(-1)×min(-1) (P < 0.01) and VO2peak (12.26 ± 4.06) ml×kg(-1)×min(-1) vs. (23.46 ± 6.15) ml×kg(-1)×min(-1) (P < 0.01) and VE/VCO(2) slope 35.47 ± 6.66 vs. 26.94 ± 3.16 (P < 0.01). There was no significant difference in resting cardiac output (CO) between the PE and normal groups, whereas peak cardiac output (peak CO) and the difference between exercise and resting cardiac output (ΔCO) were both significantly reduced in the PE group; peak CO (5.97 ± 2.25) L/min to (8.50 ± 3.13) L/min (P < 0.01), ΔCO (1.29 ± 1.59) L/min to (3.97 ± 2.02) L/min (P < 0.01). (2) The 6-minute walk distance did not correlated with CPET except for the VO2 peak in patients with PE, r = 0.675 (P < 0.01).
The cardiopulmonary functional reserve was reduced in patients with PE. CPET is an accurate, quantitative evaluation of cardiopulmonary functional reserve for PE patients.
国内外尚无研究专门评估肺栓塞（PE）患者的心肺功能储备和运动耐量，但早期运动的益处已得到广泛认可。本研究旨在采用心肺运动试验（CPET）中的惰性气体重复呼吸法评估经治疗的 PE 患者的心肺功能储备，并与传统方法进行比较。
对 40 例年龄、性别、体重指数、收缩压和肺功能匹配的患者进行了踏车式心肺运动试验（CPET）。第一组为 PE 组，包括 16 例 PE 患者（男 5 例，女 11 例），给予标准抗凝治疗 2 周。第二组为 24 名正常个体（男 10 例，女 14 例）。两组均通过超声心动图检查、6 分钟步行试验（6MWT）和 CPET 进行评估。
（1）PE 组患者的右心室收缩压（RVSP）明显高于对照组，（34.81 ± 8.15）mmHg 至（19.75 ± 3.47）mmHg（P < 0.01）。但 PE 患者的右心房收缩末期直径（RASD）和右心室舒张末期直径（RVDD）与对照组相比均无变化。PE 患者的 6 分钟步行距离明显短于正常对照组，（447.81 ± 79.20）m 至（513.75 ± 31.45）m（P < 0.01）。PE 患者的无氧阈氧耗量（VO2AT）和峰值氧耗量（VO2peak）均明显降低，而二氧化碳当量通气（VE/VCO2 斜率）较高；VO2AT（9.44 ± 3.82）ml×kg-1×min-1 至（14.62 ± 2.93）ml×kg-1×min-1（P < 0.01）和 VO2peak（12.26 ± 4.06）ml×kg-1×min-1 至（23.46 ± 6.15）ml×kg-1×min-1（P < 0.01）和 VE/VCO2 斜率 35.47 ± 6.66 至（26.94 ± 3.16）（P < 0.01）。PE 组和正常组之间静息心输出量（CO）无显著差异，但 PE 组的峰值心输出量（peak CO）和运动与静息心输出量的差值（ΔCO）均显著降低；peak CO（5.97 ± 2.25）L/min 至（8.50 ± 3.13）L/min（P < 0.01），ΔCO（1.29 ± 1.59）L/min 至（3.97 ± 2.02）L/min（P < 0.01）。（2）除 PE 患者的 VO2 peak 外，6 分钟步行距离与 CPET 无相关性，r = 0.675（P < 0.01）。
PE 患者心肺功能储备降低。CPET 是一种准确、定量评估 PE 患者心肺功能储备的方法。
