无症状吸烟者的运动心肺功能表现

目的　探讨无症状吸烟者的运动心肺功能表现 ,督促吸烟者尽早戒烟。方法　采用负荷递增运动方案 ,对 2 4名无症状吸烟者及 2 4名健康非吸烟者进行了心肺运动试验。运动中监测心率 (HR) ,每分钟氧耗量 (VO2 ) ,每分钟二氧化碳排出量 (VCO2 ) ,每分钟通气量 (VE) ,氧脉搏 (VO2 HR) ,呼吸频率 (BF)等。结果　极量运动时 ,吸烟组的最大运动负荷 ,最大氧耗量 (VO2 max) ,最大公斤体重摄氧量 (VO2 max kg) ,最大二氧化碳排出量 (VO2 max) ,最大每分钟通气量 (VE2 max)等均显著低于健康人 (P <0 .0 5 ) ,且吸烟者VO2 max kg与其吸烟指数呈负相关 (r =- 0 .6 6 ,P<0 .0 1)。结论　吸烟者在尚无临床症状时 ,其运动心肺功能已明显降低。     

吸烟对运动心肺功能的影响

目的 探讨无症状吸烟者的运动心肺功能情况.方法 采用运动负荷递增方案,对肺通气功能正常的17例非吸烟者和14例无症状吸烟者进行运动心肺功能试验,观察最大公斤体重摄氧量(VO2max/kg)、呼出潮气量(Tex)、呼吸储备(BR)、最大运动气促指数(Dimax)、无氧阈(AT)等指标的变化.结果 极量运动时吸烟组的最大公斤体重摄氧量、呼吸储备低于非吸烟组,最大运动气促指数高于非吸烟组(P＜0.05),其它观测指标差异无显著性(P＞0.05).结论 吸烟者即使尚无临床症状,其运动耐力及呼吸功能已呈现损害趋势.     

27例严重急性呼吸综合征患者康复期运动心肺功能的动态观察

目的 系统评估SARS患者康复期肺、心血管和肌肉等的综合运动反应能力。方法于患者出院后1、3、6个月时，分别对27例SARS—IgG阳性的SARS患者的运动心肺功能、静息肺功能和胸部CT进行动态观察。结果 在第一次检查时，除V03max％外，SARS患者运动心肺功能的V03max%、V02max／kg、V02max、METs、BR、HRR及VEmax等各项指标的异常率均高于静息肺功能和CT捡出的异常率。在第二、三次检查时，各项指标的异常率均明显下降，而且SARS患者的临床症状消失与运动心肺功能恢复相符合。结论 SARS患者存在运动心肺功能障碍，可能与其心肺、肌肉等的损伤、发病后活动减少有关。SARS患者运动心肺功能障碍可以逐渐恢复。     

Cardiopulmonary exercise testing in the evaluation of high risk patients with lung cancer

Background It is still unclear whether pulmonary function tests （PFTs） are sufficient for predicting perioperative risk,and whether all patients or only a subset of them need a cardiopulmonary exercise test （CPET） for further assessment.Thus, this study was designed to evaluate the CPET and compare the results of CPET and conventional PFTs to identify which parameters are more reliable and valuable in predicting perioperative risks for high risk patients with lung cancer.Methods From January 2005 to August 2008, 297 consecutive lung cancer patients underwent conventional PFTs （spirometry ＋ single-breath carbon monoxide diffusing capacity of the lungs （DLCOsb） for diffusion capacity） and CPET preoperatively. The correlation of postoperative cardiopulmonary complications with the parameters of PFT and CPET was retrospectively analyzed using the chi-square test, independent sample t test and binary Logistic regression analysis.Results Of the 297 patients, 78 did not receive operation due to advanced disease stage or poor cardiopulmonary function. The remaining 219 underwent different modes of operations. Twenty-one cases were excluded from this study due to exploration alone （15 cases） and operation-related complications （6 cases）. Thus, 198 cases were eligible for evaluation. Fifty of the 198 patients （25.2%） had postoperative cardiopulmonary complications. Three patients （1.5%）died of complications within 30 postoperative days. The patients were stratified into groups based on VO2max/pred respectively. The rate of postoperative cardiopulmonary complications was significantly higher in the group with cardiopulmonary complications were significantly correlated with age, comorbidities, and poor PFT and CPET results.used to stratify the patients＇ cardiopulmonary function status and to predict the risk of postoperative cardiopulmonary predicting perioperative risk. If available, cardiopulmonary exercise testing is strongly suggested for high-risk lung cancer patients in addition to conventional pulmonary function tests, and both should be combined to assess cardiopulmonary function status.     

