急性肺栓塞后第 1 天至 6 个月心肺功能和运动参数的预测能力

IF 1 Q4 RESPIRATORY SYSTEM Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine Pub Date : 2018-08-16 eCollection Date: 2018-01-01 DOI:10.1177/1179548418794155

Dirk Habedank, Christian Opitz, Tim Karhausen, Thomas Kung, Ingo Steinke, Ralf Ewert

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摘要

我们假设，通气量与二氧化碳排出量的斜率（V'E/V'CO2-slope）在亚严重性肺栓塞（PE）后的最初几天就能预测 6 个月后的右心室收缩压（超声心动图显示为 RVsys）。我们对 21 名血流动力学稳定的患者在入院时、第 3 天、第 7 天、第 90 天和第 180 天进行了心肺运动测试和超声心动图检查。V'E/V'CO2-斜率（48.4 ± 10.8）在第一周内下降（第 7 天为 43.0 ± 9.8），并在 6 个月的随访前恢复正常（35.0 ± 11.3；P -4），p(a-ET)CO2 在第 1 天和第 3 天之间保持异常（5.0 ± 3.9 至 6.7 ± 5.3 mmHg）。6 个月时，RVsys 从 41.7 ± 14.3 mmHg 降至 26.3 ± 13.1 mmHg（P -4）。第 7 天的 V'E/V'CO2-slope (r²= 0.27; P sys (r²= 0.28; P = .03) 与 6 个月时的 RVsys 相关。6 个月后，p(a-ET)CO2、p(a-ET)O2、V'D/V'T 与 RVsys 无关。急性 PE 后 6 个月的 RVsys 与第 7 天的 V'E/V'CO2 斜率呈正相关。

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Predictive Capability of Cardiopulmonary and Exercise Parameters From Day 1 to 6 Months After Acute Pulmonary Embolism.

We hypothesized that the slope of relation ventilation to carbon dioxide output (V'E/V'CO2-slope) could be predictive already during the very first days after submassive pulmonary embolism (PE) to right ventricular systolic pressure (RV_sys by echocardiography) after 6 months. We evaluated 21 hemodynamically stable patients at admittance, at days 3, 7, 90, and 180 by cardiopulmonary exercise testing and echocardiography. V'E/V'CO2-slope (48.4 ± 10.8) decreased within the first week (43.0 ± 9.8 at day 7) and normalized until follow-up at 6 months (35.0 ± 11.3; P < 10^-4), p(a-ET)CO₂ remained abnormal between days 1 and 3 (5.0 ± 3.9 to 6.7 ± 5.3 mmHg). RV_sys declined from 41.7 ± 14.3 to 26.3±13.1 mmHg (P < 10^-4) at 6 months. V'E/V'CO2-slope (r²= 0.27; P < .02) and RV_sys (r² = 0.28; P = .03) at day 7 correlated with RV_sys at 6 months. p_(a-ET)CO₂, p_(a-ET)O₂, V'D/V'T were not related to RV_sys after 6 months. RV_sys 6 months after acute PE is positively correlated with the V'E/V'CO2-slope at day 7.