摘要
目的探讨6min步行试验(6MWT)在先天性心脏病(CHD)术后患儿心功能评估中的价值。方法选取复旦大学附属儿科医院经心脏外科手术纠治的年龄≥3岁且随访时间≥6个月的CHD患儿为CHD组;选取健康儿童为对照组。将CHD组和对照组分为3～5岁、～8岁、～12岁和～15岁亚组。CHD组分为复杂CHD亚组和简单CHD亚组。对所有儿童行6MWT,观察6MWT步行距离(6MWD)及做功(体重与6MWD乘积),以及6MWT前后呼吸频率(RR)、心率(HR)、收缩压(SBP)和舒张压(DBP)等指标变化;同时进行平板运动试验(TET),分析6MWD、6MWT做功与TET代谢当量(METs)之间的相关性。结果 CHD组89例,对照组133例。所有研究对象均完成6MWT,其中CHD组64例和对照组133例同时完成了TET。①CHD组和对照组各年龄亚组6MWT后RR、HR及SBP均较6MWT前增加(均P<0.05),而CHD组和对照组各年龄亚组6MWT前后DBP差异无统计学意义(均P>0.05)。在同一年龄亚组中6MWT后RR、HR、SBP和DBP在CHD组与对照组间差异均无统计学意义(均P>0.05)。②CHD组3～5岁和～8岁亚组6MWD均显著短于对照组,3～5岁亚组:(383.7±52.8)vs(404.4±59.0)m,P=0.044;～8岁亚组:(442.2±58.8)vs(497.2±72.0)m,P=0.002。③CHD组～8岁亚组6MWT做功较对照组显著减少,(10631.1±3345.9)vs(14902.5±7801.2),P=0.010。④CHD组3～5岁、～8岁和～12岁亚组METs显著低于对照组(P分别为0.003、0.027和0.045)。⑤复杂CHD亚组和简单CHD亚组6MWT后RR、HR及SBP均较6MWT前增加(均P<0.05),两亚组6MWT前后DBP差异无统计学意义。复杂CHD亚组6MWD显著短于简单CHD亚组,(405.3±61.3)vs(465.1±109.4)m,P=0.008;两亚组METs差异无统计学意义。⑥CHD组和对照组6MWD与METs(r分别为0.486和0.543,均P<0.01)、6MWT做功与METs(r分别为0.601和0.404,均P<0.01)均呈显著正相关。结论 6MWT能够反映CHD术后患儿日常活动能力,是较TET更经济、方便和实用的评估心功能的有效方法之一。
Objective To explore the evaluation value of the 6-minute walk test （6MWT） on cardiac function in children with postoperative congenital heart disease during follow-up.Methods Children after CHD surgery （complicated or simple CHD） and followed up over 6 months from Children＇s Hospital of Fudan University were enrolled as CHD group, and healthy children were enrolled for control group, both groups were subgrouped by age at testing： 3-5, -8, -12 and -15 years age-subgroups.The 6MWT and treadmill test （TET） were performed on the same day. The 6-minute walk distance （6MWD）, 6-minute walk work （weight multiplied 6MWD）, and breath rate （RR）, heart rate （HR）, systolic blood pressure （SBP）, diastolic blood pressure （DBP） before and after 6 MWT were studied. The relationship between 6MWD, 6MWT work and METs was examined.Results ① RR, HR and SBP increased markedly at the termination of the test（P0.05）, but DBP did not change significantly（P0.05）in CHD and control groups by all age-groups. No significant difference was observed between CHD and control groups after 6MWT（P0.05）. ② The 6MWD was shorter in CHD group than that in control group by all age-groups, of them in CHD 3-5 [（383.7±52.8） vs （404.4±59.0）m], -8 years age-subgroup [（383.7±52.8） vs （404.4±59.0） m] the 6MWD was significantly shorter than that in control age sub-groups （P0.05）, but no difference was found in -12 [（510.2±78.9） vs （557.6±66.8）m] and -15 years age-subgroups [（595.4±89.6） vs （561.9±75.9） m] between CHD and control subgroups （P0.05）. In the complicated CHD group the 6MWD was shorter than that in the simple CHD subgroup, （405.3±61.3） vs （465.1±109.4） m, P0.01. The 6-minute walk work was smaller in CHD group than that in control group. In 3-5, -8, -12 and -15 years age-subgroups no difference was found between CHD and control groups （P0.05）. ③ The METs in CHD 3-5 , -8 and -12 years age subgroups were lower than those in the control age subgroups （P0.05）, but no difference was found in -15 age subgroup （P0.05）. In the complicated CHD subgroup the METs were lower but no difference was found between complex and simple CHD subgroup （P0.05）. The 6MWD （r=0.486, r=0.543,P0.01）and 6MWT work （r=0.601, r=0.404, P0.01） had a positive correlation with METs in CHD group and control group, respectively.Conclusions The 6MWT can reflect daily activity ability of the children with postoperative congenital heart disease. Compared to treadmill test it is the one of more effective method in evaluating the cardiac function and more easily be performed, and cost-effective.
出处
《中国循证儿科杂志》
CSCD
2012年第6期440-444,共5页
Chinese Journal of Evidence Based Pediatrics