注射用川芎嗪对肺间质纤维化患者运动心肺功能的影响

目的观察川芎嗪对肺间质纤维化患者的临床表现、运动心肺功能及血气的改善情况。方法60例肺间质纤维化患者随机分为两组,治疗组予以川芎嗪注射液治疗,对照组予口服强的松;两组均治疗2个月后观察疗效。结果治疗2个月后显示治疗组肺功能、血气及运动心肺功能指标(Wmax、VO2 max/kg、VO2/HR、VEmax)均较治疗前改善(P<0.05);与对照组比较亦有改善(P<0.05)。结论川芎嗪注射液能显著改善肺间质纤维化患者的运动心肺功能和生活质量。     

运动心肺功能试验对肝胆外科手术患者术后并发症及肺功能的预测

目的：探讨内蒙古医科大学附属医院肝胆外科手术患者术前肺功能指标对患者术后并发症的预测能力,提高手术安全性。 方法：对48例我院肝胆外科手术患者签署知情同意书后行手术前常规肺功能及运动心肺功能检查,在术后3个月后行常规肺功能和运动心肺功能复查,并追踪术后1个月内有无发生术后心肺并发症（PPC）等情况。 结果：1.在行手术的患者中,术后发生PPC组和无发生PPC组的术前静息肺功能肺功能FEV1/pred 、 DLCO/pred等指标差异无显著性意义（P＞0.05）。2.有PPC组与无PPC组,术前运动心肺功能比较结果示VO2max/pred,VO2max/kg/pred,AT,O2HR/pred等指标的差异均有显著性意义（P＜0.05）。3. 术后发生PPC组和无PPC组的术前运动心肺功能试验中VO2max/pred＜60%,VO2max/kg＜15/min?kg,O2HR/pred＜70%时术后PCC发生率有显性著差异。（P＜0.05）,在AT＞11ml/min/kg组发生PPC较AT＜11ml/min?kg组比较差异有显著性意义（P＜0.05）。 结论：1.运动心肺功能试验在预测肝胆手术术后并发症的有重要意义,优于静息肺功能。2.在预测肝胆手术后并发症时可参考的指标为：如VO2max%＜60%时需,综合评估患者情况,谨慎考虑手术。VO2max/kg＜15ml/min?kg时术后发生PPC可能性较大,因谨慎考虑手术。O2/HRmax%pred＜70%时,需谨慎考虑手术,AT＜11ml/min?kg需谨慎考虑手术,危险性较大,而AT＞11ml/min?kg危险性较少。     

Respiratory effects of non-tobacco cigarettes

Data from the Tucson epidemiological study of airways obstructive disease on smoking of non-tobacco cigarettes such as marijuana were analysed to determine the effect of such smoking on respiratory symptoms and pulmonary function. Among adults aged under 40, 14% had smoked non-tobacco cigarettes at some time and 9% were current users. The prevalence of respiratory symptoms was increased in smokers of non-tobacco cigarettes. After tobacco smoking had been controlled for men who smoked non-tobacco cigarettes showed significant decreases in expiratory flow rates at low lung volumes and in the ratio of the forced expiratory volume in one second to the vital capacity. This effect on pulmonary function in male non-tobacco cigarette smokers was greater than the effect of tobacco cigarette smoking. These data suggest that non-tobacco cigarette smoking may be an important risk factor in young adults with respiratory symptoms or evidence of airways obstruction.     

