Ergospirometrische Belastungsuntersuchungen in der Pädiatrie

ZUSAMMENFASSUNG

Hintergrund Kardiopulmonale Belastungsuntersuchungen auf dem Fahrrad oder Laufband haben in der Erwachsenenmedizin einen hohen Stellenwert. Sie dienen einerseits zur Feststellung der körperlichen Leistungsfähigkeit, andererseits auch zum Beweis oder Ausschluss kardiopulmonaler Erkrankung. In der Kinder- und Jugendmedizin finden sie im Rahmen von wissenschaftlichen Untersuchungen etwa bei kongenitaler Herzerkrankung Anwendung, um den aktuellen Gesundheitszustand zu objektivieren. Dabei wird ihr Stellenwert bei der Behandlung von chronisch kranken Kindern und Jugendlichen gerade im niedergelassenen Bereich noch unterschätzt. Ziel der Arbeit war es, die Indikationen, die Durchführung und die Ergebnisse eines Kollektivs von 100 Patienten einer kinderkardiologischen Praxis darzustellen.

Methodik Untersucht wurden 100 konsekutive Patienten (14,2 ± 3,8 Jahre) im Rahmen einer sportwissenschaftlichen Kooperation. Die Untersuchungen wurden standardisiert nach dem Godfrey-Protokoll auf dem Fahrradergometer durchgeführt. Neben der Leistungsfähigkeit in Watt/kg KG wurden die maximale Sauerstoffaufnahme, die respiratorische Austauschrate und die maximale Herzfrequenz erhoben.

Ergebnisse 80 % der Patienten hatten eine kardiologische Indikation (26 % angeborene Herzfehler, 39 % erworbene Herzerkrankung, 15 % Rhythmusstörungen). 8 % der Patienten kamen wegen einer Sporttauglichkeit im Rahmen von Leistungssport zur Untersuchung, 6 % mit onkologischer Grunderkrankung, 6 % mit allgemeinpädiatrischen Vorerkrankungen. Alle Patienten konnten problemlos die Untersuchung beenden. Patienten mit angeborenem Herzfehler hatten die niedrigste Sauerstoffaufnahme, gefolgt von Patienten mit onkologischen Erkrankungen.

Diskussion In unserem Kollektiv war die Gruppe der kardiologischen Indikation am größten, gefolgt von einem kleinen Anteil von leistungssportlich aktiven Kindern, onkologischen und allgemeinpädiatrischen Patienten. Es wäre ein wünschenswertes Ziel, auch einem größeren Kreis chronisch kranker Kinder basierend auf einer ergospirometrischen Untersuchung ein gezieltes Trainingsprogramm zur Verfügung zu stellen. Daten aus der Erwachsenen-Onkologie zeigen durchaus positive Effekte auf die Morbidität und Mortalität durch strukturierte Sportprogramme.

ABSTRACT

Background Cardiopulmonary exercise testing (CPET) is a highly accepted diagnostic tool in adult cardiology and sports medicine. It is indicated to measure physical fitness in healthy adults or to detect cardiovascular and pulmonary diseases. In pediatrics, CPET is highly used in congenital heart disease to define aerobic fitness and to measure peak oxygen uptake as a prognostic factor. Its value in other chronic diseases in childhood is still underestimated. We, therefore, describe indications, practical aspects and results of 100 consecutive patients done in a pediatric cardiology outpatient practice.

Material and methods 100 consecutive CPET studies were done in children/young adults aged 14,2 years ± 3,78. All examinations were performed according to a standardized Godfrey-protocol on a bicycle. In addition to the relative performance (W/kg), peak oxygen uptake, respiratory exchange ratio and peak heart rate were reported.

Results 80 % of all patients had a cardiologic disease (26 % congenital heart disease, 39 % acquired heart disease, 15 % rhythm disturbances). 8 % were athletes for pre-participation screenings, 6 % came with an oncological background and 6 % because of pediatric systemic diseases. All patients were able to complete stress testing without any side effects. Concerning physical fitness and maximal oxygen uptake patients with congenital heart defects showed lowest values, followed by patients after oncological disease.

Conclusion In our collective, the group of cardiac indications was the largest, followed by sports activity, oncological disease and chronic pediatric diseases. As data from adult medicine underline the importance of sports activity in oncologic diseases, these groups of pediatric patients could profit from an individualized training program based on CPET data. A better knowledge of the effect of sports training on other chronic pediatric diseases is still needed.

Schlüsselwörter

Pädiatrie - Ergospirometrie - körperliche Fitness - VO2peak

Keywords

Cardiopulmonary exercise test - paediatrics - physical fitness - VO2peak

Publication History

Received: 24 February 2020

Accepted: 12 March 2020

Article published online:
14 December 2020

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