Andreas S, Vonhof S, Kreuzer H, Figulla H R
Department of Cardiology and Pneumology, Georg August University, Göttingen, Germany.
Eur Heart J. 1995 Dec;16(12):1886-91. doi: 10.1093/oxfordjournals.eurheartj.a060843.
Patients with chronic heart failure have an increased ventilation/carbon dioxide production ratio (VE/VCO2) during exercise. Recently it was discussed whether the cause of this increase was a ventilatory stimulus driven other than by CO2. Dyspnoea during exercise is thought to be related to impaired respiratory function. However, clinical confirmation is scarce. Ninety-two patients (age 51 +/- 9 years) with heart failure due to idiopathic dilated cardiomyopathy exercised on a bicycle ergometer to exhaustion, and measurement of ventilatory gases and Swan-Ganz catheterization were performed. The maximal oxygen consumption corrected for body weight (VO2max. kg-1) was 16.6 +/- 5.5 ml x min-1 x kg-1. The increase in (VE/VCO2) during exercise was related to an increase in respiratory rate (r = 0.43; P < 0.00001) but not to an increase in cardiac index or capillary wedge pressure. Nineteen patients stopped exercising because of dyspnoea. Their maximal tidal volume and VO2max . kg-1 were lower than the 67 patients who stopped exercise because of fatigue (P < 0.001 and P < 0.00001 respectively). Other variables showed no significant difference. In conclusion, the increase in VE/VCO2 during exercise may reflect a non-CO2 driven ventilatory stimulus as it cannot be attributed to increased pulmonary vascular pressures or an insufficient increase in cardiac output leading to a ventilation-perfusion mismatch. Low oxygen uptake is a prominent finding in patients with chronic heart failure who experienced dyspnoea during exercise, and dyspnoea is in part related to impaired respiratory function.
慢性心力衰竭患者运动时通气/二氧化碳产生比值（VE/VCO2）升高。最近讨论了这种升高的原因是否是由二氧化碳以外的通气刺激驱动的。运动时的呼吸困难被认为与呼吸功能受损有关。然而，临床证实很少。92例（年龄51±9岁）因特发性扩张型心肌病导致心力衰竭的患者在自行车测力计上运动至力竭，并进行了通气气体测量和 Swan-Ganz 导管插入术。校正体重后的最大摄氧量（VO2max. kg-1）为16.6±5.5 ml x min-1 x kg-1。运动期间（VE/VCO2）的升高与呼吸频率的增加有关（r = 0.43；P < 0.00001），但与心脏指数或毛细血管楔压的增加无关。19例患者因呼吸困难停止运动。他们的最大潮气量和VO2max. kg-1低于因疲劳停止运动的67例患者（分别为P < 0.001和P < 0.00001）。其他变量无显著差异。总之，运动期间VE/VCO2的升高可能反映了一种非二氧化碳驱动的通气刺激，因为它不能归因于肺血管压力升高或心输出量增加不足导致通气-灌注不匹配。低摄氧量是运动时出现呼吸困难的慢性心力衰竭患者的一个突出表现，并且呼吸困难部分与呼吸功能受损有关。