吸烟对2型糖尿病男性患者血脂水平的影响

目的：探讨吸烟对2型糖尿病男性患者三酰甘油( TG)、胆固醇( TC)、高密度脂蛋白( HDL-C)、低密度脂蛋白( LDL-C)的影响。方法选取2型糖尿病男性患者144例,按吸烟情况分为不吸烟组(从不吸烟)、戒烟组(戒烟半年以上)、少量吸烟组(≤20支/d)、大量吸烟组(>20支/d),采用现场调查结合病例对照研究的方法,问卷调查表的形式,询问患者年龄、糖尿病病程、运动、饮食、吸烟、调脂药的应用等情况;测量血压、身高、体重、腰围、臀围,计算体重指数( BMI)、腰臀比( WHR)、体脂分数等指标。实验室检测TG、TC、HDL-C、LDL-C等,比较各组间血脂、载脂蛋白水平的差异;采用协方差分析校正其他影响因素,比较各组血脂的差异情况;逐步回归及偏相关分析,了解吸烟对血脂影响的相关性及影响程度。结果①不吸烟组与大量吸烟组比较, TG显著降低( P <0．05),校正可能的混杂因素后,两组HDL-C差异有统计学意义( P<0．05);而不吸烟组与其他组TC、TG、HDL-C差异性有所提高,但差异无统计学意义;②与吸烟组比较戒,烟组HDL-C明显降低,与大量吸烟组相比TG明显降低( P<0．05),校正混杂因素后戒烟组与吸烟组TC、LDL-C差异有所提高;③吸烟是HDL-C的独立影响因素(P<0．05,β=-0．213),HDL-C与日吸烟量呈显著负相关性(r=-0．223,P<0．05),与吸烟年限等无明显相关性。结论吸烟与年龄、BMI、血压水平、运动、DM病程、体脂分数、血糖等影响无关,为2型糖尿病男性患者脂代谢紊乱的独立危险因素。日吸烟量与HDL-C之间的负相关性,吸烟组与戒烟组、不吸烟组,戒烟组与不吸烟组之间血脂指标( TG、HDL-C)等的差异,表明吸烟促进2型糖尿病男性患者脂代谢的紊乱,戒烟对脂代谢的调节有积极的意义。     

心肺运动试验在指导2型糖尿病患者精准化运动中的效果

目的:探索心肺运动试验在指导2型糖尿病患者精准化运动中的效果。方法:选择接受心肺运动试验的2型糖尿病患者60例，随机分为对照组和干预组，每组30例。对照组给予患者常规运动指导，干预组根据患者心肺运动试验结果给予精准化指导。运动3个月后，比较两组患者试验前后的糖化血红蛋白（HbA1c）、BMI、峰值摄氧量（VO2peak）、峰值氧脉搏（O2Pulsepeak）、无氧阈（AT）、峰值潮气量（VTpeak）结果，统计患者运动过程中不良事件发生情况。结果:3个月后与基线比较，对照组患者HbA1c、BMI、O2Pulsepeak、VTpeak的变化有显著差异（P＜0.05），VO2peak、AT的变化无差异（均P＞0.05），干预组所有数值变化显著（均P＜0.05）；干预组除HbA1c（P＞0.05）外，其余数值较对照组改善程度明显（P＜0.05）；不良事件中，两组患者低血糖的发生无差异（P＞0.05），对照组心脏危险事件明显高于干预组（均P＜0.05）。结论:两种运动方式均能降低患者血糖水平，但是根据心肺运动试验结果指导2型糖尿病患者的精准化运动，更能有效提高患者心肺功能，减少运动过程中不良事件发生率。     

Effect of 2-5 years of tobacco smoking on ventilatory function tests

Smoking is a pernicious scourge of the world today. There is paucity of literature on the effect of acute smoking on ventilatory functions. The present work is undertaken to study the effect of 2-5 years of tobacco smoking on ventilatory functions. The study group consisted of 30 male, young, healthy subjects, free from cardiopulmonary diseases and with history of smoking of 2-5 years duration, on an average of 10 cigarettes per day. The control group consisted of 30 age-and sex-matched healthy individuals who had naver smoked tobacco. The ventilatory function tests were carried out using electronic spriolyser. There was a significant lowering of the following parameters in smokers: Vital capacity (VC), inspiratory reserve volume (IRV), inspiratory capacity (IC), forced vital capacity (FVC), forced expiratory volume at the end of first second (FEV1), maximum midexpiratory flow (MMEF), peak expiratory flow (PEF), midexpiratory flow75 (MEF75), maximum voluntary ventilation (MVV). This study shows that 2-5 years of tobacco smoking leads to a definite tendency to narrowing of both the large and the small airways.     

