目的 通过心肺运动试验观察心脏外科术后患者早期的运动能力特点。方法 纳入安贞医院行心脏外科术后早期心肺运动试验的患者,接受心脏外科手术后3个月内行心肺运动试验的患者40例,以手术日至心肺运动试验检查日的天数将患者分为出院组(术后30天内,20例)、术后1月组(术后30~60天,10例)和术后2月组(术后60~90天,10例),探讨不同时段心脏外科术后患者的运动能力特点;另将20例出院组按手术类型又分为大血管组(9例)、搭桥组(6例)和瓣膜组(5例),并进一步观察不同手术类型患者出院时(术后30天内)的运动能力,即观察不同时段和不同手术类型的所有患者从静息开始运动到无氧阈强度时的心率变化、收缩压变化,以及心肺运动试验指标(无氧阈、峰值摄氧量及二氧化碳通气当量)。结果 所有患者均完成无氧阈值以上的心肺运动试验,未发生运动意外等不良事件。(1)不同时段患者的运动能力:出院组达到无氧阈时的心率上升(8.8±7.1)次/分,显著低于术后1月组[(17.0±5.9)次/分]和术后2月组[(18.3±10.5)次/分],且差异有统计学意义(P<0.05);出院组的无氧阈和峰值摄氧量分别为(8.0±1.5)和(11.0±2.9)m L/(kg·min),显著低于术后1月组[(11.2±3.1)和(15.6±4.2)m L/(kg·min)]和术后2月组[(11.9±2.6)和(15.7±2.8)m L/(kg·min)],差异均有统计学意义(P<0.05),而术后1月组与术后2月组的无氧阈和峰值摄氧量组间比较,差异均无统计学意义(P>0.05);各组患者收缩压变化值及二氧化碳通气当量的组间差异均无统计学意义(P>0.05);(2)术后30天内不同手术类型患者的运动能力:大血管组和搭桥组术后患者的无氧阈[(7.2±1.3)和(7.8±0.7)m L/(kg·min)]及峰值摄氧量[(10.4±2.9)和(9.4±1.3)m L/(kg·min)],分别明显低于瓣膜组[(9.6±1.5)m L/(kg·min)及(14.2±2.3)m L/(kg·min)],且差异有统计学意义(P<0.05)。结论 心脏外科术后患者的运动能力在术后30~60天显著提高,而大血管术和搭桥术患者术后30天内的运动能力明显低于瓣膜术后患者。
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