Ohuchi H, Arakaki Y, Hiraumi Y, Tasato H, Kamiya T
Department of Pediatrics, National Cardiovascular Center, Suita, Osaka, Japan.
Int J Cardiol. 1998 Oct 30;66(3):241-51. doi: 10.1016/s0167-5273(98)00249-6.
To clarify the different cardiorespiratory response to exercise in patients with congenital heart disease and patients with chronic congestive heart failure, we investigated the effect of a progressive exercise test in 30 patients aged 10 to 24 years, including 9 patients with cyanotic congenital heart disease (group A), 13 patients who had undergone a Fontan operation (group B), and 8 patients with reduced left ventricular function (group C), and 18 healthy controls (group D). There was no difference in peak oxygen uptake among patient groups and all group A, B, and C values were lower than those in group D (P<0.001). Although peak heart rate was lower in patient groups than in group D, heart rate at a given exercise intensity was highest in group C. The oxygen pulse (oxygen uptake divided by heart rate=stroke volume x arterial venous oxygen difference), as an indicator of stroke volume, was lower in patients groups, especially in group C, than in group D. There was no difference in tidal volume between groups A and D, but the respiratory rates at any given exercise intensity were higher in group A than in the other patient groups, thus minute ventilation and the ventilatory equivalent were highest in group A. The increased respiratory rate and low tidal volume in group C resulted in rapid and shallow respiration. There was no difference in exertional symptoms at peak exercise among the groups. In addition to impaired responses of stroke volume during exercise in patients with reduced exercise capacity, there was little limitation of increase in ventilation in group B and excessive ventilation in group A. The present results suggest that relationship between ventilatory and cardiac responses during exercise in patients with cyanotic congenital heart disease with and without a Fontan operation is different from the relationship in patients with chronic congestive heart failure; however, these pathological differences did not influence exertional symptoms.
为了阐明先天性心脏病患者和慢性充血性心力衰竭患者对运动的不同心肺反应，我们对30名年龄在10至24岁的患者进行了递增运动试验，其中包括9名青紫型先天性心脏病患者（A组）、13名接受过Fontan手术的患者（B组）、8名左心室功能减退患者（C组）以及18名健康对照者（D组）。各患者组之间的峰值摄氧量没有差异，且A、B、C组的所有值均低于D组（P<0.001）。虽然患者组的峰值心率低于D组，但在给定运动强度下，C组的心率最高。作为每搏量指标的氧脉搏（摄氧量除以心率=每搏量×动静脉氧分压差）在患者组中较低，尤其是C组，低于D组。A组和D组之间的潮气量没有差异，但在任何给定运动强度下，A组的呼吸频率高于其他患者组，因此A组的分钟通气量和通气当量最高。C组呼吸频率增加和潮气量降低导致呼吸急促且浅。各组在运动峰值时的用力症状没有差异。除了运动能力降低的患者在运动期间每搏量反应受损外，B组的通气增加几乎没有限制，而A组存在过度通气。目前的结果表明，有或没有接受Fontan手术的青紫型先天性心脏病患者在运动期间通气和心脏反应之间的关系与慢性充血性心力衰竭患者不同；然而，这些病理差异并未影响用力症状。
