慢性肺源性心脏病与COPD患者心肺运动试验的对比分析

A comparative study on cardiopulmonary exercise testing in patients with chronic pulmonary heart disease and chronic obstructive pulmonary disease

目的探讨COPD引起的慢性肺心病患者心肺运动试验(CPET)的特点。方法对在1997年11月～2003年11月期间,于广东省人民医院肺功能室行CPET检查的5例慢性肺心病患者及12例COPD患者的结果进行回顾性分析。结果 (1)慢性肺心病组5例患者运动耐量均降低,2例患者运动未达无氧阈;COPD组8例患者运动耐量降低,所有患者运动均达无氧阈。(2)慢性肺心病组运动时间、最大运动功率(Wmax)、氧脉(O_2pulse)、氧脉占预计值百分比(O_2pulse pred%)、峰值摄氧量((?)O_2peak)、峰值公斤摄氧量((?)O_2peak/kg)、峰值摄氧量占预计值百分比((?)O_2peak pred%)、运动后动脉血氧分压(PaO_2后)低于COPD组,休息和最大运动时无效腔与潮气量的比值(VD/VT rest、VD/VTpeak)、最大运动时的氧通气当量((?)E/(?)O_2peak)及二氧化碳通气当量((?)E/(?)CO_2peak)高于COPD组,差异有显著性(P<0.05)。结论 COPD引起的慢性肺心病患者运动能力明显低于COPD患者,且运动同时受限于呼吸和心血管功能。通气血流比例(VA/Q)不均较COPD患者严重,表现为VD/VT rest、VD/VTpeak、(?)E/(?)O_2、(?)E/(?)CO_2明显高于正常,易发生运动后低氧血症。

Objective To study the characterisis of cardiopulmonary exercise testing in patients with chronic pulmonary heart disease caused by COPD.Methods Five patients with chronic pulmonary heart disease and twelve COPD patients performed cardiopulmonary exercise testing with cycle ergometer at pulmonary function room of Guang Dong Provincial People' s Hospital between November 1997 and November 2003.Results(1) All 5 patients with chronic pulmonary heart disease had exercise intolerance and 2 patients stopped exercising before reaching the anaerobic threshold.In COPD group,8 patients had exercise intolerance and no patients stopped exercising before reaching the anaerobic threshold.(2)Compared with the COPD group,the group of chronic pulmonary heart disease showed greater reduction in Wmax,O_2 pulse,O2 pulse pred%,VO_2 peak,VO_2peak / kg,VO_2 peak pred%and post-exercised PaO_2,whereas VD / VT rest,VD / VT peak,VE / VO_2 peak and VE / VCO_2 peak were higher in the group of chronic pulmonary heart disease (P<0.05).Conclusion Exercise capacity limitation in the patients with chronic pulmonary heart disease caused by COPD is more seriously than that of the COPD patients and it is caused by impaired pulmonary function and heart function simultaneously.VA / Q mismatch which may be displayed remarkably higher VD / VT rest,VD / VT peak,VE / V O_2,VE / VCO_2 and post-exercised hypoxemia,is more seriously in patients with chronic pulmonary heart disease.