【罂粟摘要】β-受体阻滞剂对晚期肝病患者心肺运动试验的影响
β-受体阻滞剂对晚期肝病患者心肺运动试验的影响
晚期肝病患者可能发展为门脉高压，从而导致静脉曲张破裂出血。β-受体阻滞剂可以降低门静脉压力，将出血风险降至最低。这些药物可能会减弱心肺功能的测量值，例如通过心肺运动试验测量的通气阈值和峰值氧摄取量。
探讨β-受体阻滞剂对晚期肝病患者心肺运动功能指标的影响。
对72名在肝移植前完成心肺运动试验的受试者进行横断面分析。所有受试者在试验前都保持他们通常的β受体阻滞剂剂量和服药时间。在心肺运动试验期间，测量的变量包括：通气阈值、峰值摄氧量、心率、氧脉搏、摄氧率斜率和通气当量二氧化碳斜率。
与不服用β受体阻滞剂的受试者相比，服用β受体阻滞剂的28例受试者的通气阈值（P<0.01）和最大摄氧量（P=0.02）较低。在校正年龄后，β受体阻滞剂组的终末期肝病评分、肝病病因、顽固性腹水和通气阈值仍显著低于对照组（P=0.04）。β受体阻滞剂的使用不影响氧摄取效率斜率。
与不服用β-受体阻滞剂的患者相比，服用β-受体阻滞剂的晚期肝病患者的通气阈值降低。这可能会错误地将对服用β受体阻滞剂的患者进行风险分层，并对肝移植前后的患者管理产生影响。氧摄取效率斜率不受β受体阻滞剂的影响，因此可以更好地衡量这类患者的心肺功能。
Impact of beta-blockers on cardiopulmonary exercise testing in patients with advanced liver disease
Patients with advanced liver disease may develop portal hypertension that can result in variceal haemorrhage. Beta-blockers reduce portal pressure and minimise haemorrhage risk. These medications may attenuate measures of cardiopulmonary performance, such as the ventilatory threshold and peak oxygen uptake measured via cardiopulmonary exercise testing.
To determine the effect of beta-blockers on cardiopulmonary exercise testing variables in patients with advanced liver disease.
This was a cross-sectional analysis of 72 participants who completed a cardiopulmonary exercise test before liver transplantation. All participants remained on their usual beta-blocker dose and timing prior to the test. Variables measured during cardiopulmonary exercise testing included the ventilatory threshold, peak oxygen uptake, heart rate, oxygen pulse, the oxygen uptake efficiency slope and the ventilatory equivalents for carbon dioxide slope.
Participants taking beta-blockers (n = 28) had a lower ventilatory threshold(P <.01) and peak oxygen uptake (P = .02), compared to participants not taking beta-blockers. After adjusting for age, the model of end-stage liver-disease score, liver-disease aetiology, presence of refractory ascites and ventilatory threshold remained significantly lower in the beta-blocker group (P = .04). The oxygen uptake efficiency slope was not impacted by beta-blocker use.
Ventilatory threshold is reduced in patients with advanced liver disease taking beta-blockers compared to those not taking the medication. This may incorrectly risk stratify patients on beta-blockers and has implications for patient management before and after liver transplantation. The oxygen uptake efficiency slope was not influenced by beta-blockers and may therefore be a better measure of cardiopulmonary performance in this patient population.