CAJ | 학술논문

目的：研究肺动脉高压对 COPD 患者运动耐力及通气有效性的影响。方法选择2012年10月至2014年3月在上海市肺科医院就诊 GOLDⅢ~Ⅳ级的 COPD 患者82例,其中男性68例,女性14例；按肺动脉收缩压分为2组,COPD 相关肺动脉高压组43例,COPD 无肺动脉高压组39例。对所有受试者进行常规肺功能检测、超声心动图检测以及症状限制性功率递增方案下的心肺运动试验检测,并按逐次呼吸法对呼吸交换参数进行收集和分析。计数资料用构成比表示,2组间比较用分析 t 检验或χ2检验,相关性分析用 Pearson 相关性检验。结果 COPD 相关肺动脉高压组患者,FEV1%pred、肺一氧化碳弥散量占预计值百分比以及动脉血氧分压[(29.1±10.4)%、(52.2±21.5)%和(68.9±9.5)mmHg]等参数均小于 COPD 无肺动脉高压组[(38.6±13.4)%、(52.2±21.5)%和(80.5±7.6)mmHg](P <0.05),而且在运动过程中其峰值摄氧量占预计值百分比、分钟通气量占预计值百分比及峰值功率[(0.44±0.14)%、(0.34±0.11)%和(37.8±26.5)W]也较 COPD 无肺动脉高压组明显降低[(0.44±0.14)%、(0.44±0.15)%和(60.0±37.1)W],(P <0.05)。COPD 患者肺动脉收缩压与摄氧效率斜率、动脉血氧分压、运动峰值摄氧量占预计值百分比均呈负相关(r 值为-0.403~-0.530,P <0.01),运动峰值摄氧量占预计值百分比与肺一氧化碳弥散量占预计值百分比呈正相关(r =0.578,P <0.01)。结论 COPD 患者并发肺动脉高压会导致其运动耐力及通气有效性进一步降低,其降低程度与肺动脉压力呈正相关。
목적：연구폐동맥고압대 COPD 환자운동내력급통기유효성적영향。방법선택2012년10월지2014년3월재상해시폐과의원취진 GOLDⅢ~Ⅳ급적 COPD 환자82례,기중남성68례,녀성14례；안폐동맥수축압분위2조,COPD 상관폐동맥고압조43례,COPD 무폐동맥고압조39례。대소유수시자진행상규폐공능검측、초성심동도검측이급증상한제성공솔체증방안하적심폐운동시험검측,병안축차호흡법대호흡교환삼수진행수집화분석。계수자료용구성비표시,2조간비교용분석 t 검험혹χ2검험,상관성분석용 Pearson 상관성검험。결과 COPD 상관폐동맥고압조환자,FEV1%pred、폐일양화탄미산량점예계치백분비이급동맥혈양분압[(29.1±10.4)%、(52.2±21.5)%화(68.9±9.5)mmHg]등삼수균소우 COPD 무폐동맥고압조[(38.6±13.4)%、(52.2±21.5)%화(80.5±7.6)mmHg](P <0.05),이차재운동과정중기봉치섭양량점예계치백분비、분종통기량점예계치백분비급봉치공솔[(0.44±0.14)%、(0.34±0.11)%화(37.8±26.5)W]야교 COPD 무폐동맥고압조명현강저[(0.44±0.14)%、(0.44±0.15)%화(60.0±37.1)W],(P <0.05)。COPD 환자폐동맥수축압여섭양효솔사솔、동맥혈양분압、운동봉치섭양량점예계치백분비균정부상관(r 치위-0.403~-0.530,P <0.01),운동봉치섭양량점예계치백분비여폐일양화탄미산량점예계치백분비정정상관(r =0.578,P <0.01)。결론 COPD 환자병발폐동맥고압회도치기운동내력급통기유효성진일보강저,기강저정도여폐동맥압력정정상관。
Objective To study whether the existence of pulmonary hypertension can affect the ventilatory efficiency and exercise capacity in COPD patients.Methods We evaluated 82 patients with moderate-to-severe COPD,who had pulmonary function test,echocardiography and standard incremental cycle ergometer CPET studies to maximum tolerance.Their successive breathing respiratory exchange parameters were collected and ananyzed.T test and X2 test were used for 2 sample comparison,while correlation analysis was done by Pearson correlation test.Results Compared with COPD without pulmonary hypertension group,FEV1 %pred,DL CO% and PaO 2 [(29.1 ± 10.4)%,(52.2 ±21.5 )% and (68.9± 9.5 )mmHg]were significantly lower in COPD with pulmonary hypertension group [(38.6 ± 13.4)%,(52.2±21.5)% and (80.5± 7.6)mmHg](P <0.05 ).During the exercise CPET values like peak VO 2 % peak VE% and peak workload [(0.44 ± 0.14)%,(0.34 ± 0.1 1 )% and(37.8 ± 26.5 )W] were lower in COPD with group pulmonary hypertension than COPD without pulmonary hypertension group[(0.44±0.14)%,(0.44±0.1 5 )% and (60.0 ± 37.1 )W],P <0.05.SPAP were found correlate well with PaO 2 ,OUES and peak VO 2 % in these COPD patients(r = -0.530,-0.430,-0.403,P <0.01).And a correlation between peak VO 2 % and DL CO% was also be found (r =0.578,P <0.01). Conclusions The existence of pulmonary hypertension can reduce the ventilatory efficiency and exercise capacity in COPD patients,and the exercise capacity is correlated negatively with pulmonary arterial pressure.