Zhang Ye, Sun Xing-Guo, Liu Fang, Hao Lu, Song Ya, Tai Wen-Qi, Ge Wan-Gang, Li Hao, Shi Chao, Xu Fan, Wang Ji-Nan, Zhang Yan-Fang, Zhou Qing-Qing, Chen Rong, Zou Yu-Xin, Ma Ming-Xin, Xia Rui, Huang Yan, Xie You-Hong
Fuwai Hospital,Chinese Academy of Medical Sciences/National Center for Cardiovascular Diseases/ State Key Laboratory of Cardiovascular Diseases/Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100037.
Fuwai Hospital,Chinese Academy of Medical Sciences/National Center for Cardiovascular Diseases/ State Key Laboratory of Cardiovascular Diseases/Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100037;The Affiliated Rehabilitation Hospital of Chongqing Medical University, Chongqing 400050.
Zhongguo Ying Yong Sheng Li Xue Za Zhi. 2021 Mar;37(2):147-153. doi: 10.12047/j.cjap.0080.2021.118.
To verify that the cardiopulmonary exercise testing (CPET) performed by clinical subjects is the maximum extreme exercise, we designed The Max test（Max）during clinical CPET. We used Max to verify the accuracy of the quantitative CPET evaluation result, and whether it is feasible and safe to use the specific value of a certain index as the standard for stopping CPET. Two hundred and sixteen cases from Fuwai Hospital were selected during June 2017 to January 2019,including 41 healthy person（control group） and 175with cardiovascular diseases（patient group）,The patients had a CPET peak RER ≤ 1.10, or the peak heart rate and peak blood pressure were basically non-responsive.The Max was first attempted in 60 subjects,and this study is further expanded . When the CPET ended, they had a 5-minute break, then the Max, during which, they cycled with a velocity of ≥ 60 r/min, at a constant intensity equivalent to to 130% of peak work,until exhausted.The difference and percentage difference between the peak heart rate and the peak oxygen uptake were calculated. ①If the percentage difference of heart rate and oxygen uptake are all less than -10%,then the Max is defined as failure,otherwise it is succesful. 2 If the percentage difference is between -10%~10%, then the Max is successful, which proved that the CPET is precise.③If the difference is ≥10%, the Max is successful, which proves that the CPET is non-extreme exercise. Patient group's Peak VO(L/min,ml/(min·kg)),anaerobic threshold (L/min,ml/(min·kg),%pred),Peak VO/HR(ml/beat, % pred),Peak RER,Peak SBP,Peak WR,peak heart rate,OUEP （ratio,%pred） were lower than those of the control group(P<0.05)．The VE/ VCO Slope （ratio,%pred）and Lowest VE/ VCO（ratio,%pred） were higher in the patient group than in the control group (P<0.05)．No adverse events occurred during the CPET and Max in all cases. Among the 216 cases,Max was successful in 198 cases(91.7%)．CPET was proved to be maximum extreme exercise for 182 cases,non-maximum extreme exercise for 16 cases,and failed in 18 cases(8.3%)． For CPET with a low peak RER and a maximum challenge,the Max can confirm the accuracy of the objective quantitative assessment of CPET. Max is safe and feasible,and that deserved further research and clinical application.
为验证临床受试者进行的心肺运动试验（CPET）是否为最大极限运动，我们在临床CPET期间设计了最大试验（Max）。我们使用Max来验证CPET定量评估结果的准确性，以及将某一指标的特定值作为停止CPET的标准是否可行和安全。选取2017年6月至2019年1月期间阜外医院的216例患者，包括41例健康人（对照组）和175例心血管疾病患者（患者组），患者CPET的峰值呼吸交换率（RER）≤1.10，或峰值心率和峰值血压基本无反应。首先对60例受试者进行Max试验，并进一步扩大本研究。当CPET结束时，让受试者休息5分钟，然后进行Max试验，在此期间，他们以≥60转/分钟的速度骑行，以相当于峰值功率130%的恒定强度骑行，直至力竭。计算峰值心率与峰值摄氧量之间的差值和百分比差值。①如果心率和摄氧量的百分比差值均小于-10%，则将Max定义为失败，否则为成功。②如果百分比差值在-10%至10%之间，则Max为成功，这证明CPET是精确的。③如果差值≥10%，则Max为成功，这证明CPET不是极限运动。患者组的峰值摄氧量（L/分钟，毫升/（分钟·千克））、无氧阈（L/分钟，毫升/（分钟·千克），%预计值）、峰值摄氧量/心率（毫升/次，%预计值）、峰值RER、峰值收缩压、峰值做功、峰值心率、运动结束时摄氧量（比值，%预计值）均低于对照组（P<0.05）。患者组的每分钟通气量/二氧化碳排出量斜率（比值，%预计值）和最低每分钟通气量/二氧化碳排出量（比值，%预计值）高于对照组（P<0.05）。所有病例在CPET和Max试验期间均未发生不良事件。在216例病例中，Max试验成功198例（91.7%）。CPET被证明为最大极限运动的有182例，非最大极限运动的有16例，失败的有18例（8.3%）。对于峰值RER较低且具有最大挑战性的CPET，Max可以确认CPET客观定量评估的准确性。Max是安全可行的，值得进一步研究和临床应用。
