Barlow C W, Davey P P, Qayyum M S, Conway J, Paterson D J, Robbins P A
Laboratory of Physiology, University of Oxford, United Kingdom.
J Card Fail. 1998 Jun;4(2):105-14. doi: 10.1016/s1071-9164(98)90250-0.
Exercise-induced hyperkalemia, which may contribute to exercise hyperpnea and exertional fatigue, is increased in patients with chronic heart failure (CHF). This study examined whether differences in leg blood flow during exercise could be responsible for alterations in the level of hyperkalaemia, as well as the effect of physical training.
We studied 10 subjects with CHF (ejection fraction 23 +/- 3.9%; mean +/- SD) and 10 subjects with normal left ventricular function (NLVF) who had undergone previous coronary bypass graft surgery (ejection fraction 64 +/- 8.0%; mean +/- SD). Subjects performed incremental cycle exercise to exhaustion before and after physical training. The rises in femoral venous potassium concentration ([K+]), heart rate, lactate, and ventilation (VI) with exercise were all greater in the subjects with CHF than in those with NLVF (P < .05). There was no difference between the groups in leg blood flow during submaximal exercise but peak leg flow was greater in the group with NLVF (P < .01). Physical training was well tolerated and both groups increased their peak VO2 (8 +/- 3.2% CHF (P < .05); 11 +/- 2.7% NLVF (P < .01); mean +/- SE). Training resulted in a reduced rise in femoral venous [K+] and VI (P < .05), but did not affect leg blood flow during submaximal exercise in either group.
The rise in the femoral venous [K+] with exercise is increased in patients with CHF and can be reduced by physical training. These changes are not a consequence of different leg blood flows, either between groups or with training. The study also suggests that femoral venous [K+] is not a powerful regulator of leg blood flow during exercise.
运动诱发的高钾血症在慢性心力衰竭（CHF）患者中有所增加，这可能导致运动性呼吸急促和运动性疲劳。本研究探讨运动期间腿部血流的差异是否可能是高钾血症水平改变的原因，以及体育锻炼的影响。
我们研究了10例CHF患者（射血分数23±3.9%；均数±标准差）和10例左心室功能正常（NLVF）且曾接受冠状动脉搭桥手术的患者（射血分数64±8.0%；均数±标准差）。受试者在体育锻炼前后进行递增式自行车运动直至力竭。运动时，CHF患者股静脉钾浓度（[K+]）、心率、乳酸和通气量（VI）的升高均高于NLVF患者（P<.05）。次最大运动期间两组的腿部血流无差异，但NLVF组的峰值腿部血流更大（P<.01）。体育锻炼耐受性良好，两组的峰值摄氧量均增加（CHF组增加8±3.2%（P<.05）；NLVF组增加11±2.7%（P<.01）；均数±标准误）。锻炼导致股静脉[K+]和VI的升高降低（P<.05），但对两组次最大运动期间的腿部血流均无影响。
CHF患者运动时股静脉[K+]升高，体育锻炼可使其降低。这些变化不是两组之间或锻炼后腿部血流不同的结果。该研究还表明，运动期间股静脉[K+]不是腿部血流的有力调节因素。
