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背景化疗对人体整体功能具有显著损害,但目前尚缺乏对化疗患者整体功能变化进行客观定量评估的可靠方法。目的探讨心肺运动试验(CPET)对食管癌患者化疗前后整体功能变化的评估作用。方法选取2006—2007年度在德州大学安德森癌症中心进行术前化疗的白种人男性食管癌患者6例,分别在化疗前后进行CPET检查,按照美国加州大学洛杉矶分校医学中心标准连续递增功率方案完成症状限制性极限运动,通过对数据标准化分析计算其核心指标,从系统软件导出静息状态、热身状态、无氧阈状态、极限状态时的循环指标及呼吸指标。结果 6例食管癌患者化疗后,除1例患者无氧阈略有升高外,其余患者的峰值摄氧量、无氧阈、峰值氧脉搏、摄氧效率平台、峰值负荷功率和递增功率运动时间均降低;化疗后,除1例患者的二氧化碳通气当量斜率略有降外,其余所有患者的二氧化碳通气当量斜率和二氧化碳通气当量最低值均升高。食管癌患者化疗前后无氧阈(L/min、ml·min-1·kg~(-1)、%pred)、二氧化碳通气当量斜率(slope、%pred)、递增功率运动时间(min)比较,差异均无统计学意义(P>0.05);化疗后峰值摄氧量(L/min、ml·min-1·kg~(-1)、%pred)、峰值氧脉搏(ml/次、%pred)、摄氧效率平台(比值、%pred)、峰值负荷功率(W)较化疗前降低,二氧化碳通气当量最低值(比值、%pred)较化疗前升高(P<0.05)。食管癌患者化疗后极限状态时摄氧量较化疗前降低(P<0.05);静息状态时心率较化疗前升高,收缩压较化疗前降低(P<0.05);热身状态时舒张压、平均动脉压较化疗前降低(P<0.05);4个状态时氧脉搏较化疗前降低(P<0.05);静息状态、热身状态、极限状态时摄氧通气效率较化疗前降低(P<0.05);极限状态时二氧化碳通气当量较化疗前升高(P<0.05)。食管癌患者化疗后热身状态时潮气末二氧化碳分压较化疗前降低(P<0.05);静息状态、热身状态、极限状态时潮气末氧分压较化疗前升高(P<0.05);极限状态时每呼吸摄氧量较化疗前降低(P<0.05);无氧阈状态、极限状态时每呼吸二氧化碳排出量较化疗前降低(P<0.05)。结论化疗使得食管癌患者循环和细胞代谢功能显著降低,而呼吸受限相对较轻,且处于相对代偿反应。CPET检查可以对食管癌患者化疗前的整体功能进行客观定量评估,同时也可以对化疗所造成的整体功能改变进行评估。
Background Chemotherapy has significant damage to the overall function of the human body, but there is a lack of reliable methods for objective and quantitative assessment of overall functional changes in patients undergoing chemotherapy. Objective To investigate the assessment of the changes in the overall function of patients with esophageal cancer before and after chemotherapy with cardiopulmonary exercise test (CPET). Methods Six male Caucasian esophageal cancer patients undergoing preoperative chemotherapy at the Anderson Cancer Center of Texas University from 2006 to 2007 were enrolled in this study. CPET was performed before and after chemotherapy, and the symptoms were completed according to the continuous power plan of UCLA Medical Center Restrictive extreme exercise, through the standardization of data analysis of its core indicators, derived from the system software, resting state, warm-up state, anaerobic threshold state, the limit state of the cycle index and respiratory index. Results In 6 patients with esophageal cancer, except for one patient with elevated anaerobic threshold, the other patients had peak oxygen uptake, anaerobic threshold, peak oxygen pulse, oxygen uptake efficiency platform, peak load power and progressive power movement The time was reduced. After chemotherapy, except for one patient, the slope of carbon dioxide equivalent was slightly lower, and the lowest value of both the carbon dioxide ventilation equivalence slope and the lowest carbon dioxide ventilation equivalent of all other patients were increased. The anaerobic threshold (L / min, ml · min-1 · kg -1,% pred), slope (% pred), progressive power movement time (min) (P> 0.05). The peak oxygen uptake (L / min, ml · min -1 · kg -1,% pred), peak oxygen pulse (ml / time,% pred ), The oxygen uptake efficiency platform (ratio,% pred) and peak load power (W) decreased compared with that before chemotherapy, and the lowest value of carbon dioxide ventilation equivalent ratio (% pred) was higher than that before chemotherapy (P <0.05). The oxygen uptake in patients with esophageal cancer after chemotherapy was lower than that before chemotherapy (P <0.05). The resting heart rate was higher than that before chemotherapy, and the systolic blood pressure was lower than that before chemotherapy (P <0.05). The diastolic blood pressure, Mean arterial pressure was lower than that before chemotherapy (P <0.05). Oxygen pulsation in four states was lower than that before chemotherapy (P <0.05), and the oxygen uptake efficiency at resting state, warm-up state and limit state was lower than before chemotherapy (P < 0.05). In the limit state, the carbon dioxide equivalent of ventilation was higher than that before chemotherapy (P <0.05). The partial pressure of end-tidal carbon dioxide in patients with esophageal cancer during warm-up was lower than that before chemotherapy (P <0.05). The resting partial oxygenation and the state of extreme warm-up were significantly higher than those before chemotherapy (P <0.05) (P <0.05). In the anaerobic threshold state, the amount of carbon dioxide per breath in the limit state was lower than that before chemotherapy (P <0.05). Conclusion Chemotherapy can significantly reduce the circulatory and cellular metabolic function of patients with esophageal cancer, while the respiratory restriction is relatively light, and in a relatively compensatory response. The CPET test provides an objective and quantitative assessment of the overall function of patients with esophageal cancer before chemotherapy, as well as the assessment of overall functional changes caused by chemotherapy.