论文部分内容阅读
目的摄氧效率(OUE)在评估心肺疾病的病情、预后等方面已引起广泛关注。研究表明,摄氧效率是一个客观的、不依赖个人主观因素的评估心肺储备功能的良好指标,并且与心衰患者的疾病严重程度、预后等情况具有很强的相关性。但是对于COPD患者的OUE特点,目前却少见相关研究报道。本研究探讨摄氧效率(OUE)在慢性阻塞性肺疾病(COPD)患者中的特点,并分析其对于COPD患者运动耐力的影响。方法选择2009年8月至2012年8月在上海市肺科医院呼吸科就诊的稳定期GOLDⅠ~Ⅳ级COPD患者共59例(GOLDⅠ级15例、GOLDⅡ级16例、GOLDⅢ级19例、GOLDⅣ级9例)和29例同年龄段健康志愿者进行常规肺功能检测(PFT)及斜坡式功率递增症状限制性心肺运动试验(CPET),按照逐次呼吸法对呼吸交换参数进行收集和分析。结果(1)COPD组OUES、OUEP[(1.90±0.32),(31.47±5.46)与对照组[(2.23±0.39),(35.38±4.22)]比较,差异均有统计学意义(t值分别为4.57,3.39,P值均<0.01)。(2)对GOLDⅠ~Ⅳ级患者组及对照组的OUES、OUEP、OUE@AT运用方差分析,结果有统计学差异(F值分别为10.86,6.66,4.12,P值均<0.01)(3)进一步多重分析发现,GOLDⅠ级患者组的OUES、OUEP、OUE@AT(2.09±0.31,34.15±4.91,34.23±4.84)与对照组[(2.23±0.39),(35.38±4.22),(33.71±3.90)]没有出现统计学差异(P值均>0.05);GOLDⅡ~Ⅳ级患者组的OUES[(2.05±0.26),(1.76±0.28),(1.63±0.19)]均低于对照组(2.23±0.39),差异有统计学意义(P值均<0.05);GOLDⅡ~Ⅲ级患者组的OUEP、OUE@AT[(31.18±4.41),(30.60±4.64);(28.54±4.99),(29.26±4.52)]均低于对照组[(35.38±4.22,33.71±3.90)],差异有统计学意义(P值均<0.05)。(4)COPD组的OUES、OUEP、OUE@AT与患者运动耐力(峰值摄氧量占预计值的百分比,peakVO2%pred)均呈正相关(r值分别为0.500,0.516,0.625,P值均<0.001)。结论 COPD患者的摄氧效率较正常人明显下降,并且与患者的运动耐力呈明显正相关性。
Objective Oxygen absorption efficiency (OUE) in the assessment of cardiopulmonary disease, prognosis, has attracted wide attention. Studies have shown that oxygen uptake efficiency is an objective, good indicator of cardiopulmonary reserve independent of individual subjective factors and has a strong correlation with disease severity and prognosis in patients with heart failure. However, OCD features of COPD patients are rarely reported at present. This study explored the characteristics of oxygen uptake (OUE) in patients with chronic obstructive pulmonary disease (COPD) and analyzed their effects on exercise tolerance in patients with COPD. Methods A total of 59 patients with stable stage GOLD Ⅰ ~ Ⅳ COPD were enrolled in Department of Respiratory Medicine, Shanghai Pulmonary Hospital from August 2009 to August 2012 (15 cases of GOLDⅠ, 16 cases of GOLDⅡ, 19 cases of GOLDⅢ, 19 cases of GOLD Ⅳ (N = 9) and 29 healthy volunteers of the same age underwent routine pulmonary function test (PFT) and ramp power increase symptom-limited cardiopulmonary exercise test (CPET). Respiratory exchange parameters were collected and analyzed according to the breath-by-breath method. Results (1) Compared with control group [(2.23 ± 0.39), (35.38 ± 4.22), COPD group OUES, OUEP [(1.90 ± 0.32), (31.47 ± 5.46)], the differences were statistically significant 4.57, 3.39, P <0.01). (2) The ANOVA of OUES, OUEP and OUE @ AT in GOLD Ⅰ ~ Ⅳ group and control group were statistically significant (F = 10.86, 6.66, 4.12, P <0.01) Further multiplex analysis found that the OUES, OUEP, OUE @ AT (2.09 ± 0.31,34.15 ± 4.91,34.23 ± 4.84) and the control group [(2.23 ± 0.39), (35.38 ± 4.22), (33.71 ± 3.90 ) Were significantly lower than those in control group (P <0.05). OUES of patients with GOLDⅡ ~ Ⅳ grade were (2.05 ± 0.26), (1.76 ± 0.28) and (1.63 ± 0.19) (P <0.39). There was significant difference between the two groups (P <0.05). The levels of OUEP, OUE @ AT in patients with GOLDⅡ ~ Ⅲ grade were (31.18 ± 4.41), (30.60 ± 4.64), (28.54 ± 4.99) 4.52)] were lower than the control group [(35.38 ± 4.22,33.71 ± 3.90)], the difference was statistically significant (P <0.05). (4) OUES, OUEP and OUE @ AT in COPD group were positively correlated with exercise tolerance (peak oxygen uptake percentage, peakVO2% pred) (r values were 0.500, 0.516 and 0.625, P < 0.001). Conclusion The oxygen uptake efficiency of patients with COPD is significantly lower than that of normal people, and positively correlated with exercise tolerance of patients.