合并限制性通气功能障碍对稳定期Ⅱ、Ⅲ级慢性阻塞性肺疾病患者运动能力的影响  

Effect of coexistent restrictive ventilation impairment on pulmonary diffusing capacity and motion activity in patients with stable moderate to severe

作　　者：陈宇清[1] 吕成坚[1] 周新[1] 朱东[1] 

机构地区：[1]上海交通大学附属第一人民医院呼吸科,上海200080

出　　处：《诊断学理论与实践》2012年第4期387-390,共4页Journal of Diagnostics Concepts & Practice

摘　　要：目的：观察合并限制性通气功能障碍对稳定期Ⅱ、Ⅲ级慢性阻塞性肺疾病（COPD）患者的肺功能和运动能力的影响。方法：将68例稳定期Ⅱ、Ⅲ级COPD患者根据肺总量（TLC）〈80%预计值分为单纯气流阻塞组（32例）和合并限制性通气功能障碍组（阻塞合并限制组）（36例）,受试前8 h内均未应用支气管舒张剂。2组患者在吸入沙丁胺醇400μg后接受常规肺通气功能、弥散功能和呼吸肌力测试,并进行6 min步行试验（6MWT）。结果 ：与正常老年人相比,稳定期Ⅱ~Ⅲ级COPD患者存在较严重的呼出气流受限,导致肺过度充气,肺残气量/肺总量比值（RV/TLC）显著增高。对于合并限制性通气功能障碍的COPD患者,其体质量指数（BMI）较单纯气流阻塞组患者明显降低[（21.8±2.6）kg/m2比（23.2±2.9）kg/m2,P〈0.05],深吸气量（IC）和最大通气量（MVV）也均显著低于单纯气流阻塞的COPD患者,6MWT结果仅为（307.9±26.8）m。合并限制性通气功能障碍的COPD患者其一氧化碳弥散量（DLCO）较单纯气流阻塞组患者显著降低[（49.6±18.9）%比（64.4±20.8）%,P〈0.05],但弥散率（DLCO/VA）却与单纯气流阻塞患者无明显差异[（72.4±24.8）%比（76.5±23.1）%,P〉0.05]。结论：严重营养不良导致COPD患者的BMI显著降低,引起较严重的呼吸肌功能障碍,运动耐力也明显减退。合并限制性通气功能障碍可造成COPD患者的肺弥散功能显著减退,运动能力进一步降低,但对DLCO/VA的影响则不明显。Objective To study the change in pulmonary diffusing capacity, motion activity and respiratory muscle strength in chronic obstructive pulmonary disease （COPD） patients accompanied with restrictive ventilation impairment. Methods Sixty-eight stable COPD patients with Global Initiative for Chronic Obstructive Lung Disease （GOLD） grade Ⅱ-Ⅲ [post-bronchodilator forced expiratory volume in one second （FEV1） ranging from 31%-79% predicted value] were enrolled. Pulmonary function test （PFT） and diffusing capacity for carbon monoxide （DLco） by single-breath method were measured after bronchodilator （salbutamol 400 μg） inhalation, and six minute walk test （6MWT） was performed. Results Compare with health elderly people, COPD patients were found to have severe limited expiratory flow and hyperinflation. Thirty-six patients were diagnosed as having coexistent restrictive ventilation impairment defined as TLC〈80% predicted. In these patients, body mass index （BMI） was （21.8±2.6） kg/m2; inspiratory capacity （IC） and maximal voluntary ventilation （MVV） decreased significantly when compared with that in patients with COPD only, and 6 minute walking distance was lesser [（307.9±26.8） vs （355.9±30.3） m, P〈0.05]. DLco was much lower in patients with coexisting restrictive ventilation impairment [（49.6±18.9）% vs （64.4±20.8）% ,P〈0.05], but no difference was found in DLco/VA[（72.4±24.8）% vs （76.5± 23.1）%, P〉0.05]. Conclusions Low BMI resultes in severe impairment of respiratory muscle strength and motion activity, leading to restrictive ventilation impairment in patients with COPD. DLco declines significantly in COPD patients with coexisting restrictive ventilation impairment and 6 minute walking distance decreases significantly, but DLco/VA is not affected.

关 键 词：慢性阻塞性肺疾病 弥散 呼吸肌力 6min步行试验 

分 类 号：R562.13[医药卫生—呼吸系统]