心肺运动试验定量评估PCI前后心肺功能的临床研究

Clinical value of cardiopulmonary exercise testing in quantitative evaluation of cardiopulmonary function before and after percutaneous coronary intervention

摘要:

目的：探讨症状限制的极限心肺运动试验（cardiopulmonary exercise testing，CPET）在定量评估经皮冠状动脉腔内血管成形术（percutaneous coronary intervention，PCI）前后心肺功能中的临床应用价值。方法：利用CPET对12例正常人及12例冠脉造影术确诊冠心病拟行PCI的患者手术前后心肺功能分别定量评估，利用标准化分析对CPET指标进行解读；并在同期测定左室射血分数（left ventricular ejection fraction，LVEF），比较手术前后CPET指标的变化及与LVEF的相关性。结果：LVEF术前[（42.83±5.92）%]与术后[（45.08±4.76）%]比较，具有统计学差异（P＜0.05）；CPET核心指标峰值摄氧量、无氧阈值、峰值氧脉搏、摄氧效率平台、二氧化碳通气当量斜率、二氧化碳通气当量最低值、峰值负荷功率、递增功率运动时间正常对照组分别为（1.99±0.19） L/min、（1.22±0.19） L/min、（14.18±2.59） mL/次、（47.10±4.44）、（23.01±2.63）、（25.06±2.43）、（162±17.6） W、（6.47±0.80） min，术前组上述指标分别为（1.41±0.46） L/min、（0.87±0.23） L/min、（11.43±3.29） mL/次、（40.13±5.18）、（27.85±4.81）、（29.55±3.90）、（112.00±51.10） W、（5.28±1.81） min，术前组均低于正常对照组（P<0.05）；术后组各指标分别为（1.59±0.33） L/min、（1.02±0.20） L/min、（12.37±2.72） mL/次、（39.20±5.60）、（26.93±2.88）、（29.30±2.82）、（132.00±31.70） W、（6.21±1.05） min，与术前比较，峰值摄氧量、无氧阈值、峰值氧脉搏、峰值负荷功率、递增功率运动时间均提高，具有统计学差异（P<0.05）；摄氧效率平台、二氧化碳通气当量斜率、二氧化碳通气当量最低值与术前比较无统计学差异（P＞0.05）；CPET核心指标与LVEF呈高度相关（r值绝对值为0.579~0.908，均P<0.05）。结论：CPET的核心指标可用于无创定量监测PCI术前后心肺功能的变化情况，具有良好的临床应用价值。

Abstract:

Objective：To investigate the clinical value of symptom-limited cardiopulmonary exercise testing（CPET） in the quantitative evaluation of cardiopulmonary function before and after percutaneous coronary intervention（PCI）. Methods：A total of 12 healthy in－dividuals and 12 patients who were diagnosed with coronary heart disease by coronary angiography and planned to undergo PCI were enrolled，and CPET was performed for the quantitative evaluation of cardiopulmonary function before and after PCI. The CPET param－eters were interpreted by standardized analysis. Left ventricular ejection fraction（LVEF） was measured at the same time. The changes in CPET parameters after PCI and their correlation with LVEF were analyzed. Results：There was a significant change in LVEF after PCI（42.83%±5.92% vs. 45.08%±4.76%，P<0.05）. As for the core CPET parameters，compared with the normal control group，the pre-PCI group had significantly lower peak oxygen uptake（1.41±0.46 L/min vs. 1.99±0.19 L/min，P<0.05），anaerobic threshold（0.87±0.23 L/min vs. 1.22±0.19 L/min，P<0.05），peak oxygen pulse （11.43±3.29 mL/time vs. 14.18±2.59 mL/time，P<0.05），oxygen uptake efficiency plateau（40.13±5.18 vs. 47.10±4.44，P<0.05），peak load power（112.00±51.10 W vs. 162.00±17.60 W，P <0.05），and increasing power movement time（5.28±1.81 min vs. 6.47±0.80 min，P<0.05） and significantly higher slope of ventilatory equivalent for carbon dioxide（27.85±4.81 vs. 23.01±2.63，P<0.05） and mini－mum ventilatory equivalent for carbon dioxide（29.55±3.90 vs. 25.06±2.43，P<0.05）；in the post-PCI group，these parameters were 1.59±0.33 L/min，1.02±0.20 L/min，12.37±2.72 mL/time，39.20±5.60，26.93±2.88，29.30±2.82，132.00±31.70 W，and 6.21±1.05 min，respectively，and compared with the pre-PCI group，the post-PCI group had significant increases in peak oxygen uptake，anaerobic threshold，peak oxygen pulse，peak load power，and increasing power movement time（P<0.05），while there were no significant differences in oxygen uptake efficiency plateau，slope of ventilatory equivalent for carbon dioxide，and minimum ventilatory equivalent for carbon dioxide between the pre-PCI group and the post-PCI group（P>0.05）. The core CPET parameters were highly correlated with LVEF（absolute r value=0.579-0.908，all P<0.05）. Conclusion：The core CPET parameters can be used for noninvasive quanti－tative monitoring of changes in cardiopulmonary function after PCI and has a good clinical value.