Mahler D A, Franco M J
Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756-0001, USA.
J Cardiopulm Rehabil. 1996 Nov-Dec;16(6):357-65. doi: 10.1097/00008483-199611000-00004.
Noninvasive measurement of metabolic and cardiorespiratory variables can be readily obtained using computerized systems as part of exercise testing of patients on a cycle ergometer or treadmill. The major indications for CPEX are: to assess exercise-related symptoms, especially dyspnea and chest pain; to measure exercise capacity including acceptability of patients with end-stage heart disease for cardiac transplantation; to evaluate for impairment/disability; to establish safety and guidelines for exercise training; and to assess response to specific therapy. As most patients with chronic cardiorespiratory disorders reduce their activities and consequently become deconditioned, CPEX should be considered as part of the initial evaluation. The results of CPEX should enable the physician to understand the reason(s) for the patient's exercise limitation and usually support the recommendation that the patient participate in a reconditioning or rehabilitation program. Should expired gases be measured as routine for all exercise tests? The use of CPEX depends on the clinical question. If the question is, "Does the patient have ischemic heart disease?", then a standard "cardiac stress test" is adequate. If the clinical question is, "Why is the individual limited in exercise ability?" or "Why is a patient breathless with activities?", then comprehensive CPEX is indicated. One important issue relating to CPEX is cost effectiveness. Do the results of CPEX justify the expense? There are little if any data to answer this question. However, if CPEX can establish a specific diagnosis, exclude significant heart disease, estimate work capacity, and/or provide guidelines for prescription of exercise intensity, this information may be invaluable to the individual patient and to the health-care provider. It is possible that CPEX may answer a specific clinical question and thereby actually eliminate the need and reduce the cost of additional expensive diagnostic tests. A prospective assessment of the cost effectiveness of CPEX will be important for select clinical problems.
使用计算机系统作为患者在自行车测力计或跑步机上进行运动测试的一部分，可以轻松获得代谢和心肺变量的无创测量值。心肺运动试验（CPEX）的主要适应证包括：评估与运动相关的症状，尤其是呼吸困难和胸痛；测量运动能力，包括终末期心脏病患者对心脏移植的可接受性；评估功能障碍/残疾情况；制定运动训练的安全性和指导方针；以及评估对特定治疗的反应。由于大多数慢性心肺疾病患者会减少活动，从而导致身体机能下降，因此应将CPEX视为初始评估的一部分。CPEX的结果应使医生能够了解患者运动受限的原因，并通常支持患者参与身体机能恢复或康复计划的建议。是否应将呼出气体测量作为所有运动测试的常规项目？CPEX的使用取决于临床问题。如果问题是“患者是否患有缺血性心脏病？”，那么标准的“心脏应激试验”就足够了。如果临床问题是“为什么个体运动能力受限？”或“为什么患者活动时会气喘吁吁？”，那么就需要进行全面的CPEX。与CPEX相关的一个重要问题是成本效益。CPEX的结果是否值得花费这笔费用？几乎没有数据可以回答这个问题。然而，如果CPEX能够确立特定诊断、排除重大心脏病、估计工作能力和/或提供运动强度处方指导方针，那么这些信息对于个体患者和医疗保健提供者可能是非常宝贵的。CPEX有可能回答特定的临床问题，从而实际上消除对额外昂贵诊断测试的需求并降低成本。对CPEX成本效益的前瞻性评估对于某些临床问题将很重要。
