心肺运动试验ppt课件_1

MITCHELL HOROWITZCardiopulmonary Exercise TestingOutline Description of CPET Who should and who should not get CPET When to terminate CPET Exercise physiology Define terms: respiratory exchange ratio, ventilatory equivalent, heart rate reserve, breathing reserve, oxygen pulse Pattern of CPET results COPD vs CHFRationale for Exercise TestingCardiopulmonary measurements obtained at rest may not estimate functional capacity reliablyClinical Exercise Tests 6-min walk test Submaximal Shuttle walk test Incremental, maximal, symptom-limited Exercise bronchoprovocation Exertional oximetry Cardiac stress test CPETKarlman WassermanCoupling of External Ventilation and Cellular MetabolismAdaptations of Wassermans GearsGeneral Mechanisms of Exercise Limitation Pulmonary Ventilatory Respiratory muscle dysfunction Impaired gas exchange Cardiovascular Reduced stroke volume Abnormal HR response Circulatory abnormality Blood abnormality Peripheral Inactivity Atrophy Neuromuscular dysfunction Reduced oxidative capacity of skeletal muscle Malnutrition Perceptual Motivational EnvironmentalWhat is CPET? Symptom-limited exercise test Measure airflow, SpO2, and expired oxygen and carbon dioxide Allows calculation of peak oxygen consumption, anaerobic thresholdComponents of Integrated CPET Symptom-limited ECG HR Measure expired gas Oxygen consumption CO2 production Minute ventilation SpO2 or PO2 Perceptual responses Breathlessness Leg discomfortModified Borg CR-10 ScaleIndications for CPET Evaluation of dyspnea Distinguish cardiac vs pulmonary vs peripheral limitation vs other Detection of exercise-induced bronchoconstriction Detection of exertional desaturation Pulmonary rehabilitation Exercise intensity/prescription Response to participation Pre-op evaluation and risk stratification Prognostication of life expectancy Disability determination Fitness evaluation Diagnosis Assess response to therapyMortality in CF Patients Nixon et al; NEJM 327: 1785; 1992. Followed 109 patients with CF for 8 yrs from CPET Peak VO2 81% predicted: 83% survival Peak VO2 59-81% predicted: 51% survival Peak VO2 14 ml/kg/min: 1-yr survival 94% 2-yr survival 84% Peak VO2 14 ml/kg/min: 1-yr survival 47% 2-yr survival 32%CPET to Predict Risk of Lung Resection in Lung CancerLim et al; Thorax 65:iii1, 2010Alberts et al; Chest 132:1s, 2007Balady et al; Circulation 122:191, 2010 Peak VO2 15 ml/kg/min No significant increased risk of complications or death Peak VO2 200/120) Significant pulmonary HTN Tachyarrhythmia, bradyarrhythmia High degree AV block Hypertrophic cardiomyopathy Electrolyte abnormality Moderate stenotic valvular heart disease Advanced or complicated pregnancy Orthopedic impairmentIndications for Early Exercise Termination Patient request Ischemic ECG changes 2 mm ST depression Chest pain suggestive of ischemia Significant ectopy 2nd or 3rd degree heart block Bpsys 240-250, Bpdias 110-120 Fall in BPsys 20 mmHg SpO2 1 (CO2 production O2 consumption). Carbon dioxide regulates ventilation. Ventilation will disproportionately increase at lactate threshold to eliminate excess CO2. Increase in ventilatory equivalent f