长期氧疗对改善慢性阻塞性肺疾病患者右心功能的疗效观察

Efficiency oflong-term oxygen therapy on right ventricular functionin patients with chronic obstructive pulmonary disease

目的：评价长期氧疗对改善慢性阻塞性肺疾病（COPD）患者右心功能的疗效。方法选择2011年10月至2012年3月无锡市人民医院门诊或住院检查二维心脏超声未见异常、肺功能Ⅰ级的COPD患者40例，其中男性22例、女性18例，每日夜间连续吸氧10h，氧流量为2L/min，观察1年。并于氧疗前1d、氧疗后3个月、6个月、1年，同时进行心脏超声及肺功能检测。比较氧疗前后右心功能、肺功能各项指标的变化。结果应用心脏超声斑点追踪技术测得右室游离壁基底段应变（Sbasfw）、右室游离壁基底段应变率（SRbasfw）、右室游离壁中间段应变（Smidfw）及右室游离壁中间段应变率（SRmidfw）于氧疗后3个月比氧疗前1d升高，且差异有统计学意义（P＜0.05）；随着氧疗持续时间的延长， Sbasfw，SRbasfw，Smidfw及SRmidfw升高更加显著（P＜0.01）；右心室纵向缩短率（Tm%）于氧疗后3个月即有升高，且与氧疗前比较，差异有统计学意义（P＜0.05），随着氧疗持续时间的延长继续升高（P＜0.01）；右室游离壁三尖瓣环收缩期峰值位移（T1），室间隔三尖瓣环收缩期峰值位移（T2），三尖瓣环连线中点收缩期峰值位移（Tm）在氧疗后6个月出现升高，与氧疗前比较，差异有统计学意义（P＜0.05），并随氧疗持续升高。1s用力呼气容积（FEV1）、FEV1占预计值百分比氧疗后1年比氧疗前升高，且差异有统计学意义（P＜0.05）。结论长期氧疗可明显改善COPD患者的右心收缩功能，且对右心功能的改善早于肺功能。

ObjectiveTo analyze the efficiency oflong-term oxygen therapy ontheright ventricular functionin the patients with chronic obstructive pulmonary disease（COPD）.Methods A total of40 COPD patients（22 males and 18 females） withpulmonary function levelⅠbutnormal two-dimensionalelectrocardiogramadmitted in our hospital from October 2011 to March 2012were enrolled in the study. They allinsistently tookoxygen uptakeat alow flow rateof2L/min, 10h per day for1 year. Echocardiography and lung function testwere performed in1d before,in3and 6months and 1 year after oxygen uptake, respectively.ResultsSpeckletrackingechocardiography indicatedthat strain of basal segments of right ventricular free wall （Sbasfw）,strain rate of basal segments of right ventricular free wall （SRbasfw）, strain of middle segments of right ventricular free wall （Smidfw）, andstrain rate of middle segments of right ventricular free wall （SRmidfw） were alldramatically increased after 3 months’ oxygen uptake treatmentthanthe values in1d before treatment（P〈0.05）. Withthe time elapse ofoxygen uptaking, Sbasfw, SRbasfw, Smidfw and SRmidfwwereobviously increased （P〈0.01）. Right ventricular longitudinal shortening （Tm%）was elevated in3 months after oxygen uptake, which were significantly higher than before treatment（P〈0.05）, and continued to arise along with the treatment（P〈0.01）.Tricuspid annular systolic peak displacement at right ventricular free wall （T1）,tricuspid annular systolic peak displacementat interventricular septum（T2）andtricuspid annular systolic peak displacementat midpoint of tricuspid annulus （Tm）all began toincrease after 6 month, whichhad statistical difference withthedata before oxygen uptake（P〈0.05）, and continuedto elevatewith oxygen uptake time. Forced expiratory volume in one second （FEV1） and percentage of FEV1were obviously higherafter 1 year’s treatment than before（P〈0.05）.ConclusionLong-term oxygen therapy significantly improvesthe right ventricular systolic functionin COPD patients, and its effect appearsearlieron theimprovementto right ventricular function thantolung function.