中重度慢性阻塞性肺疾病患者动态肺过度充气与运动能力的关系

【目的】探讨慢性阻塞性肺疾病(COPD)患者动态肺过度充气与运动能力的关系。【方法】对26例稳定期中重度COPD患者和12例健康人进行常规肺通气功能、弥散功能、肺容量和症状限制递增功率踏车心肺运动测试。在静息状态和运动过程中每隔1 min记录受试者潮式呼吸时流速容积曲线和深吸气量(IC)。【结果】COPD组在症状限制递增功率运动高峰时,IC(L)较静息状态下降(1.55±0.46 vs 2.17±0.50,P<0.001);运动高峰时ΔIC与摄氧量呈负相关(r=-0.422,P<0.05);运动高峰时IC与静息状态时IC呈负相关(r=-0.743,P<0.001),与运动高峰时潮气量(VT)呈负相关(r=-0.755,P<0.001)。【结论】动态肺过度充气可能是COPD患者在症状限制递增功率运动中运动能力下降的主要原因之一。     

围手术期呼吸功能锻炼对肺癌患者术后呼吸功能的影响

目的：探讨围手术期呼吸功能锻炼对肺癌患者术后呼吸功能的影响。方法方便选取该院肿瘤科于2015年1＿12月期间收治的100例肺癌患者的临床资料进行回顾性分析,所有患者经随机抽样法分为对照组与观察组,每组50例,其中对照组围术期内开展常规护理干预,观察组在围术期常规护理的基础上开展呼吸功能锻炼护理指导,并对两组患者的呼吸功能进行评价。结果锻炼前,两组患者的肺功能相关指标之间比较差异无统计学意义,P﹥0.05；锻炼后,观察组的最大肺活量、1 s用力呼气量以及1 s用力呼气量/用力肺活量分别为(3.26±0.61﹚V/L、(2.34±0.72﹚V/L以及(79.35±7.56﹚%,均得到明显提高,而且与对照组比较明显优于对照组,差异具有统计学意义,P﹤0.05。结论正确合理的呼吸功能锻炼护理指导可以帮助肺癌术后患者明显提高肺功能,改善呼吸效率,提高护理质量。     

冠心病与非冠心病患者在心肺功能相关指标中的差异

目的观察冠心病与非冠心病患者心肺运动试验中的无氧阈、血氧动力学和心肺储备功能的差别。方法根据冠状动脉造影结果将70例胸痛患者分成冠心病组和非冠心病组,进行心肺运动试验,测量两组间二氧化碳呼吸当量、血动力学和无氧阈等心肺功能指标并作比较。结果两组在VO2peak、AT、VT、O2pulsepeak、VCO2和VE/VCO2@AT方面相比较,冠心病组患者的指标值低于非冠心病患者,差异有统计学意义,P〈0.05。结论冠心病与非冠心病患者在VO2peak、AT、VT和O2pulsepeak等心肺功能相关指标中存在一定的差异。     

有氧运动对左心室射血分数正常的心力衰竭患者心肺功能的影响

将左心室射血分数正常的心力衰竭患者89例随机分为有氧运动组与对照组。对照组使川标准内科药物治疗;有氧运动组在对照组治疗方案基础上,加用康复运动方案及运动处方。观察16周后,分别对2组患者心肺功能指标进行检测。结果显示,治疗前2组患者各项指标组问差异无统计学意义;治疗16周后有氧运动组患者最大氧耗量、CO2排出量、峰值心率、步行距离、每搏耗氧量均较治疗前明显提高,改善幅度均优于对照组。提示,有氧运动能显著改善左心室射叭分数正常的慢性心力衰竭患者心肺功能。     

Association between smoking, pancreatic insulin secretion and insulin resistance in Chinese subjects with or without glucose intolerance

