男性非小细胞肺癌合并慢性阻塞性肺疾病患者运动耐量、通气效率特点临床研究  

A clinical study on the characteristics of exercise tolerance and ventilatory efficiency among the male patients with non-small cell lung cancer and chronic obstructive pulmonary disease

作　　者：王丹 李瑾[2] 高民 张淼[2] 张明[1,2] 张耀莹 陈伟[1,2] WANG Dan;LI Jin;GAO Min(Xuzhou Clinical Introduction of Medical Experts Team Project,Jiangsu,Xuzhou,221010)

机构地区：[1]徐州医科大学附属徐州康复医院,江苏省徐州市221010 [2]徐州市中心医院,徐州医科大学徐州临床学院

出　　处：《中国康复医学杂志》2021年第9期1094-1100,共7页Chinese Journal of Rehabilitation Medicine

基　　金：徐州市引进临床医学专家团队项目(2018TD007);徐州市科技计划项目(KC18184)。

摘　　要：目的:观察男性非小细胞肺癌(NSCLC)合并慢性阻塞性肺疾病(COPD)患者运动耐量及通气效率特点。方法:将32例男性NSCLC患者根据是否合并COPD分为NSCLC合并COPD组(NSCLC-COPD组,n=12)和未合并COPD组(NSCLC-non COPD组,n=20),以同期行心肺运动试验(CPET)的健康体检者为对照组(n=20)。所有NSCLC患者在肺切除术前完成症状限制性最大负荷运动测试,对CPET结果进行比较分析。结果:与对照组比较,NSCLC-non COPD组与NSCLC-COPD组的峰值摄氧量(VO_(2)peak)、峰值摄氧量/预计值(VO_(2)peak/pred%)、峰值公斤摄氧量(peak VO_(2)/kg)、无氧阈(AT)均下降(均P<0.05),二氧化碳通气当量斜率(VE/VCO_(2)slope)、二氧化碳通气当量最低值(VE/VCO_(2)nadir)均上升(均P<0.05),且NSCLC-COPD组VE/VCO_(2)slope、VE/VCO_(2)nadir均高于NSCLC-non COPD组(P<0.05)。与对照组和NSCLC-non COPD组相比,NSCLC-COPD组在测试的不同状态下(静息、热身、无氧阈时、峰值时)VE/VCO_(2)均上升(P<0.05)。而与对照组相比,NSCLC-non COPD组在无氧阈时、峰值时VE/VCO_(2)的上升才有显著性差异(均P<0.05)。NSCLC-COPD组潮气末二氧化碳分压(PET-CO_(2))四个阶段均低于对照组(P<0.05),在峰值运动时,与NSCLC-non COPD组比较有显著性差异(P<0.05)。结论:与健康人群比较,NSCLC患者运动耐量减损,且合并COPD的NSCLC患者整个运动阶段通气效率显著下降,单纯肺癌患者未见此特点。CPET可为NSCLC-COPD患者肺切除术前的风险评估提供依据。Objective:To explore the characteristics of aerobic exercise tolerance and ventilatory efficiency during cardiopulmonary exercise testing(CPET) among the male patients with non-small cell lung cancer(NSCLC) and chronic obstructive pulmonary disease(COPD).Method: A total of 32 NSCLC patients and 20 healthy controls were enrolled in this study. NSCLC patients were divided into NSCLC-COPD group(n=12) and NSCLC-non-COPD group(n=20). All NSCLC patients conducted symptom-limited maximum CPET before pneumonectomy,and the results were compared and analyzed.Result: Compared with control group,NSCLC-non COPD group and NSCLC-COPD group had lower peak VO_(2),peak VO_(2)/predicted,peak VO_(2)/kg and anaerobic threshold(AT)(all P<0.05),as well as higher VE/VCO_(2) slope and VE/VCO_(2) nadir. When compared with NSCLC-non COPD group, NSCLC-COPD group had lower VO_(2) and higher VE/VCO_(2) values(P<0.05). Compared with control group and NSCLC-non COPD group,VE/VCO_(2) values in different exercise stages of NSCLC-COPD group were significantly higher(all P<0.05). Significant difference was also found in VE/VCO_(2) values at AT and peak exercise between control group and NSCLCnon COPD group(all P<0.05). Compared with control group,partial pressure of end-tidal carbon dioxide(PETCO_(2))values in four stages of NSCLC-COPD group were markedly lower(all P<0.05). Significant difference also existed in PETCO_(2) at peak exercise between NSCLC-COPD group and NSCLC-non COPD group(P<0.05).Conclusion:Compared with healthy subjects,exercise tolerance of NSCLC patients is slightly impaired and ventilation efficiency of NSCLC-COPD patients is significantly decreased but not in NSCLC-non COPD group.CPET can provide a basis for risk assessment of NSCLC-COPD patients before pneumonectomy.

关 键 词：非小细胞肺癌 慢性阻塞性肺疾病 心肺运动试验 运动耐量 通气效率 

分 类 号：R563[医药卫生—呼吸系统] R493[医药卫生—内科学]