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中国应用生理学杂志 ›› 2021, Vol. 37 ›› Issue (2): 147-153.doi: 10.12047/j.cjap.0080.2021.118

• 研究论文 • 上一篇    下一篇

Max试验验证症状限制心肺运动试验为最大极限运动进一步临床研究*

张也1, 孙兴国1,2△, 刘方1, 郝璐1,5, 宋雅1,2, 台文琦1, 葛万刚1, 李浩1, 石超1, 徐凡1, 王继楠1,2, 张艳芳1,2, 周晴晴1,2, 陈荣1,3, 邹昱馨1,4,5, 马铭欣1,3, 夏蕊1,3, 黄燕1,3, 谢友红2   

  1. 1.国家心血管病中心 中国医学科学院阜外医院,北京协和医学院心血管疾病国家重点实验室,心血管疾病国家临床医学研究中心,北京100037;
    2.重庆医科大学附属康复医院,重庆400050;
    3.辽宁省大连儿童医院,大连116000;
    4.聊城市立医院儿童医院,山东 聊城252000;
    5.河南省人民医院, 郑州450003
  • 收稿日期:2020-08-12 修回日期:2021-03-10 出版日期:2021-03-28 发布日期:2021-10-20
  • 通讯作者: Tel:010-88398300;E-mail: xgsun@lundquist.org
  • 基金资助:
    * 国家高技术研究发展计划(863计划)课题资助项目(2012AA021009); 国家自然科学基金医学科学部面上项目(81470204); 中国康复医疗机构联合重大项目基金(20160102); 中国医学科学院国家心血管病中心阜外医院科研开发启动基金(2012-YJR02); 首都临床特色应用研究与成果推广(Z161100000516127); 北京康复医院2019-2021科技发展专项(2019-003); 北京协和医学院教学改革项目(2018E-JG07); 北京协和医学院-国家外国专家局外国专家项目(2015,2016,T2017025,T2018046,G2019001660); 重庆市卫计委医学科研计划项目(2017MSXM090); 重庆市科委社会事业与民生保障科技创新专项项目(cstc2017shmsA130063)

Max test verify further clinical research for whether individualized symptom-limited cardiopulmonary exercise testing is the maximum extreme exercise

ZHANG Ye1, SUN Xing-guo1,2△, LIU Fang1, HAO Lu1,5, SONG Ya1,2, TAI Wen-qi1, GE Wan-gang1, LI Hao1, SHI Chao1, XU Fan1, WANG Ji-nan1, ZHANG Yan-fang1,2, ZHOU Qing-qing1,2, CHEN Rong, 1,3, ZOU Yu-xin1,4,5, MA Ming-xin, 1,3, XIA Rui1,3, HUANG Yan1,3, XIE You-hong2   

  1. 1. Fuwai Hospital,Chinese Academy of Medical Sciences/National Center for Cardiovascular Diseases/ State Key Laboratory of Cardiovascular Diseases/Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100037;
    2. The Affiliated Rehabilitation Hospital of Chongqing Medical University, Chongqing 400050;
    3. Dalian Children's Hospital, Dalian 116000;
    4. Liaocheng People's Hospital, Liaocheng 252000;
    5. Henan Provincial People's Hospital, Henan 450003, China
  • Received:2020-08-12 Revised:2021-03-10 Online:2021-03-28 Published:2021-10-20

