Abstract: Objective　To analyze the data concerning systolic blood pressure（SBP） and heart rate（HR） in symptom-limited maximal cardiopulmonary exercise tests（CPETs），in order to explore whether it is right or not to use 85% of maximal age-predicted heart rate（85% MPHR） and a specific SBP level to terminate the CPET.Methods　Data of 112 symptom-limited maximal CPETs completed with incremental protocols by 85 participants in the cardiopulmonary exercise laboratory of Ronald Reagan UCLA Medical Center，between January 1974 and January 2004 were collected from the Principles of Exercise Testing and Interpretation （Fourth Edition）．We analyzed 111 CPETs with HR data（the other one was excluded due to lack of corresponding data） and 97 CPETs with intra-arterial blood pressure（the other 15 were excluded due to lack of corresponding data）．We calculated and counted the number and percentage of the CPETs with recorded maximum HR ≥85% MPHR，and compared the differences and percentage differences of exercise duration（time），work rate（WR），HR，breath frequency（f），minute ventilation（V?E），carbon dioxide output（V?CO2），oxygen uptake（V?O2），oxygen pulse （O2P），and respiratory exchange ratio（RER） at peak exercise and while HR reached 85%MPHR using paired t test.We also did the similar calculation and count of the number and percentage of the CPETs with recorded SBP≥210，220 and 250 mmHg，and the comparisons of the differences and percentage differences of the aforementioned parameters between the peak exercise and while SBP≥210，220 and 250 mm Hg.Results　There were 64（58%） CPETs during which the maximum HR ≥85% MPHR，in all of 111 CPETs with recorded HR.There were significant differences for all measurements of time，WR，HR，f，V?E，V?CO2，V?O2，O2P and RER（P<0.001） between the peak and HR≥85% MPHR in these 64 CPETs.There were 39，28 and 9 CPETs during which the peak SBP≥210，220 and 250 mm Hg，respectively，in all of 97 CPETs with recorded intra-arterial BP.There were significant differences for all measurements of 9 parameters（time，WR，HR，f，V?E，V?CO2，V?O2，O2P，and RER）（P<0.05） between the peak exercise and while SBP≥210 and 220 mm Hg in these 39 and 28 CPETs，respectively.However，there were no significant differences for all measurements of the above-mentioned 9 parameters between the peak exercise and SBP≥250 mm Hg（P>0.05） in these 9 CPETs.Conclusion　As not all of （only most of） the participants had a maximum HR ≥85% MPHR，and a minority of them had a SBP ≥210 mm Hg during the CPET，we should not affirm that the participants fail to achieve a maximal effort during CPET even if the maximum HR <85% MPHR and/or peak SBP <210 mm Hg.Moreover，we should not stop the exercise by maximum HR≥85% MPHR and /or peak SBP≥210 or 220 mm Hg.However，we may consider to use the SBP≥ 250 mm Hg as an indicator of termination of CPET.

Key words: Blood pressure, Heart rate, Symptom limited peak exercise, Cardiopulmonary exercise testing, Standard for stopping exercise, Safety and risk

摘要： 目的　对完成症状限制性最大极限心肺运动试验（CPET）者收缩压及心率数据进行再分析，以期探讨CPET终止指征之85%最大预计心率（MPHR）及收缩压的最佳界值作为终止试验标准的依据是否可行。方法　对第4版Principles of Exercise Testing and Interpretation一书中于1974年1月—2004年1月在美国加州大学洛杉矶分校医学中心CPET实验室按照标准连续递增功率方案完成症状限制性最大极限CPET的精选85例受试者共112例次CPET进行分析。除1例次无心率记录外共有111例次CPET记录了心率；除15例次没有进行直接动脉测压外共有97例次直接动脉测定收缩压值的CPET。计算峰值心率≥85% MPHR的CPET例次及其所占百分数、峰值运动时和达到85% MPHR时CPET测定指标的差值及百分差值，收缩压≥210、220、250 mm Hg的CPET例次及其所占百分数、峰值运动时和收缩压≥该特定值时CPET测定指标的差值及百分差值。结果　CPET的峰值心率≥85% MPHR的有64例次，占58%。该64例次CPET峰值运动时与达到85% MPHR时的运动时间、功率、心率、呼吸频率、分钟通气量、二氧化碳排出量、摄氧量、氧脉搏和呼吸交换率比较，差异有统计学意义（P<0.001）。所有97例次直接动脉测压的CPET中，收缩压≥210、220、250 mm Hg 的分别是39、28、9例次。峰值运动与达到210、220 mm Hg时的运动时间、功率、心率、呼吸频率、分钟通气量、二氧化碳排出量、摄氧量、氧脉搏和呼吸交换率比较，差异有统计学意义（P<0.05）。但是当收缩压≥250 mm Hg时与峰值运动时的所有测定指标比较，差异无统计学意义（P>0.05）。结论　大多数CPET患者峰值心率≥85% MPHR，但也有很多患者没有达到此值；所以即不能以85% MPHR作为停止运动的标准，也不能以未达到85% MPHR而否定CPET患者的极限努力。大多数CPET患者收缩压没有达到210 mm Hg，所以不能以收缩压不够高来否定患者的极限努力，也不能以210、220 mm Hg来停止运动；但是可以考虑250 mm Hg作为终止运动的指征。

关键词: 血压, 心率, 症状限制性极限运动, 心肺运动试验, 终止运动标准, 安全与风险