慢性阻塞性肺疾病患者通气有效性与运动后心脏功能的关系

doi:10.3969/j.issn.1006-9771.2021.07.013

Abstract

Abstract:

Objective To observe the relationship of ventilatory efficiency to cardiac function, especially heart rate recovery after exercise for patients with chronic obstructive pulmonary disease (COPD).

Methods From January, 2019 to December, 2020, 190 patients with COPD were recruited for Cardiopulmonary Exercise Testing. The general condition, medical history and medication history, lung function test and parameters of Cardiopulmonary Exercise Testing were recorded. They were divided into normal group and delay group according to whether the heart rate decline more than twelve beats within a minute after Cardiopulmonary Exercise Testing.

Results There were 89 patients (46.84%) in the delay group. Compared with the normal group, the delay group were older (Z = 2.282, P < 0.05), with less ratio of force exiratory volume in the first second in prediction (FEV_1.0%) (Z = 3.626, P < 0.001), maximum power (t = 5.547, P < 0.001), breath reserve (BR) (t = 2.122, P < 0.05) and higher minimum ventilation equivalent of carbon dioxide (VE/VCO_2nadir) (Z = 3.296, P = 0.001). Logistic regression showed that the COPD severity, VE/VCO_2nadir and BR correlated with heart rate recovery. After adjusting for gender, age, body mass index and COPD severity, VE/VCO_2nadir was an independent risk factor for delayed heart rate recovery (OR = 1.203, 95%CI 1.032 to 1.873, P = 0.004), and the best cut-off point was 33.15 (AUC = 0.6387, 95%CI 0.5595 to 0.7178, P = 0.001).

Conclusion The ventilatory inefficiency may increase the risk of abnormal heart rate recovery after exercise in COPD patients.

Key words: chronic obstructive pulmonary disease, Cardiopulmonary Exercise Testing, heart rate recovery, ventilatory efficiency

CLC Number:

R562.2

ZENG Bin,LIU Ya-kang,WANG Long-ping,ZHANG Ming-sheng. Relationship of Ventilatory Efficiency to Cardiac Function after Exercise in Patients with Chronic Obstructive Pulmonary Disease[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(7): 812-818.

Figures/Tables 4

References 32

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项目	所有患者(n = 190)	正常组(n = 101)	延迟组(n = 89)	χ²/Z/t值^a	P值^a
男性(n)	126	71	55	1.530	0.216
年龄(岁)	69(61,74)	67(60,72)	70(63,77)	2.282	0.023
BMI(kg/m²)	21.69±3.03	22.02±2.87	21.33±3.18	1.579	0.116
持续吸烟(n)	38	18	20	0.639	0.424
高血压病(n)	85	45	40	0.003	0.957
糖尿病(n)	19	11	8	0.190	0.663
FVC(L)	2.48(2.04,3.09)	2.63(2.24,3.26)	2.28(1.88,2.83)	2.993	0.003
FVC%pre(%)	78.10(64.36,85.70)	80.11(68.77,91.60)	76.32(61.80,83.90)	2.915	0.004
FEV₁(L)	1.32(0.98,1.64)	1.43(1.06,1.92)	1.09(0.82,1.47)	4.538	< 0.001
FEV₁%pre(%)	52.50(38.69,68.90)	61.35(41.50,73.52)	46.80(36.00,61.10)	3.626	< 0.001
FEV₁/FVC(%)	56.91(43.60,63.53)	60.51(49.21,64.85)	52.05(39.72,60.88)	3.596	<0.001
气道阻塞严重程度分级(Ⅰ/Ⅱ/Ⅲ/Ⅳ级,n)	27/82/64/17	22/45/27/7	5/37/37/10	12.870	0.005
使用糖皮质激素(n)	92	48	44	0.069	0.792
使用β受体激动剂(n)	137	68	69	2.448	0.118
使用M受体抑制剂(n)	89	42	47	2.839	0.092
使用β受体抑制剂(n)	32	18	14	0.148	0.701
使用钙离子拮抗剂(n)	26	11	15	1.424	0.233

