CPET心肺运动试验VIP免费

MITCHELLHOROWITZCardiopulmonaryExerciseTestingOutlineDescriptionofCPETWhoshouldandwhoshouldnotgetCPETWhentoterminateCPETExercisephysiologyDefineterms:respiratoryexchangeratio,ventilatoryequivalent,heartratereserve,breathingreserve,oxygenpulsePatternofCPETresultsCOPDvsCHFRationaleforExerciseTestingCardiopulmonarymeasurementsobtainedatrestmaynotestimatefunctionalcapacityreliablyClinicalExerciseTests6-minwalktestSubmaximalShuttlewalktestIncremental,maximal,symptom-limitedExercisebronchoprovocationExertionaloximetryCardiacstresstestCPETKarlmanWassermanCouplingofExternalVentilationandCellularMetabolismAdaptationsofWasserman’sGearsGeneralMechanismsofExerciseLimitationPulmonaryVentilatoryRespiratorymuscledysfunctionImpairedgasexchangeCardiovascularReducedstrokevolumeAbnormalHRresponseCirculatoryabnormalityBloodabnormalityPeripheralInactivityAtrophyNeuromusculardysfunctionReducedoxidativecapacityofskeletalmuscleMalnutritionPerceptualMotivationalEnvironmentalWhatisCPET?Symptom-limitedexercisetestMeasureairflow,SpO2,andexpiredoxygenandcarbondioxideAllowscalculationofpeakoxygenconsumption,anaerobicthresholdComponentsofIntegratedCPETSymptom-limitedECGHRMeasureexpiredgasOxygenconsumptionCO2productionMinuteventilationSpO2orPO2PerceptualresponsesBreathlessnessLegdiscomfortModifiedBorgCR-10ScaleIndicationsforCPETEvaluationofdyspneaDistinguishcardiacvspulmonaryvsperipherallimitationvsotherDetectionofexercise-inducedbronchoconstrictionDetectionofexertionaldesaturationPulmonaryrehabilitationExerciseintensity/prescriptionResponsetoparticipationPre-opevaluationandriskstratificationPrognosticationoflifeexpectancyDisabilitydeterminationFitnessevaluationDiagnosisAssessresponsetotherapyMortalityinCFPatientsNixonetal;NEJM327:1785;1992.Followed109patientswithCFfor8yrsfromCPETPeakVO2>81%predicted:83%survivalPeakVO259-81%predicted:51%survivalPeakVO2<59%predicted:28%survivalMortalityinCHFPatientsMancinietal;Circulation83:778;1991.PeakVO2>14ml/kg/min:1-yrsurvival94%2-yrsurvival84%PeakVO2≤14ml/kg/min:1-yrsurvival47%2-yrsurvival32%CPETtoPredictRiskofLungResectioninLungCancerLimetal;Thorax65:iii1,2010Albertsetal;Chest132:1s,2007Baladyetal;Circulation122:191,2010PeakVO2>15ml/kg/minNosignificantincreasedriskofcomplicationsordeathPeakVO2<15ml/kg/minIncreasedriskofcomplicationsanddeathPeakVO2<10ml/kg/min40-50%mortalityConsidernon-surgicalmanagementAbsoluteContraindicationstoCPETAcuteMIUnstableanginaUnstablearrhythmiaAcuteendocarditis,myocarditis,pericarditisSyncopeSevere,symptomaticASUncontrolledCHFAcutePE,DVTRespiratoryfailureUncontrolledasthmaSpO2<88%onRAAcutesignificantnon-cardiopulmonarydisorderthatmayaffectorbeadverselyaffectedbyexerciseSignificantpsychiatric/cognitiveimpairmentlimitingcooperationRelativeContraindicationstoCPETLeftmainor3-VCADSeverearterialHTN(>200/120)SignificantpulmonaryHTNTachyarrhythmia,bradyarrhythmiaHighdegreeAVblockHypertrophiccardiomyopathyElectrolyteabnormalityModeratestenoticvalvularheartdiseaseAdvancedorcomplicatedpregnancyOrthopedicimpairmentIndicationsforEarlyExerciseTerminationPatientrequestIschemicECGchanges2mmSTdepressionChestpainsuggestiveofischemiaSignific...