实用器官移植电子杂志 ›› 2024, Vol. 12 ›› Issue (1): 8-12.DOI: 10.3969/j.issn.2095-5332.2024.01.003? ?

• 论著 • 上一篇    下一篇

通过心肺运动试验初步探索左心室辅助装置对终末期心力衰竭患者术后早期活动耐量的影响

陈志高 1,胡俊龙 1,王保才 1,孙俊杰 1,轩继中 1,张晓雪 1,孟树萍 2,赵亮 3,杨雷一 4,林松 5,程兆云 1   

  1. 1.阜外华中心血管病医院成人心外一病区,河南 郑州 450000;

    1. 阜外华中心血管病医院成人心外科重症监护室,河南 郑州 450000 ;

    2. 阜外华中心血管病医院麻醉科,河南 郑州 450000 ;

    3. 阜外华中心血管病医院体外循环科,河南 郑州 450000 ;

    4. 阜外华中心血管病医院康复中心,河南 郑州 450000)

  • 出版日期:2024-01-20 发布日期:2024-03-06
  • 基金资助:

    河南省医学科技攻关计划(联合共建)项目(LHGJ20190788)

Initially exploration of the effect of left ventricular assist device on early postoperative activity tolerance inpatients with end-stage heart failure by cardiopulmonary exercise test

ChenZhigao1,Hu Junlong1,WangBaocai1,Sun Junjie1,Xuan Jizhong1,ZhangXiaoxue1,Meng Shuping2,Zhao Liang3,Yang Leiyi4,Lin Song5,Cheng Zhaoyun1.    

  1. 1. Fuwai Central China Cardiovascular Hospital Adult Cardiac Surgery Ward 1,ZhengZhou 450000,Henan,China;

    2.FuwaiCentralChinaCardiovascularHospitalAdultCardiac Surgery IntensiveCareUnit,ZhengZhou 450000,Henan,China ;

    3.Fuwai Central China Cardiovascular Hospital Department of Anesthesiology,ZhengZhou 450000,Henan,China ;

    4.FuwaiCentralChinaCardiovascularHospitalDepartment ofExtracorporealCircuIation,ZhengZhou 450000,Henan,China ;5.FuwaiCentralChinaCardiovascularHospitalRehabilitationCentre,ZhengZhou 450000,Henan,China.

  • Online:2024-01-20 Published:2024-03-06

摘要:

目的 通过心肺运动试验(cardiopulmonary exercise test,CPET)对终末期心力衰竭患者左心室辅助(left ventricular assist device,LVAD)术后运动能力恢复的情况进行初步探索。方法 回顾性分析2021 年 10 月至 2022 年 10 月,于阜外华中心血管医院接受 LVAD 植入术的 11 例终末期心力衰竭患者,这部分患者术后早期进行心肺运动试验检查并收集相关参数进行分析。结果 2021 年 10 月至 2022 年 10 月完成的 11 例 LVAD 患者中,男性为 9 例占比 81.8%,平均年龄为 42 岁 ;病因方面主要为扩张型心肌病 7 例和心肌致密化不全 2 例,占比 81.8% ;4 例患者为 IABP 过渡至 LVAD,占比 36.4%。术前超声心动图提示这部分患者左心功能较差〔左心室射血分数(21.4±4.2)%,左室舒张末径(80.6±10.4)mm〕,但右心功能处于正常范围〔右室前后径(24.8±4.9)mm,三尖瓣环收缩期位移(18.2±4.7)mm〕。SWAN-GANZ 导管提示肺动脉压力偏高〔肺动脉收缩压(41.5±8.7)mmHg,1 mmHg = 0.133 kPa〕。临床结局方面 :1 例患者出现围手术期死亡,10 例患者存活良好。术后活动耐量方面 :术后 30 d 时活动耐量较差,但术后 3 个月时活动耐量均有明显改善,其中峰值摄氧量显著提高〔(12.9±2.8)ml/(kg·min)比(15.8±1.3)ml/(kg·min),P = 0.05〕,二氧化碳通气有效性斜率显著下降〔42.6±6.3)ml/(kg·min)比(31.7±6.6)ml/(kg·min),P = 0.001〕。结论 LVAD 是治疗终末期心力衰竭的有效手段,能够显著改善心衰患者的活动耐量。

关键词:

 , 心肺运动试验 左心室辅助装置 活动耐量

Abstract:

Objective To initially explore of left ventricular assisted method(left ventricular assistdevice, LVAD)on cardiopulmonary exercise test (cardiopulmonary exercise test, CPET). Methods Ananalysis of 11 patients with end-stage heart failure who underwent LVAD implantation in our hospital from October 2021to October 2022 was conducted,these patients underwent cardiopulmonary exercise test early after surgery and relevantparameters were collected for analysis. Results Among the 11 LVAD patients from October 2021 to October 2022,9 cases were males (81.8%),and the mean age was 42 years ;A total number of 7 cases were dilated cardiomyopathyand 2 cases were myocardial insufficiency,accounting for 36.4%. Preoperative echocardiography suggested that thesepatients had poor left heart function〔left ventricular ejection fraction(21.4±4.2)%,left ventricular diastolic diameter(80.6±10.4)mm〕,but the right heart function was in the normal range〔right ventricular anterior and posterior diameter(24.8±4.9)mm,(18.2±4.7)mm systolic displacement of the tricuspid annulus〕. The SWAN-GANZ catheter indicateda high pulmonary artery pressure〔pulmonary artery systolic pressure(41.5±8.7)mmHg〕. Clinical outcome: onepatient had perioperative death,and 10 patients survived well. Postoperative activity tolerance: The activity tolerancewas poor at 30 days after surgery,but activity tolerance improved significantly at 3 months,with peak oxygen uptake〔(12.9 ± 2.8)ml/(kg·min)vs(15.8 ± 1.3)ml/(kg·min),P = 0.05〕and the slope of carbon 2 ventilation effectiveness〔(42.6 ± 6.3)ml/(kg·min)vs(31.7 ± 6.6)ml/(kg·min),P = 0.001〕. Conclusion LVAD is an effective means totreat end-stage heart failure and can significantly improve the activity tolerance in patients with heart failure.

Key words:

 , Cardiopulmonary exercise test; Left ventricular assist device; Activity tolerance