背景:尽管经常使用6分钟步行测试(6MWT),在接受Fontan手术的患者中,尚未通过增量穿梭步行测试(ISWT)评估运动能力。目前尚不清楚这些测试是否会导致这些患者的临床相关心肺反应。
目的:我们旨在评估Fontan患者对6MWT和ISWT的心肺反应,将反应与对照中的反应进行比较,并检查两个现场测试之间的协议。
方法:使用6MWT评估次最大运动能力,使用ISWT的最大运动能力,用手动测力计的股四头肌等距肌肉力量,和使用生物电阻抗装置的身体成分。
结果:21名Fontan患者(16.42±6.63岁,5F/16M)和21个对照(16.57±4.30年,包括7F/14M)。虽然两组之间的身体成分相似(p>0.05),Fontan患者的股四头肌等距肌力和6MWT和ISWT距离均低于对照组(p<0.05)。在6MWT和ISWT中,测试前和测试后心率(HR),氧饱和度(SpO2),呼吸困难,Fontan患者和对照组之间的腿部疲劳存在显着差异(p<0.05)。此外,ISWT导致HR发生了更显著的变化,Fontan患者的SpO2和腿部疲劳比6MWT高(p<0.05)。Bland-Altman地块为6MWT与ISWT表明两项测试一致。
结论:HR有显著变化,SpO2,呼吸困难,和腿部疲劳在两个测试。安全性与6MWT相似,但对不良事件更为谨慎,ISWT还可以作为现场测试进行,以评估Fontan患者的运动能力并确定更明显的运动诱发反应(尤其是氧饱和度降低).
Despite the frequent use of the 6-minute walk test (6MWT), exercise capacity has not been assessed with the incremental shuttle walk test (ISWT) in patients who have undergone the Fontan procedure. It is unclear whether these tests cause clinically relevant cardiorespiratory responses in these patients.
We aimed to assess cardiorespiratory responses to the 6MWT and ISWT in Fontan patients, compare the responses with those in the controls, and examine the agreement between the two field tests.
Submaximal exercise capacity was assessed using the 6MWT, maximal exercise capacity using the ISWT, quadriceps isometric muscle strength with a hand dynamometer, and body composition using a bioelectrical impedance device.
Twenty-one Fontan patients (16.42±6.63 years, 5F/16M) and 21 controls (16.57±4.30 years, 7F/14M) were included. While body composition was similar between the groups (p>0.05), quadriceps isometric muscle strength and 6MWT and ISWT distance were lower in the Fontan patients than in the controls (p<0.05). In both the 6MWT and ISWT, pre- and post-test heart rate (HR), oxygen saturation (SpO2), dyspnea, and leg fatigue differed significantly between the Fontan patients and the controls (p<0.05). In addition, the ISWT resulted in a more significant change in HR, SpO2, and leg fatigue than the 6MWT in the Fontan patients (p<0.05). Bland-Altman plots for the 6MWT vs. the ISWT indicated agreement between the two tests.
There were remarkable changes in HR, SpO2, dyspnea, and leg fatigue in both tests. With similar safety to the 6MWT but with more caution applied for adverse events, the ISWT can also be performed as a field test to evaluate exercise capacity and identify more pronounced exercise-induced responses (especially oxygen desaturation) in Fontan patients.