肺过度充气对慢性阻塞性肺疾病患者运动耐力及呼吸模式的影响

发布时间：2018-06-12 09:09

本文选题：肺过度充气 + 慢性阻塞性肺疾病　；参考：《苏州大学》2012年硕士论文

【摘要】：第一部分肺过度充气对慢性阻塞性肺疾病患者呼吸模式及气体交换的影响【目的】探讨不同程度肺过度充气对稳定期中重度慢性阻塞性肺疾病（COPD）患者在运动过程中呼吸模式及气体交换的影响。【方法】对54例处于稳定期的中重度COPD患者进行常规肺功能测定（PFT）及斜坡式功率递增症状限制性心肺运动试验（CPET），根据胸内气体容积占预计值的百分比（Vtg%pred）及一氧化碳弥散量占预计值的百分比（DLCO%pred）将受试者分为两组，A组为低肺过度充气组（Vtg%pred 150%pred且DLco%pred≥80%pred，29人），B组为高肺过度充气组（Vtg%pred≥150%pred且DLco%pred80%pred，25人）。测定并分析两组间肺通气功能、呼吸模式、气体交换及运动耐力的差异。【结果】 1．静息期，两组间潮气量（VT）及呼吸频率（BF）差异无统计学意义。峰值运动期，A组的VT显著高于B组（p0.001），并且两组间分钟通气量（VE）的差异（p0.001）也显著高于静息期（p0.05）。 2．峰值运动期，两组间吸气时间（tI）与呼气时间（tE）的比值（tI/tE）、VT/tI及VT/tE均有显著的统计学差异（p0.01），并且B组的呼吸困难程度（VE/MVV）明显高于A组（p0.001）。 3．CPET测定结果显示， B组相较于A组其峰值运动负荷（Peak Load）、峰值摄氧量（Peak VO2）、通气有效性及峰值运动期氧脉搏（Peak O2pulse）均显著下降（p0.05）。两组间终止运动原因的差异具有统计学意义（p0.05），B组中更多的患者由于呼吸困难终止试验。 4．COPD患者的峰值摄氧量占预计值的百分比（Peak VO2%pred）与PFT参数中的Vtg%pred及DLco%pred相关性最强（分别为r=-0.55及0.68, p0.001）。Peak VO2与Peak VT具有显著相关性（r=0.77, p0.001），Peak VT则与静息时测定的深吸气量（IC）具有显著相关性（r=0.63, p0.001）。【结论】高肺过度充气COPD患者相较于低肺过度充气COPD患者，其VT在运动过程中可增加的弹性幅度更小，峰值运动期呼气时间在呼吸周期中所占的比例明显增加，并且具有更严重的运动耐力下降、通气功能受限、换气效率下降及呼吸困难程度。第二部分吸气分数与稳定期中重度COPD患者运动耐力的相关性【目的】探讨IC、IC与肺总量之比（IC/TLC）（或称吸气分数，IF）及相关肺功能指标与稳定期中重度COPD患者运动耐力的相关性。【方法】对50例处于稳定期的中重度COPD患者及34例同年龄段健康志愿者进行PFT及斜坡式功率递增症状限制性CPET，测定相关肺通气功能参数、气体交换参数，，记录受试者CPET的终止原因。【结果】 1．COPD患者的IF与运动耐力（Peak VO2%pred）有显著的相关性（r=0.52,p0.001）, IF可作为预估COPD患者运动耐力减低的独立变量，并且其敏感度及特异度均高于第一秒用力呼气量占预计值的百分比（FEV1%pred），多重线性回归模型方程为：Peak VO2%pred=65.9IF+0.45FEV1%pred+35.8（RC2=0.39,p0.001）， 2．低IF值（＜0.23）的COPD患者（18例）比高IF值（≥0.23）COPD患者（32例）有着更严重的肺过度充气及运动耐力下降，峰值运动时的两者的BF无显著性差异,前者的Peak VE及Peak VT均较后者下降。【结论】吸气分数为反映肺过度充气的良好指标，且较FEV1更好的预估稳定期中重度COPD患者的运动耐力。
[Abstract]:Part 1 Effect of hyperinflation on respiratory pattern and gas exchange in patients with chronic obstructive pulmonary disease
[Objective] to investigate the effects of pulmonary hyperinflation on breathing patterns and gas exchange in patients with moderate or severe chronic obstructive pulmonary disease (COPD) during exercise.
[Methods] 54 patients with moderate and severe COPD in the stable period were measured by routine lung function test (PFT) and sloped power increasing symptom restrictive cardiopulmonary exercise test (CPET). The percentage of predicted gas volume (Vtg%pred) and percentage of carbon monoxide dispersion (DLCO%pred) were divided into two groups, A group, and group A. For the low lung hyperinflatable group (Vtg%pred 150%pred and DLco%pred > 80%pred, 29 people), B group was hyperinflated Lung Group (Vtg%pred > 150%pred and DLco%pred80%pred, 25 people). The differences in pulmonary ventilation function, breathing pattern, gas exchange and exercise endurance were measured and analyzed between the two groups.
[results]
In the 1. resting period, there was no significant difference between the two groups of tidal volume (VT) and respiratory frequency (BF). The peak exercise period, the VT in group A was significantly higher than that in the B group (p0.001), and the difference in VE (p0.001) between the two groups was significantly higher than that in the rest period (P0.05).
