摘要
目的分析急性心肌梗死（AMI）患者接受经皮冠状动脉介入治疗（PCI）后心肺运动试验（CPET）的相关数据,探讨完全及不完全血运重建术后AMI患者CPET的临床特点。方法纳入2015年4月-2016年6月就诊于沈阳军区总院心内科接受PCI治疗后行CPET检查的AMI患者344例,其中完全血运重建组243例（CR组,70.6%）,未完全血运重建组101例（IR组,29.4%）。全部受试者均使用瑞士Schiller CS-200心肺运动试验系统进行测试,收集其临床资料进行分析。结果 CR组与IR组基线资料无统计学差异。两组终止运动心肺试验的主要原因均为疲劳乏力,其他终止原因依次为心电图出现缺血型ST段压低、达到次极量目标心率、血压过度增高、胸痛及呼吸困难,终止原因两组间差异均无统计学意义,且均未发生恶性心律失常及死亡等不良事件。无论CR组还是IR组,无氧阈时摄氧量（AT时VO2）、峰值摄氧量（峰值VO2）均较正常值明显降低,用力肺活量（FVC%）轻度下降。CR组峰值VO2和FVC均高于IR组（P〈0.05）。结论 AMI接受PCI术后患者心肺运动耐力减低主要表现为峰值VO2和AT时VO2明显下降,FVC%轻度下降;早期行心肺运动试验具有良好的安全性;CR可改善AMI患者的峰值VO2和FVC。
Objective To analyze cardiopulmonary exercise testing（CPET）data of patients with acute myocardial infarction（AMI）, after undergoing percutaneous coronary intervention（PCI）. Methods Between April 2015 and June 2016,a total of 344 patients with AMI who underwent CPET after stent implantation in General Hospital of Shenyang Military Region were enrolled.Patients were assigned to complete revascularization（CR） group（n = 243,70.6%） and incomplete revascularization（IR） group（n =101,29.4%）. Physical capacity after PCI is measured using cardiopulmonary exercise testing（Ergo-Spiro CS-200,Schiller,Switzerland）. Results There were no statistically significant differences between groups in baseline data. The primary cause of an early test termination was muscle fatigue both in CR and IR group（97.42% vs 96.67%,respectively）. The others were myocardial ischemia showed by electrocardiogram,achievement of the predicted submaximal heart rate,abnormal blood pressure,chest pain and dyspnea. There were no differences in each cause of early test termination between two groups. None of the tests terminated because of severe arrhythmia,syncope or sudden death. All patients had lower VO2 at AT,VO2 peak and FEV%（11.4 ± 3.1 and 10.9 ± 2.7,normal value 16-33 ml/Kg/min;15.1 ± 4.0 and 14.1 ± 3.8,normal value 40-55 ml/Kg/min;72.1 ± 14.7 and 70.3 ± 14.9,normal value≥ 80,respectively） than normal range. Comparing with the incomplete revascularization group,patients with complete revascularization showed a significant increase in peak VO2/kg（15.1 ± 4.0 vs 14.1 ± 3.8,P〈0.05） and forced vital capacity（FVC）（2.88 ± 0.74 vs 2.69 ± 0.68,P〈0.05）. Conclusion After undergoing PCI, decreased exercise tolerance of cardio-respiratoryin patients with AMI mainly manifests in a significantly decreased value of VO2 at AT and VO2 peak,and lower FVC%. CPET is a safe strategy to assess patients with AMI early after PCI. Complete revascularization with PCI could improve the peak VO2/kg and FVC of p
出处
《中华保健医学杂志》
2016年第5期371-373,共3页
Chinese Journal of Health Care and Medicine
关键词
急性心肌梗死
经皮冠状动脉内介入治疗
不完全血运重建
心肺运动试验
Acute myocardial infarction
Percutaneous coronary intervention
Incomplete vascularization
Cardiopulmonary exercise testing
