Griffin M J, O'Sullivan J J, Scott A, Maurer B J
Department of Cardiology, St Vincents Hospital, Dublin, Ireland.
Br Heart J. 1993 May;69(5):388-90. doi: 10.1136/hrt.69.5.388.
Exercise induced hypotension is a specific but insensitive indicator of severe coronary artery disease. Skin blood flow is subject to control by baroreceptor mediated reflexes as well as thermoregulatory reflexes. Monitoring skin temperature or the skin to central temperature gradient may be a more sensitive indicator of impaired cardiac output response to exercise than hypotension.
Central and skin temperature changes associated with exercise were studied in 10 normal volunteers and eight patients with impaired resting ventricular function due to ischaemic heart disease. Patients exercised according to a modified Bruce protocol. The two sample independent t test was applied to compare the central and peripheral temperatures in the two groups at three minute intervals during exercise and at two minute intervals after exercise.
A significant decrease was found in mean (1 SEM) central temperature on exercise in our patient group (98.2(0.2) degrees F to 97.2(0.3) degrees F), compared with the normal increase in central temperature (97.7(0.2) degrees F to 98.3(0.3) degrees F). Mean (1 SEM) skin temperature changes reflected the expected skin blood flow changes with exercise in normal subjects. In the patient group skin temperature declined during exercise (89.7(2.1) degrees F to 86.6(1.7) degrees F) and was significantly lower than normal from six minutes onwards.
The abnormal peripheral temperature changes of patients with impaired resting ventricular function is an early and sensitive indicator of an abnormal haemodynamic response to exercise. It is possible that skin temperature measurement during exercise could help detect exercise induced ventricular dysfunction due to ischaemia or impaired cardiac output due to valvar heart disease.
运动诱发的低血压是严重冠状动脉疾病的一个特定但不敏感的指标。皮肤血流受压力感受器介导的反射以及体温调节反射的控制。监测皮肤温度或皮肤与中心温度梯度可能是比低血压更敏感的运动时心输出量反应受损的指标。
研究了10名正常志愿者和8名因缺血性心脏病导致静息心室功能受损的患者运动时中心温度和皮肤温度的变化。患者按照改良的布鲁斯方案进行运动。采用两样本独立t检验比较两组在运动期间每隔三分钟以及运动后每隔两分钟时的中心温度和外周温度。
与正常受试者中心温度的正常升高（从97.7(0.2)华氏度升至98.3(0.3)华氏度）相比，我们的患者组在运动时平均（±1标准误）中心温度显著下降（从98.2(0.2)华氏度降至97.2(0.3)华氏度）。正常受试者运动时平均（±1标准误）皮肤温度变化反映了预期的皮肤血流变化。在患者组中，运动期间皮肤温度下降（从89.7(2.1)华氏度降至86.6(1.7)华氏度），并且从六分钟起显著低于正常水平。
静息心室功能受损患者外周温度的异常变化是运动时血流动力学反应异常的早期且敏感的指标。运动期间测量皮肤温度可能有助于检测因缺血导致的运动诱发的心室功能障碍或因瓣膜性心脏病导致的心输出量受损。