In the 2. peak exercise period, the ratio of tI to expiratory time (tE), VT/tI and VT/tE were statistically significant (P0.01), and the degree of dyspnea (VE/MVV) in the B group was significantly higher than that in the A group (p0.001).
The results of 3.CPET assay showed that the peak exercise load (Peak Load), peak oxygen uptake (Peak VO2), ventilation effectiveness and peak exercise oxygen pulse (Peak O2pulse) in the B group decreased significantly (P0.05). The difference between the two groups was statistically significant (P0.05). More patients in the B group were due to the termination of dyspnea. Test.
The percentage of the peak oxygen uptake of 4.COPD patients (Peak VO2%pred) is the strongest correlation with Vtg%pred and DLco%pred in the PFT parameters (r=-0.55 and p0.001).Peak VO2 and Peak VT have significant correlation.
[Conclusion] COPD patients with hyperinflatable lung hyperinflation compared with low lung hyperinflatable COPD patients, the increase in the elastic amplitude of VT in the exercise process is smaller, the peak exercise period of expiratory time in the respiratory cycle is significantly increased, and has a more serious movement endurance, ventilation function limited, ventilation efficiency decline and respiratory distress. It's difficult.
The second part is the correlation between inspiratory fraction and exercise endurance in moderate and severe COPD patients.
[Objective] to investigate the correlation between IC, IC and the ratio of total lung volume (IC/TLC) (or inhaled fraction, IF) and related lung function indexes with the exercise endurance of moderate and severe COPD patients at stable stage.
[Methods] 50 patients with moderate and severe COPD in stable period and 34 healthy volunteers of the same age group were treated with PFT and ramp power increasing symptom restrictive CPET. The parameters of pulmonary ventilation function and gas exchange parameters were measured, and the cause of CPET termination was recorded.
[results]
The IF of 1.COPD patients has a significant correlation with the exercise endurance (Peak VO2%pred) (r=0.52, p0.001). IF can be used as an independent variable for predicting the decrease of exercise endurance in COPD patients, and its sensitivity and specificity are higher than the percentage of the first second forced expiratory volume (FEV1% PRED), and the multiple linear regression model equation is Peak VO2%pred=65. .9IF+0.45FEV1%pred+35.8 (RC2=0.39, p0.001),
2. COPD patients with low IF value (< 0.23) (18 cases) had more severe pulmonary hyperinflation and lower exercise endurance than high IF (0.23) COPD patients (32 cases), and there was no significant difference in BF in peak exercise. The Peak VE and Peak VT in the former were all lower than those of the latter.
[Conclusion] inspiratory fraction is a good indicator of pulmonary hyperinflation. It is better than FEV1 in predicting exercise tolerance of moderate and severe COPD patients in stable stage.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.9

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