Zellers T M, Driscoll D J, Mottram C D, Puga F J, Schaff H V, Danielson G K
Section of Pediatric Cardiology, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1989 Dec;64(12):1489-97. doi: 10.1016/s0025-6196(12)65704-8.
To determine the effect of the Fontan operation on exercise tolerance and cardiorespiratory response to exercise, we compared the preoperative and postoperative responses to graded exercise to maximal effort in 20 patients who underwent a modified Fontan procedure. The mean interval between preoperative and postoperative exercise testing was 1.8 years. Postoperatively, total work performed, duration of exercise, and maximal oxygen uptake were significantly increased. Although cardiac output increased during exercise, the response was subnormal, and stroke volume was unchanged. The heart rate and systolic blood pressure during maximal exercise were not significantly changed from preoperative values, but the diastolic blood pressures during rest and maximal exercise were significantly increased postoperatively. Systemic arterial blood oxygen saturation increased after the modified Fontan operation, but during exercise, a mild but significant desaturation occurred (93% compared with 90%). The ventilatory equivalent for oxygen decreased toward normal during exercise. The respiratory rate and oxygen consumption during resting remained unchanged from preoperative values. For this subset of patients, these data indicate that exercise tolerance improves, cardiac output and stroke volume responses to exercise are subnormal, and ventilatory response to exercise decreases toward normal after the modified Fontan operation.
为了确定Fontan手术对运动耐量以及运动时心肺反应的影响，我们比较了20例接受改良Fontan手术患者术前和术后对分级运动直至最大努力程度的反应。术前和术后运动测试的平均间隔时间为1.8年。术后，总做功量、运动持续时间和最大摄氧量显著增加。尽管运动期间心输出量增加，但反应低于正常水平，且每搏输出量未改变。最大运动时的心率和收缩压与术前值相比无显著变化，但术后静息和最大运动时的舒张压显著升高。改良Fontan手术后全身动脉血氧饱和度增加，但运动期间出现轻度但显著的氧饱和度降低（从93%降至90%）。运动期间氧通气当量趋向正常。静息时的呼吸频率和耗氧量与术前值相比未改变。对于这组患者，这些数据表明改良Fontan手术后运动耐量提高，运动时的心输出量和每搏输出量反应低于正常水平，且运动时的通气反应趋向正常。
