《适者生存》PPT课件

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1、適者生存：心臟運動測試的新風貌Survivalofthefittest:Anewlookatcardiacexercisetest2007物理治療繼續再教育課程中華民國物理治療學會主辦慈濟技術學院物理治療系與研發中心承辦講員：黃千惠8/3/20211主題大綱傳統心臟運動測試（cardiacextest，CET）介紹：歷史沿革與方法；強調『運動中』的變化新近心臟運動測試發展：預測死亡率；強調『運動開始』『運動恢復』的變化，主要是心跳文獻回顧：運動後心跳恢復率的預後意義台灣資料：血管正常者之心跳恢復率8/3/20212Cardiacexercisetest:CETCardiacpu

2、lmonaryexercisetest:CPET8/3/20213傳統心臟運動測試起源：thediscoverythatexerciseinp’twithcoronarydiseaseproducedSTsegmentdepressionFeil&Siegel(1928)exercisedp’twithanginatobringaboutpain.Theyperformedstresstestbysit-ups.Master（1929）publishedpaperusingpulseandBPtoevaluatethecardiaccapacity.（Hiscontribution:

3、exerciseprotocolratherthanuseofECG.）8/3/20214傳統心臟運動測試重要沿革1Goldhammer&Scherf(1932):STdepressionwaspresentin75%p’twithanginaandproposedtheuseofexercisetoconfirmthediagnosisofcoronaryischemia.Katz&Landt(1935):lead5isbetterintermsofdiscriminationthanlead4.UseofanoxiatobringchangesinSTsegment.8/3/2

4、0215傳統心臟運動測試重要沿革2Missal(1938):havingp’trunup3-6flightsofstairsandhemightbethefirsttouseamaxstresstestandtothepointofpainandemphasizedthenecessityoftakingtherecordingasquicklyaspossiblethereafter.8/3/20216傳統心臟運動測試重要沿革3Risemanetal(1940):thefirsttousecontinuousmonitoringanddiscoveredthatSTdepres

5、sionappearedbeforetheonsetofpainandpersistedforatimeafterthepainsubsided.Theyconcludedthatexercisewasoflittlevaluebecauseofitspoordiscriminationbetweenthenormalandtheabnormalsubjects.8/3/20217傳統心臟運動測試重要沿革4Johnsonetal(1942):developedHarvardStepTest.Usepulsecountsduringrecoveryandprovideanindexo

6、fphysicalfitness.Hellerstein&katz(1949):STdepressionisprimarilyadiastolicinjurycurrentmanifestedduringtheTQinterval.8/3/20218傳統心臟運動測試重要沿革5Woodetal:Pushthep’ttothemaxleveloftheircapacityTheamountofworkshouldnotbefixed,butadjustedtotheindividualThemorestrenuousworkwouldproduceahigherpercentageof

7、positivetestsRecommendtheuseofthestresstesttouncoverlatentmyocardialischemia.8/3/20219傳統心臟運動測試重要沿革6Bruce(1956):worktestperformedonatreadmillandestablishedguidelinethatwouldmoreorlessgroupp’tintotheNYHDCIthroughIVAstrand&Ryhming:m