CAJ | 학술논문

目的探讨慢性阻塞性肺疾病(COPD)患者运动状态下二氧化碳通气当量(EqCO2)的变化及其影响因素.方法 40例男性稳定期COPD患者(COPD组)和15名健康男性(对照组)行症状自限性运动心肺试验,同步实时测定每分钟通气量(VE)、摄氧量(VO2)、二氧化碳排出量(VCO2)和EqCO2(即VE/VCO2),在运动高峰时抽取动脉血,测定动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、肺泡气-动脉血氧分压差(P(A-a)O2)和生理死腔/潮气量比值(VD/VT).结果在运动高峰时,COPD组最大VO2(VO2max)、最大VCO2(VCO2max)、PaO2[分别为(14.8±3.6)ml·kg-1·min-1、(19.4±5.9)ml·kg-1·min-1、(87.6±13.9)mm Hg]明显低于对照组[分别为(18.9±4.2)ml·kg-1·min-1、(25.3±7.1)ml·kg-1·min-1、(113.9±13.6)mm Hg,均P<0.01],EqCO2、PaCO2、P(A-a)O2、VD/VT[分别为33.0±5.1、(43.5±3.1)mm Hg、(43.5±3.1)mm Hg、0.33±0.12]明显高于对照组[分别为28.5±2.6(P<0.01)、(39.6±4.9)mm Hg(P<0.01)、(12.6±6.3)mm Hg(P<0.01)、0.26±0.07(P<0.05)].多元回归分析显示COPD组运动高峰时的EqCO2与VD/VT呈显著正相关(r=0.57,P<0.01).结论 COPD患者运动状态下EqCO2明显增高,VD/VT增大可能是引起COPD患者运动高峰时EqCO2增高的一个重要因素.
목적 탐토만성조새성폐질병(COPD)환자운동상태하이양화탄통기당량(EqCO2)적변화급기영향인소.방법 40례남성은정기COPD환자(COPD조)화15명건강남성(대조조)행증상자한성운동심폐시험,동보실시측정매분종통기량(VE)、섭양량(VO2)、이양화탄배출량(VCO2)화EqCO2(즉VE/VCO2),재운동고봉시추취동맥혈,측정동맥혈양분압(PaO2)、동맥혈이양화탄분압(PaCO2)、폐포기-동맥혈양분압차(P(A-a)O2)화생리사강/조기량비치(VD/VT).결과 재운동고봉시,COPD조최대VO2(VO2max)、최대VCO2(VCO2max)、PaO2[분별위(14.8±3.6)ml·kg-1·min-1、(19.4±5.9)ml·kg-1·min-1、(87.6±13.9)mm Hg]명현저우대조조[분별위(18.9±4.2)ml·kg-1·min-1、(25.3±7.1)ml·kg-1·min-1、(113.9±13.6)mm Hg,균P<0.01],EqCO2、PaCO2、P(A-a)O2、VD/VT[분별위33.0±5.1、(43.5±3.1)mm Hg、(43.5±3.1)mm Hg、0.33±0.12]명현고우대조조[분별위28.5±2.6(P<0.01)、(39.6±4.9)mm Hg(P<0.01)、(12.6±6.3)mm Hg(P<0.01)、0.26±0.07(P<0.05)].다원회귀분석현시COPD조운동고봉시적EqCO2여VD/VT정현저정상관(r=0.57,P<0.01).결론 COPD환자운동상태하EqCO2명현증고,VD/VT증대가능시인기COPD환자운동고봉시EqCO2증고적일개중요인소.
Objective To compare the difference in the ventilatory equivalent for carbon dioxide (EqCO2 ) between the patients with chronic obstructive pulmonary disease (COPD) and normal adults at maximal exercise, and to identify the factors inducing the abnormal change of EqCO2 in COPD patients. Methods Forty male COPD patients and fifteen normal males underwent symptom-limited cardiopulmonary exercise testing. Oxygen uptake and carbon dioxide output were measured breath-by-breath. Arterial blood samples were collected at maximal exercise to undergo gas analysis so as to calculate the dead space/tidal volume ratios ( VD/VT ) and alveolar-arterial PO2 difference [P(A-a)O2]. Results The maximal oxygen uptake, maximal carbon dioxide output, and arterial partial pressure of carbon dioxide (PaCO2) of the COPD patients were (14.8±3.6) ml·kg-1· min-1, (19.4±5.9) ml·kg-1· min-1, and (87.6± 13.9) mm Hg respectively, all significantly lower than those of the normal controls [( 18.9 ± 4.2) ml· kg-1· min-1 , (25.3±7.1 ) ml·kg-1· min-1, and ( 113.9±13.6) mm Hg respectively,all P <0.01]; and the EqCO2, PaCO2, P(A-a)O2, and VD/VT of the COPD patients at maximal exercise were 33.0±5.1, (43.5±3.1 ) nun Hg, (43.5±3.1 ) mm Hg, 0.33 +0.12 respectively, all significantly higher than those of the normal controls [28.5±2.6, (39.6±4.9) mm Hg, (12.6±6.3) mm Hg, and 0.26±0.07 respectively, P < 0.01, P < 0.01, P < 0.01, P < 0. 05]. Multiple regression analysis showed that EqCO2 was significantly positively correlated with VD/VT at maximal exercise in the COPD patients ( r = 0.57,P < 0.01 ). Conclusion Increased VD/VT may play an important role causing increase in EqCO2 during exercise in patients with COPD.