适者生存31.ppt

9/15/20191適者生存:心臟運動測試的新風貌Survivalofthefittest:Anewlookatcardiacexercisetest2007物理治療繼續再教育課程中華民國物理治療學會主辦慈濟技術學院物理治療系與研發中心承辦講員:黃千惠9/15/20192主題大綱?傳統心臟運動測試(cardiacextest,CET)介紹:歷史沿革與方法;強調『運動中』的變化?新近心臟運動測試發展:預測死亡率;強調『運動開始』『運動恢復』的變化,主要是心跳?文獻回顧:運動後心跳恢復率的預後意義?台灣資料:血管正常者之心跳恢復率9/15/20193Cardiacexercisetest:CETCardiacpulmonaryexercisetest:CPET9/15/20194傳統心臟運動測試?起源:thediscoverythatexerciseinp'twithcoronarydiseaseproducedSTsegmentdepression?Feil&Siegel(1928)exercisedp'twithanginatobringaboutpain.?Theyperformedstresstestbysit-ups.?Master(1929)apacity.(Hiscontribution:exerciseprotocolratherthanuseofECG.)9/15/20195傳統心臟運動測試重要沿革1?Goldhammer&Scherf(1932):STdepressionwaspresentin75%p'twithanginaandproposedtheuseofexercisetoconfirmthediagnosisofcoronaryischemia.?Katz&Landt(1935):?Missal(1938):havingp'trunup3-?al(1940):thefirsttousecontinuousmonitoringanddiscoveredthatSTdepressionappearedbeforetheonsetofpainandpersistedforatimeafterthepainsubsided.??al(1942):.?Hellerstein&katz(1949):?Woodetal:Pushthep'ttothemaxleveloftheircapacity?Theamountofworkshouldnotbefixed,butadjustedtotheindividual?Themorestrenuousworkwouldproduceahigherpercentageofpositivetests??Bruce(1956):hatwouldmoreorlessgroupp'tintotheNYHDCIthroughIV?Astrand&Ryhming:maxoxygenuptakecouldbepredictedbytheHRatsubmaxexercise