慢性阻塞性肺疾病患者运动负荷初期血流动力学应答的探究

Hemdynamic response to exercise in patients wits chronic obstructive pulmonary disease(COPD)

目的实验通过恒定运动负荷试验观测慢性阻塞性肺疾病（ＣＯＰＤ）及正常人于室内空气和吸氧时运动负荷初期（运动负荷后１～３分钟）血流动力学变化，探究运动负荷初期血流动力学应答检测对ＣＯＰＤ肺动脉高压诊断及疗效评价的可行性。方法采用右心导管动态观测其肺动脉平均压（ｍＰＡＰ），心排血量（ＣＯ）及混合静脉血氧饱和度（ＳｖＯ２）。结果与对照组比较，ＣＯＰＤ组于室内空气和吸氧时运动负荷初期ＰＡＭＰ均明显增高，ＳｖＯ２明显降低，ＣＯ呈逐渐增加趋势，且运动负荷３分钟时血流动力学变化与１５分钟时差异无显著性。ＣＯＰＤ组ｍＰＡＰ及ＳｖＯ２于运动负荷后达到相对恒定明显迟于对照组，但吸氧可缩短ＣＯＰＤ组ｍＰＡＰ和ＳｖＯ２到达相对恒定的时间，且接近对照组。结论检测ＣＯＰＤ运动负荷初期血流动力学应答对ＣＯＰＤ肺动脉高压诊断及疗效判定有重要的临床意义。

Objective The present study was undertaken to assess the cardiopulmonary response during the initial period of exercise.Methodw Eight patients with COPD and 10 normal subjects were investigated during exercise(35W)in room air and oxygen breathing for15 minutes,respectively.Pulmonary arterial mean pressure(mPAP),cardiac output(CO)and mixed venous oxygen saturation (SO 2)were measured by Swan Ganz catheter during exercise.Results Compared with normal controls,mPAP in COPD patients was increased and SO 2 decreased markedly both in room air and oxygen breathing during exercise.And CO increased relative slowly than that of normal controls.Furthermore,in patients with COPD,the time to reach their steady state in mPAP and SO 2 during exercise were delayed compared with normal controls.Moreover,we found that the time to reach their steady state in mPAP and SO 2 were shortened when the patients were given oxygen breathing during exercise.Conclusions The results indicate that the measurement of initial changes in mPAP and SO 2 during exercise have important clinical significance for evaluating the cardiopulmonary response in patients with COPD.