参数	所有患者(n = 190)	正常组(n = 101)	延迟组(n = 89)	χ²/Z/t值^a	P值^a
W_max(W)	81.80±29.76	92.25±26.24	69.94±29.19	5.547	< 0.001
W_max%pre (%)	67.00(52.70,92.00)	76.53(60.00,94.08)	62.20(43.00,81.90)	3.933	< 0.001
VO_2max(L/min)	1.14(0.92,1.41)	1.27(1.11,1.57)	1.00(0.82,1.19)	5.983	< 0.001
VO_2max%pre (%)	70.25±23.40	75.36±20.50	64.46±25.20	5.451	< 0.001
VO_2max@kg〔L/(min·kg)〕	18.00(15.00,21.00)	20.00(17.00,23.50)	16.00(13.00,19.00)	5.436	< 0.001
VE_max(L/min)	41.25(32.70,50.60)	44.70(37.00,54.25)	36.45(28.50,46.30)	4.490	< 0.001
BR (L/min)	11.40±16.99	13.80±18.79	8.69±14.31	2.122	0.035
BRexh (n)	111(58.42%)	52(51.49%)	59(66.29%)	4.270	0.039
VD/VT	0.24(0.21,0.27)	0.23(0.20,0.26)	0.25(0.22,0.28)	2.831	0.005
VE/VCO_2slop	28.98(25.21,32.94)	28.62(25.18,32.08)	29.33(25.24,34.09)	0.393	0.695
VE/VCO_2nadir	31.75(28.20,35.40)	29.90(27.25,33.90)	33.20(29.20,36.90)	3.296	0.001
HR-0 (/min)	129.91±21.10	136.04±20.26	122.96±19.98	4.471	< 0.001
HR-1 (/min)	118.03±19.45	116.64±19.66	119.61±19.20	1.053	0.293
HRR_d (/min)	11.88±10.08	19.41±6.89	3.35±5.04	18.118	< 0.001

因素		单因素		多因素模型1		多因素模型2		多因素模型3
因素		P值	OR (95%CI)	P值	OR (95%CI)	P值	OR (95%CI)	P值	OR (95%CI)
性别		0.740	0.865 (0.367~2.037)	0.189	1.974 (0.716~5.438)	0.118	2.163 (0.823~5.686)	0.426	1.459 (0.576~3.695)
年龄		0.068	1.029 (0.998~1.060)	0.123	1.026 (0.993~1.059)	0.272	1.019 (0.985~1.053)	0.078	1.029 (0.997~1.062)
BMI		0.117	0.926 (0.841~1.019)	0.532	0.967 (0.870~1.075)	0.936	1.005 (0.898~1.123)	0.331	0.950 (0.858~1.053)
VD/VT		0.013	4604.187 (5.835~3632731.066)	0.142	493.912 (0.126~1935337.612)	—	—	—	—
VE/VCO_2nadir		0.001	1.101 (1.040~1.166)	—	—	0.004	1.203 (1.032~1.873)	—	—
BR		0.040	0.982 (0.965~0.999)	—	—			0.855	0.932 (0.436~1.991)
气道阻塞严重程度分级	整体	0.009	—	0.046	—	0.011		0.041
	Ⅰ	—	1.00	—	1.00	—	1.00	—	1.00
	Ⅱ	0.018	3.618 (1.248~10.484)	0.025	3.480 (1.170~10.351)	0.028	3.456 (1.144~10.443)	0.021	3.747 (1.215~11.554)
	Ⅲ	0.001	6.030 (2.026~17.941)	0.006	4.925 (1.581~15.338)	0.003	3.456 (1.144~10.443)	0.005	6.233 (1.731~22.438)
	Ⅳ	0.009	6.286 (1.598~24.727)	0.023	5.457 (1.268~23.492)	0.004	8.526 (1.969~36.925)	0.014	7.481 (1.504~37.208)

Relationship of Ventilatory Efficiency to Cardiac Function after Exercise in Patients with Chronic Obstructive Pulmonary Disease

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