运动指脉氧监测在稳定期慢性阻塞性肺疾病中管理价值探讨

The value research of monitoring oxygen saturation during the walk in the management of patients with chronic obstructive pulmonary disease

目的:评价运动指脉氧(pulse oxygen saturation,SpO_2)监测在稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)中的管理价值。方法 :选取23例稳定期COPD患者,同时选取20例既往无呼吸系统疾病的受试者作为对照组,在接受运动平板试验时监测指脉氧并比较两组间差异,分析COPD组运动指脉氧与肺功能、COPD评估测试(COPD assessment test,CAT)评分、改良医学委员会呼吸困难指数(modified medical research council dyspnea scores,m MRC)评分及过去1年急性加重次数的相关性。结果:(1)COPD组亚极量运动过程中最低指脉氧(SpO_2ML)低于对照组,差异具有统计学意义(P<0.05);(2)COPD组SpO_2ML与第1秒用力呼气容积(FEV1)、用力肺活量(FVC)及FEV1占预计值百分比(FEV1%pred)相关,与FEV1/FVC、每分钟最大通气量(MVV)及每升肺泡容积的一氧化碳弥散量(DLCO/VA)无明显相关性,与过去1年急性加重次数无明显相关性;(3)COPD组运动过程中CAT评分与静息SpO_2、SpO_2ML及SpO_2波动值(ΔSpO_2)无相关性。m MRC评分与SpO_2ML及ΔSpO_2相关,与静息SpO_2无相关性。结论:(1)COPD患者更易发生运动相关的低氧血症,且肺功能受损越重,运动中手指脉氧下降更显著。(2)COPD患者排除心血管疾病后,SpO_2ML可作为COPD管理中一项有临床意义的监测指标,有望成为COPD筛查的一项检测指标。

Objective： To investigate the value of monitoring the pulse oxygen saturation（SpO2） during walking in the stable chronic obstructive pulmonary disease（COPD） patients. Methods： Twenty-three patients with stable COPD were selected, 20 healthy adults without previous respiratory disease were selected as the control group. SpO2 were monitored during treadmill exercise. The differences between the two groups were compared. The correlation between SpO2 and pulmonary function, COPD assessment test （CAT） score, modified medical research council dyspnea scores（mMRC） and the number of acute execration in the past year were analyzed. Results： ①The nadir SpO2 of the COPD group during the exercise（SpO2ML） was lower than the control group during the exercise with highly significant differences （P〈0.05）. ② SpO2ML was associated with forced expiratory volume in the first second （FEV1）, forced vital capacity （FVC）, FEV1%pred and was no significant correlation between FEV1/FVC, maximum ventilatory volume per minute（MVV） and diffusion capacity for carbon monoxide per liter of alveolar volume （DLCO/VA）. The acute execration during the past 1 year was not associated with SpO2ML. ③ The CAT score had no significant correlation between the rest SpO2, SpO2ML and ΔSpO2. The mMRC score was associated with SpO2ML, ΔSpO2 and had no significant correlation with the rest SpO2. Conclusion： ①COPD patients are more likely to be exercise-induced hypoxemia. The worse the lung function, the more significant decline in SpO2. ②SpO2ML could be a predictive indicator of the COPD management when the cardiovascular disease was ruled out, and will be a clinical indicator for COPD screening.