稳定期慢性阻塞性肺疾病患者运动时低氧血症的发生及相关因素  

Hypoxemia in patients with chronic obstructive pulmonary disease during exercise

作　　者：郭忠良[1] 蔡映云[2] 梁永杰[1] 杨文兰[2] 朱蕾[2] 揭志军[2] 

机构地区：[1]上海市东方医院呼吸科,200120 [2]上海医科大学附属中山医院肺科

出　　处：《中国康复医学杂志》2000年第1期14-17,共4页Chinese Journal of Rehabilitation Medicine

摘　　要：目的：探讨运动时低氧血症与静息时常规肺功能和血气分析指标、运动后呼吸生理改变及最大运动能力的关系。方法：３０ 例稳定期中重度慢性阻塞性肺疾病（ＣＯＰＤ）患者，运动前进行肺功能检查和血气分析。应用自行车功率仪进行递增负荷运动试验，运动过程通过呼吸感应性体表描记仪监测胸腹呼吸运动之和与潮气量之比（ＴＣＤ／ＶＴ） 。结果：３０ 例受试者中１４ 例运动时出现低氧血症，其常规肺功能指标和最大运动能力指标均显著低于其余１６例。极量运动时血氧饱和度（ＳａＯ２ｍｉｎ） 与静息时ＰａＣＯ２ 和ＲＶ／ＴＬＣ 显著负相关，与ＦＥＶ１ ％ ｐｒｅｄ 、ＦＶＣ％ ｐｒｅｄ、ＭＶＶ％ ｐｒｅｄ 和ＰａＯ２ 等均有一定的相关性；极量运动时ＳａＯ２ 下降幅度与静息时ＰａＣＯ２ 、ＰａＯ２ 和ＲＶ 显著相关；ＳａＯ２ｍｉｎ与ＴＣＤ／ＶＴ 的变化负相关；ΔＳａＯ２ 与ＶＥｍａｘ 相关；ＳａＯ２ｍｉｎ 和ΔＳａＯ２ 与最大运动能力指标无明显的相关性。结论：ＣＯＰＤ患者运动时可出现低氧血症，肺充气过度和通气功能损害是引起运动时低氧血症的主要因素，运动时诱发的胸腹矛盾呼吸和运动时通气不足对低氧血症的发生有一定的影响；运动时低氧血症与最大运动能力无明显的相关性。Objective:To evaluate the relationship between exercise hypoxaemia and clinic characteristics.Method:30 stable moderate to severe chronic obstructive pulmonary disease(COPD) patients were included.All of the patients completed routine pulmonary function testing and blood gases analysing.The exercise capacity of the patients were measured with ergometer,and oxygen saturation(SaO 2),heart rate(HR),blood pressure(BP),and thoracoabdominal motion(assessed by TCD/VT) were monitored.Minute ventilation,tidal volume,respiratory rate,oxygen uptake( VO 2),carbon dioxide output (VCO 2) were measured from the analysis of the expiration every 20s with a computerized system.Result:In 14 of the 30 patients the SaO 2 were lower than 90% during exercise.They had worse lung function and lower exercise capacity than those without hypoxaemia.SaO 2 at maximal exercise were significantly negativly correlated with rest PaCO 2,and also correlated with RV/TLC,RV,FEV 1%pred,FVC%pred,MVV%pred and rest PaO 2.The decrease of SaO 2 during exercise was significantly related with RV,rest PaO 2 and PaCO 2,SaO 2min was weakly correlated with the change of TCD/VT.Delta SaO 2 was related with VE max ,SaO 2min and delta SaO 2 was unrelated with exercise capacity.Conclusion:Hypoxemia during exercise in COPD patients was mainly related with ventilatory impairments,and also strongly correlated with rest PaO 2 and PaCO 2,and weakly related with deranged thoracoabdominal motion during exercise.Hypoxemia was unrelated with exercise capacity. Author′s address\ Dept. of Pulmonary Disease,East Hospital,Shanghai,200120

关 键 词：慢性 阻塞性肺疾病 运动试验 低氧血症 

分 类 号：R563[医药卫生—呼吸系统]