心肺运动试验对慢性阻塞性肺疾病患者肺功能的评估价值研究  

Value of Cardiopulmonary Exercise Test in the Evaluation of the Pulmonary Function of Patients With Chronic Obstructive Pulmonary Disease

作　　者：桂珍珍[1] 夏岑峰[1] 高艳[1] 王绍金[1] 张鹏[1] 张锦[1] 

机构地区：[1]宁夏医科大学总医院呼吸与危重症医学科,宁夏回族自治区银川市750004

出　　处：《中国全科医学》2016年第5期507-510,520,共5页Chinese General Practice

摘　　要：目的探讨心肺运动试验(CPET)评估慢性阻塞性肺疾病(COPD)患者肺功能的特点以及与常规肺功能检查(PFT)评估的一致性。方法选取2014年1—9月在宁夏医科大学总医院门诊就诊的稳定期COPD患者26例为试验组,同期体检健康志愿者29例为对照组。两组均行PFT及CPET,记录相关参数并进行比较,且分析PFT与CPET评估COPD患者肺功能的吻合性。结果 PFT结果显示,两组用力肺活量(FVC)间差异无统计学意义(P>0.05);而试验组第1秒用力呼气末容积(FEV1)、FEV_1占预计值百分比(FEV_1%pred)、FEV_1/FVC均低于对照组,差异有统计学意义(P<0.05)。CPET检查结果显示,两组峰值运动时CO2输出量(peak VCO_2)、无氧阈(AT)时CO_2通气当量(VE/VCO_2)间差异均无统计学意义(P>0.05);而试验组峰值功率(Wmax)、峰值摄氧量(peak VO2)、峰值公斤摄氧量(peak VO_2/kg)、peak VO_2占预计值百分比(peak VO_2%pred)、AT、最大心率(HRmax)、氧脉搏(O2/HRmax)、最大分钟通气量(VEmax)、呼吸储备(BRmax)均低于对照组,运动前后血氧饱和度(Sa O_2)差值高于对照组,差异有统计学意义(P<0.05)。PFT与CPET评估COPD患者肺功能严重程度分布间差异有统计学意义(u=3.290,P=0.001)。26例患者中,有8例(30.8%)患者两种评估方法分级一致;16例(61.5%)患者CPET评估的肺功能损害程度较PFT严重;PFT评估为重度和极重度的10例患者中,仅有2例与CPET评估分级不一致。结论 CPET在COPD患者肺功能早期诊断中较静态肺功能灵敏。Objective To investigate the features of cardiopulmonary exercise test（ CPET） in the evaluation of the pulmonary function of patients with chronic obstructive pulmonary disease（ COPD） and its consistency with conventional pulmonary function test（ PFT） in the evaluation of pulmonary function of COPD patients. Methods We enrolled 26 patients who were at the stable period of COPD and received treatment in the outpatient department of Ningxia Medical University General Hospital from January to September in 2014. We also enrolled 29 healthy volunteers who received physical examinations in the same period. PFT and CPET were conducted on both groups,and relevant parameters were recorded and compared between the two groups. The consistency between PFT and CPET in the assessment of the lung function of COPD patients was analyzed.Results The result of PFT showed that the two groups were not significantly different in forced vital capacity（ FVC）（ P 〉0. 05）; the trial group was lower than control group in FEV_1,FEV_1% pred and FEV_1/ FVC（ P 〈0. 05 for all）. The result of CPET showed that the two groups were not significantly different in peak VCO_2 and VE / VCO_2（ P 〉0. 05 for all）; trial group was lower in Wmax,peak VO_2,peak VO_2/ kg,peak VO_2% pred,AT,HRmax,O_2/ HRmax,VEmax and BRmax and was higher in Sa O_2 before and after exercise than control group（ P 〈0. 05 for all）; there were significant differences between PFT and CPET in the assessment of the distribution of lung function abnormality severity（ u = 3. 290,P = 0. 001）. Among the 26 patients,there were 8（ 30. 8%） patients who had consistency in the results made by the two assessment methods; there were 16（ 61. 5%）patients who had higher grade in lung function abnormalities assessed by CPET than by PFT; of the 10 patients who were severe and extremely severe in lung function abnormalities assessed by PFT, only 2 patients had results inconsistent with CPET.Conclusion CPET may be a more sensitive test in early diagnos

关 键 词：肺疾病 慢性阻塞性 心肺运动试验 肺功能 

分 类 号：R563[医药卫生—呼吸系统]