心肺功能测定与冠心病的诊断和预后评价-王宁夫

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1、心肺功能测定与冠心病的诊断和预后评价南京医科大学附属杭州医院心内科王宁夫CardiopulmonaryExerciseTestAndCAD心肺运动试验与心电图运动试验对比EuropeanHeartJournal2003Volume24,Number14P<0.0001P<0.00010102030405060708090特异性%敏感性%心肺运动试验心电图运动试验Detectionofexerciseinducedischaemia:anewroleforCEPTTheprognosticanddiagnosticvalueoftheexercisetestis

2、maximized,whenmultipleexercisefindingsareconsideredanditseems,thatrespiratorygasanalysisoffersnewperspectivesinthissense.CardiologistsshouldrealisethatwithCPETwehaveanenormouslypowerfultooltoourdisposal.EuropeanHeartJournal2003Volume24,Number14EditorialThepredictivevalueofcardioresp

3、iratoryfitnessFranzX.Kleber*CharitéMedicalSchool,UkbAcademicTeachingHospital,Berlin,Germany,EHJ200425:1428-1437.[Abstract][FullText]Furthermore,peakoxygenconsumptionisamoreaccurateandreproduciblemeasureandhasbeenshowntobeanexcellentpredictorofoutcomeinvariousdiseases.Recently,large

4、scaleinvestigationsofexercisecapacityderivedfrompeakcardiorespiratoryexercisedatahavebeenusedtostudytherelationshipbetweenVO2maxandriskofcardiacandallcausedeathandinheartfailurecardiopulmonaryexercisetestresultshavebeenestablishedasoutstandingprognosticinformation.心肺运动试验(CPET)定义CPET

5、可提供一个包括呼吸系统，心血管系统，造血系统以及骨骼肌系统综合运动反应的整体评估，这是测定单一器官系统功能所无法充分反应的。该试验具有无创、动态、生理性的特点。慢性心力衰竭心预后的评估目前最常用的是Weber-Janicki分级PeakoxygenpulseduringexerciseasapredictorforcoronaryheartdiseaseandallcausedeathHeart2006;92:1219-1224Objective:ToinvestigatetheprognosticvalueofpeakoxygenpulseandVO2wit

6、hrespecttocoronaryheartdiseaseandoveralldeath.Design:Prospectivepopulation-basedstudybasedon1596menwithoutCHDortheuseofßblockersatbaseline.Duringanaveragefollowupof14years,267mendied,67ofthemduetoCHD.Therespectiveriskforoveralldeathwas1.79(95%CI1.21to2.65).心肺运动试验与冠心病及预后P<0.0001P<0.0

7、0010102030405060708090VO2/pulse<13.5ml死亡率VO2/pulse>17.5ml冠心病发病率2.45倍(95%CI1.10to5.45)1.79(95%CI1.21to2.65)VO2分层及预后的评估SurvivalcurvesforpatientsachievingpeakVO2valuesaboveversusbelow10,12,14,and16mL·kg·min预后的评估整个队列随访信息完成了98.3%，在平均四年的随访过程中，187病人死亡(29%)，101进行了心脏移植，精确的1和5年生存率分别为90.5%和73.

8、4%，运动峰值氧耗量(VO2)是独立的