恢复期肺栓塞患者的运动心肺功能特点及临床应用价值

发布时间：2019-06-16 16:06

【摘要】：【目的】通过心肺运动试验（cardiopulmonary exercise testing,CPET），研究恢复期肺栓塞（pulmonary thromboembolism, PTE）患者的运动耐力、通气有效性和摄氧效率，分析相关参数在运动中的变化趋势和反应特点。【方法】对50例恢复初期肺栓塞患者和50例同年龄段健康志愿者进行斜坡式功率递增症状限制性极限CPET、常规肺功能检测（PFT）及动脉血气分析（arterial bloodgas analysis, ABG），测定相关的人体功能学检测参数。【结果】（1）与正常人相比，PTE患者的峰值功率（peakLoad）、峰值摄氧量（peak（V|·）O_2）和OUEP、OUES和OUE@AT均明显降低，而（V|·）E/（V|·）CO_2@AT、（V|·）E/（V|·）CO_2-slope和Lowest（V|·）E/（V|·）CO_2则明显升高。（2）在静息期、热身期、无氧阈和峰值运动时PTE患者的（V|·）O_2、（V|·）E/（V|·）CO_2、潮气末二氧化碳分压（PETCO_2）和（V|·）O_2/（V|·）E与正常人相比均具有显著统计学差异（p0.001），且两组间各参数在运动中的变化趋势和反应特点亦不相同。从静息期至峰值运动时，正常人的（V|·）O_2逐渐升高，但PTE患者（V|·）O_2的递增速率则明显降低；正常人的（V|·）E/（V|·）CO_2随功率的递增逐渐降低，，AT时降至最低，直到通气代偿点之后又开始升高，而PTE患者的（V|·）E/（V|·）CO_2一直处于较高水平；从静息期至AT正常人的PETCO_2逐渐上升，至AT时达到最大值，而后逐渐下降，但是PTE患者的PETCO_2始终保持低值；正常人的（V|·）O_2/（V|·）E随功率的递增先上升后下降，AT时达到最大值，而PTE患者的（V|·）O_2/（V|·）E从静息期至AT无明显变化，AT之后开始下降，但无统计学差异。(3)PTE患者的Lowest（V|·）E/（V|·）CO_2与一氧化碳弥散量占预计值的百分比（DLCO%pred）呈显著负相关（分别为r=-0.753, p0.001），而peakPETCO_2与DLCO%pred呈明显正相关（r=0.655,p0.01）。OUES、 OUEP和OUE@AT与DLCO%pred均有显著相关性（分别为r=0.683,0.505,0.491; p0.001,0.01,0.01）【结论】恢复初期肺栓塞患者的其运动耐力、通气有效性及摄氧效率都是降低的，各相关参数在CPET中的变化趋势和反应特点与正常人明显不同，且与DLCO%pred具有很好的相关性，为肺栓塞患者的临床疗效评估及抗凝时间窗的选择提供了重要的参考依据。
[Abstract]:[Objective] To study the movement endurance, ventilation effectiveness and oxygen uptake efficiency of patients with pulmonary embolism (PTE) in the recovery period through cardiopulmonary exercise (CPET). [Methods] 50 patients with initial pulmonary embolism and 50 healthy volunteers of the same age group were subjected to ramp-type power-increasing symptom-limiting CPET, conventional pulmonary function test (PFT) and arterial blood gas analysis (ABG). [Results] (1) The peak power (peak load), peak oxygen uptake (peak (V | 路) O _ 2) and OEP, OUES, and OUE@AT of PTE patients were significantly lower than that of normal persons, and (V | 路) E/ (V | 路) CO_2@AT, (V | 路) E/ (V | 路) CO _ 2-slope and Lowest (V | 路) E/ (V | 路) CO _ 2 were clear. (2) In resting period, warm-up period, oxygen-free threshold and peak exercise, the (V | 路) O _ 2, (V | 路) E/ (V | 路) CO _ 2, the end-tidal carbon dioxide partial pressure (PETCO _ 2) and (V | 路) O _ 2/ (V | 路) E of the patients had significant statistical difference (p0.001), and the change tendency and the reaction characteristics of the parameters in the exercise were not the same. From the rest period to the peak exercise, the (V | 路) O _ 2 of the normal person was gradually increased, but the increasing rate of the (V | 路) O _ 2 in the normal person was decreased gradually. The (V | 路) E/ (V | 路) CO _ 2 of the normal person was gradually decreased with the increase of the power, and the (V | 路) E/ (V | 路) CO _ 2 of the patient started to rise after the ventilation compensation point, and the (V |.) E/ (V |.) After the AT, the maximum value was reached, while the (V | 路) O _ 2/ (V | 路) E in the PTE patients had no significant change from the rest period to the AT, and the AT began to decrease after the AT, but no statistics (3) There was a significant negative correlation between (V | 路) E/ (V | 路) CO _ 2 and carbon monoxide dispersion in PTE (r =-0.753, p0.001), while peakPETCO _ 2 was positively correlated with DLCO% pred (r = 0.655, p0). 01). The OUES, OUEP and OUE @ ATs have a significant correlation with DLCO% pred (r = 0.683, 0.505, 0.491; p0.001, 0.01,0, respectively) (.01)[Conclusion] The exercise endurance, the effectiveness of the ventilation and the oxygen uptake efficiency of the patients with the initial pulmonary embolism are reduced. The trend and the response characteristics of the relevant parameters in the CPET are obviously different from that of the normal person, and the correlation with the DLCO% pred is very good, and it is important for the evaluation of the clinical curative effect of the patients with pulmonary embolism and the selection of the anti-coagulation time window.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.5

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