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Kokyu to Junkan Volume 58, Issue 10 （October 2010）

呼吸と循環 58巻10号（2010年10月発行）

Japanese English

研究

虚血性心疾患患者のI-ECOHに及ぼすβ遮断剤の影響 Effect of β-adrenoceptor Blockers on I-ECOH in Patients with Ischemic Heart Disease 露木和夫 ^1,2 , 坂元孝子 ¹ , 富永ゆき ¹ , 石綿幸代 ¹ , 大関泰弘 ¹ , 海老根東雄 ¹ , 渡邊紳一 ² Kazuo Tsuyuki ^1,2 , Takako Sakamoto ¹ , Yuki Tominaga ¹ , Yukiyo Ishiwata ¹ , Yasuhiro Ozeki ¹ , Kunio Ebine ¹ , Shinichi Watanabe ² ¹小田原循環器病院 ²神奈川工科大学健康福祉支援開発センター ¹Odawara Cardiovascular Hospital ²Development Center to Support Health and Welfare, Kanagawa Institute of Technology キーワード：酸素摂取量 , 心拍数 , 心肺予備能 , oxygen uptake , heart rate , cardio-pulmonary functional reserve Keyword: 酸素摂取量 , 心拍数 , 心肺予備能 , oxygen uptake , heart rate , cardio-pulmonary functional reserve pp.1065-1069

発行日 2010年10月15日 Published Date 2010/10/15

DOI https://doi.org/10.11477/mf.1404101566

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要旨　虚血性心疾患(IHD)患者の運動時心拍数増加曲線勾配(I-ECOH)に，β遮断剤の投与が影響を及ぼすか否か，そしてpropranolol，atenololおよびcarvedilol間に，その差異があるか否を明らかにすることを目的に本研究を行った．β遮断剤を服用した85例のIHD患者(β群)，およびβ遮断剤を服用していない74例のIHD患者(非β群)に心肺運動負荷試験を施行した．I-ECOHは，運動時の酸素摂取量(VO₂)に対する心拍数(HR)の増加勾配で，次の式のBと定義した．HR＝A・exp^B・VO2．I-ECOHとVO₂ peakは，β群および非β群ともに有意な負の直線関係を認めた(p＜0.001)．またβ群の回帰直線は，非β群のそれと比較すると下方偏位した．I-ECOHとVO₂ peakとの回帰直線は，VO₂ peakが高値になるにしたがいatenolol群，propranolol群およびcarvedilol群の順で，非β群の回帰直線より強く下方偏位した．以上のことから，IHD患者のI-ECOHは，β遮断剤服用時に心肺予備能を過大評価する．そして，その過大評価は心肺予備能の高さやβ遮断剤の種類によって程度が異なることが示唆された．

　This study was conducted to clarify the effect of β-adrenoceptor blockers on the inclination of an exponential curve-fitting model for oxygen uptake(VO₂)and heart rate(HR)during graded exercise(I-ECOH)in patients with ischemic heart disease(IHD). A treadmill exercise test was used to measure the VO₂(l/kg/min)and HR(beats/min)during graded exercise in IHD patients who received(β group, n＝85)and patients who did not receive β-adrenoceptor blockers(non-β group, n＝74). The β group was divided into three groups according to the β-adrenoceptor blockers used〔propranolol(n＝36), atenolol(n＝19)and carvedilol(n＝30)〕. I-ECOH was derived from the following equation:HR＝A exp^B・VO2. The constant “B” represents I-ECOH. The following two identifications were made:1) The relation between peak VO₂ and I-ECOH in the β and non-β groups, 2) The relation between peak VO₂ and I-ECOH in IHD patients who received three different kinds of β-adrenoceptor blockers. There were inverse correlations between peak VO₂ and I-ECOH in the β group(r＝－0.54, p＜0.001)and the non-β group(r＝－0.64, p＜0.001). The regression line in the β group was deflected downwards in comparison with the non-β group. As peak VO₂ increased, three regression lines were deflected downwards in the respective order of “atenolol,“propranolol” and “carvedilol” group. In conclusion, these results suggest that I-ECOH overestimates the cardio-pulmonary functional reserve in IHD patient who have received β-adrenoceptor blockers. And the overestimation depends on the degree of the cardio-pulmonary functional reserve and kinds of β-adrenoceptor blockers that are used.