心肺运动试验ppt课件_1

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1、MitchellHOROWitzCardiopulmonaryExerciseTestingOutlineDescriptionofCPETWhoshouldandwhoshouldnotgetCPETWhentoterminateCPETExercisephysiologyDefineterms:respiratoryexchangeratio,ventilatoryequivalent,heartratereserve,breathingreserve,oxygenpulsePatternofCPETresultsCOPDvsCHFRationaleforExe

2、rciseTestingCardiopulmonarymeasurementsobtainedatrestmaynotestimatefunctionalcapacityreliablyClinicalExerciseTests6-minwalktestSubmaximalShuttlewalktestIncremental,maximal,symptom-limitedExercisebronchoprovocationExertionaloximetryCardiacstresstestCPETKarlmanWassermanCouplingofExternal

3、VentilationandCellularMetabolismAdaptationsofWasserman’sGearsGeneralMechanismsofExerciseLimitationPulmonaryVentilatoryRespiratorymuscledysfunctionImpairedgasexchangeCardiovascularReducedstrokevolumeAbnormalHRresponseCirculatoryabnormalityBloodabnormalityPeripheralInactivityAtrophyNeur

4、omusculardysfunctionReducedoxidativecapacityofskeletalmuscleMalnutritionPerceptualMotivationalEnvironmentalWhatisCPET?Symptom-limitedexercisetestMeasureairflow,SpO2,andexpiredoxygenandcarbondioxideAllowscalculationofpeakoxygenconsumption,anaerobicthresholdComponentsofIntegratedCPETSymp

5、tom-limitedECGHRMeasureexpiredgasOxygenconsumptionCO2productionMinuteventilationSpO2orPO2PerceptualresponsesBreathlessnessLegdiscomfortModifiedBorgCR-10ScaleIndicationsforCPETEvaluationofdyspneaDistinguishcardiacvspulmonaryvsperipherallimitationvsotherDetectionofexercise-inducedbroncho

6、constrictionDetectionofexertionaldesaturationPulmonaryrehabilitationExerciseintensity/prescriptionResponsetoparticipationPre-opevaluationandriskstratificationPrognosticationoflifeexpectancyDisabilitydeterminationFitnessevaluationDiagnosisAssessresponsetotherapyMortalityinCFPatientsNixo

7、netal;NEJM327:1785;1992.Followed109patientswithCFfor8yrsfromCPETPeakVO2>81%predicted:83%survivalPeakVO259-81%predicted:51%survivalPeakVO2<59%predicted:28%survivalMortalityinCHFPatientsMancinietal;Circulation83:778;1991.PeakVO2>14ml/kg/min:1-yrsurvival94%2-yrsurvival84%PeakVO2≤14ml/kg