摘要: 目的: 验证临床受试者所完成的心肺运动试验(CPET)为最大极限运动,进一步设计完善Max试验验证CPET结果客观定量功能评估的准确性及以某特定指标的特定数值作为停止运动的标准是否可行。方法: 选择2017年9月至2019年1月在阜外医院签署知情同意书后进行CPET和Max试验受试者216例。其中正常受试者41例,因CPET峰值呼吸交换率(RER)≤1.10,或运动中心率和血压不上升,对CPET极限运动结果存在质疑的临床患者175例进行研究。其中60例已初步报告,本研究进一步扩大研究。Max试验方法:完成CPET测试后,先蹬车≥60 r/min,再施加130%峰值功率的恒定功率,鼓励受试者运动至不能坚持的极限状态。计算分析Max试验30 s的最大心率和最大摄氧量、及其与峰值心率和峰值摄氧量之间的差值和百分差值。百分差值=(Max值-峰值值)/Max值× 100%。评测标准:①若心率和摄氧量任一指标的差值百分比≤-10%(Max测试的数值低于CPET峰值数据)则定义Max试验操作失败,否则为成功;2若心率和摄氧量的差值百分比均在-10%~10%,则Max试验操作成功,证明CPET数据为极限运动,CPET 峰值相关数据较为准确;③若心率和摄氧量差值任一指标差值百分比≥10%时,则Max试验操作成功,证明CPET结果为非极限运动。结果: 病例组峰值摄氧量(L/min、ml/(min·kg)、%pred)、无氧阈(L/min、ml/(min·kg)、%pred)、峰值氧脉搏(ml/beat、%pred)、峰值RER、峰值收缩压(mmHg)、峰值运动负荷(W/min)、峰值心率(bpm)、摄氧有效性峰值平台(OUEP)(比值、%pred)低于正常组,二氧化碳通气有效性平均90 s最低值(Lowest Ve/VCO2)(比值、%pred)、二氧化碳通气效率斜率(Ve/VCO2 Slope)(比值、%pred)高于正常组(P<0.05)。所有正常组与病例组均安全无任何事件完成CPET和Max试验。216例受试者中,Max试验成功198例(91.7%),其中证明CPET为极限运动182例,为非极限运动16例;失败18例(8.3%)。结论: 在临床检查中,若对CPET结果是否为最大极限存在质疑,利用Max试验可验证CPET是否为极限运动。Max试验方法安全可行,值得进一步深入研究和临床推广应用。

关键词: 心肺运动试验, 症状限制最大极限运动, 呼吸交换率, Max试验, 血压, 心率

Abstract: Objective: To verify that the cardiopulmonary exercise testing (CPET) performed by clinical subjects is the maximum extreme exercise, we designed The Max test(Max)during clinical CPET. We used Max to verify the accuracy of the quantitative CPET evaluation result, and whether it is feasible and safe to use the specific value of a certain index as the standard for stopping CPET. Methods: Two hundred and sixteen cases from Fuwai Hospital were selected during June 2017 to January 2019,including 41 healthy person(control group) and 175with cardiovascular diseases(patient group),The patients had a CPET peak RER ≤ 1.10, or the peak heart rate and peak blood pressure were basically non-responsive.The Max was first attempted in 60 subjects,and this study is further expanded . When the CPET ended, they had a 5-minute break, then the Max, during which, they cycled with a velocity of ≥ 60 r/min, at a constant intensity equivalent to to 130% of peak work,until exhausted.The difference and percentage difference between the peak heart rate and the peak oxygen uptake were calculated. ①If the percentage difference of heart rate and oxygen uptake are all less than -10%,then the Max is defined as failure,otherwise it is succesful. 2 If the percentage difference is between -10%~10%, then the Max is successful, which proved that the CPET is precise.③If the difference is ≥10%, the Max is successful, which proves that the CPET is non-extreme exercise. Results: Patient group's Peak VO2(L/min,ml/(min·kg)),anaerobic threshold (L/min,ml/(min·kg),%pred),Peak VO2/HR(ml/beat, % pred),Peak RER,Peak SBP,Peak WR,peak heart rate,OUEP (ratio,%pred) were lower than those of the control group(P<0.05).The VE/ VCO2 Slope (ratio,%pred)and Lowest VE/ VCO2(ratio,%pred) were higher in the patient group than in the control group (P<0.05).No adverse events occurred during the CPET and Max in all cases. Among the 216 cases,Max was successful in 198 cases(91.7%).CPET was proved to be maximum extreme exercise for 182 cases,non-maximum extreme exercise for 16 cases,and failed in 18 cases(8.3%).Conclusion: For CPET with a low peak RER and a maximum challenge,the Max can confirm the accuracy of the objective quantitative assessment of CPET. Max is safe and feasible,and that deserved further research and clinical application.

Key words: cardiopulmonary exercise testing, symptom limitation maximum extreme exercise, respiratory exchange rate, max testing, blood pressure, heart rate

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