高原地区慢性肺心病缓解期无严重低氧血症患者运动时氧疗作用的研究  

Effects of supplemental oxygen during activities in patients with chronic cor pulmonale without severe hypoxemia at rest in high altitude area

作　　者：杨生岳[1] 冯恩志[1] 张瑛[1] 董红梅[1] 高玲[1] 

机构地区：[1]解放军第四医院兰州军区呼吸内科中心,青海西宁810014

出　　处：《中国呼吸与危重监护杂志》2002年第2期96-99,共4页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：解放军总后勤部卫生部"十五"科研课题(01MB014)

摘　　要：目的 探讨高原地区慢性肺心病缓解期不伴严重低氧血症患者运动时去氧饱和及评价氧疗对呼吸困难和从事运动能力的短期效果。方法 42例动脉氧分压(PaO_2)≥50 mm Hg的患者测定肺功能、血气、呼吸肌功能后进行6min步行试验(WT),每个患者在同一天完成3种WT。首先在呼吸空气条件下进行基础WT(BWT),然后随机吸压缩空气WT(CAWT),间隔1 h后进行吸氧WT(O_2WT);或先O_2WT,间隔1 h后再进行CAWT。每种试验结束后即刻测定动脉氧饱和度(SaO_2)、呼吸肌功能。试验前、后用Borg评分标准评估呼吸困难指数。依据BWT时SaO_2下降≥5％和<5％将患者分为去氧饱和(DS)和无去氧饱和(NDS)两组。结果 BWT时DS者占69.0％,NDS者占31.0％。两组基础一秒钟用力呼气容积(FEV_1)占预计值百分比(FEV_1占预计值％)、动脉血二氧化碳(PaCO_2)差异无显著性(P>0.05),DS组PaO_2最大吸气压(PImax)、最大呼气压(PEmax)及最大跨膈压(Pdimax)显著低于NDS组(P<0.05或<0.01)。DS组O_2WT时,运动后SaO_2、步行距离、PImax、PEmax及Pdimax均显著高于BWT、CAWT(P<0.01),SaO_2下降幅度、运动后Borg指数显著低于BWT、CAWT(P均<0.01)。NDS组除(O_2WT、运动后Borg指数和SaO_2下降幅度与BWT、CAWT差异显著(P<0.01)外,余各项指标差异均无显著性(P>0.05)。Objective To assess desaturation during activity and evaluate the short-term effects of oxygen therapy on dyspnea and performance during activities in patients with chronic cor pulmonale without severe hypoxemia at rest in high altitude area (HAECCP) .Methods 42 patients with stable HAEC-CP with PaO2 levelsi>50 mm Hg at rest were initially evaluated by lung function tests,blond gas analysis, and respiratory muscle function lasts, then underwent the following three 6-mm walking tests( WTs) in a random sequence:basal WT(BWT), WT while breathing compressed air(CAWT) ,and WT while breath-ing O2(O2WT) .Every patient performed three WTs in the same day with at least a 60-min interval between each test.SaO2 and respiratory muscle function were measured immediately after every tests.Dyspnea was measured by Rorg scale measurement before and after the test.Patients were divided into two groups: desaturator (DS, a drop of SaO2at least 5% during BWT) and nondesaturator (NDS). Results During the BWT,29 of 42 patients(69% ) were defined as desaturators. PaO2 , maximal inspi-ratory pressure(Plmax), maximal expiratory pressure(I'Emax), maximal trarisdiaphragmatic pressure (Pdimax) in DS group were markedly lower than those in NDS group ( P < 0.01 or < 0.05) at rest.During the O2WT in DS group, final SaO2, walking distance, PImax, PEmax and Pdimax were much higher, the range of SaO2 dropped and final Borg score were markedly lower than those during BWT or CAWT( all P < 0.01), respectively. Except final Borg score and the range of SaO2 dropped during the O2WT,all parameters among three WTs had no significant difference (all P>0.05) in NDS group. Walking distance, final Borg score were positively correlated with FEV1 % predicted, PImax, PE-max and Pdimax (P < 0.01 or < 0.05), not correlated with PaCO2, (P > 0.05) during the BWT.Conclusions Most of COPD patients were desaturated during the BWT. The severer the hypox-emia and the worse the respiratory function, the more significant the desaturation was. O2 administration prevents des

关 键 词：慢性阻塞性肺疾病 肺心病 运动 氧疗 高原 

分 类 号：R541.5[医药卫生—心血管疾病]