Background  There are studies suggesting smoking may increase the risk of type 2 diabetes. Effects of smoking on insulin secretion and insulin resistance (IR) are, however, controversial.
Methods  This is a cross-sectional study. Since there were very few smokers among Hong Kong Chinese women, only men (n=1068) were analyzed in this report. Fasting and 2-hour plasma glucose and insulin were measured. Insulinogenic index as well as beta-cell function and IR based on homeostatic model assessment (HOMA) by computer model (HOMA Calculator v2.2) were calculated.
Results  Of the 1068 men, 147 had newly diagnosed diabetes, 131 newly diagnosed impaired glucose tolerance (IGT) and 790 were non-diabetic normal controls. Smokers had similar fasting and 2-hour insulin levels, insulinogenic index and HOMA derived beta-cell function as compared to non-smokers in the groups with diabetes, IGT or normal oral glucose tolerance test (OGTT). IR was also similar between smokers, ex-smokers and non-smokers in those with normal OGTT. In men with IGT or diabetes, after adjustment for age and body mass index, smokers were more insulin resistant as compared to non-smokers (IR, IGT: 1.59±1.07 vs 1.03±0.54, P<0.05; diabetes: 1.96±1.36 vs 1.06±0.45, P<0.01). With Logistic regression analysis, comparing smokers and non-smokers, IR was independently associated with smoking (odds ratio (95% CI), IGT: 2.23 (1.05, 4.71); diabetes: 3.92 (1.22, 12.58)). None of the other insulin parameters enter into the model among those with normal OGTT or comparing ex-smokers and non-smoker or smokers and ex-smokers.
Conclusions  In Chinese men, smoking did not show any direct association with insulin levels and pancreatic insulin secretion. Smoking men with IGT or diabetes appeared more insulin resistant than their non-smoking counterparts.

     

Reference Values for Lung Function Tests in Men: Regression Equations with Smoking Variables

Prediction formulas for static and dynamic spirometry, gas distribution, static lung mechanics and the transfer test were derived from measurements in healthy men. The measurements included total lung capacity, residual volume, airways resistance, static elastic recoil pressure of the lung, static compliance, closing volume, slope of the alveolar plateau (phase III), flow-volume variables (including mean transit time) during breathing of air or a helium/oxygen mixture, and conventional spirometric indices. The results from 146 smokers and 124 never-smokers were evaluated separately and combined. For all lung function tests a single regression equation was obtained. The prediction formulas included time-related smoking variables and were valid for both smokers and never-smokers. For many lung function tests, a nonlinear age coefficient resulted in a significant reduction in variance compared with simple linear models. Heavy tobacco smoking influenced most lung function tests less than ageing from 20 to 70 years, but for airways resistance, transfer factor and phase III the opposite was found.     

登楼试验预测肺叶切除术后心肺并发症的研究

目的:评价登楼试验预测肺癌患者肺叶切除术后心肺并发症的作用。方法:将需行肺叶切除术的418例肺癌患者行肺功能检查后随机分成两组,P组中ppoFEV1%>30%者205例行手术治疗,S组行登楼试验,于60s内可以登楼48级台阶、静息状态呼吸室内空气时SpO2>90%者200例经术前功能锻炼后行手术治疗,并将S组分为无并发症组和并发症组,对两组间的登楼试验结果进行比较。结果:405例患者接受手术,术后出现心肺并发症47例(11.6%),其中心律失常14例、心功能衰竭7例、心肌梗死1例、肺部感染14例、肺不张5例、肺动脉栓塞1例、呼吸衰竭5例(其中1例死亡)。P组出现心肺并发症25例(12.19%),S组出现并发症22例(11.00%),二组并发症发生率差异无统计学意义(P>0.05)。S组中的无并发症组和并发症组患者的ppoFEV1%、DLCO%、ΔHR差异有统计学意义,登楼时间和ΔSpO2差异无统计学意义。结论:登楼试验是一种简便、经济的预测肺癌患者肺叶切除术后心肺并发症的手段。     

运动心肺功能试验在肺手术前后的变化特征

目的:观察不同手术方式、切除范围术后运动心肺功能的变化特征,并根据术前运动心肺功能检测结果及切除肺段数预计患者术后运动心肺功能情况,建立预计方程式.方法:对46例肺切除手术患者进行手术前、手术后3个月常规肺功能及运动心肺功能检查,观察不同病种、手术方式、切除范围术后运动心肺功能的演变特征,并建立术后运动心肺功能指标的预计方程式.结果:肺切除术后所有肺通气功能指标与运动心肺功能指标都较术前有不同程度下降(P＜0.05);恶性肺肿瘤患者,VO2max /kg%pred、VO2/HRmax下降程度比良性肺肿瘤组大(P＜0.05);不同范围肺切除组相比较差异有统计及意义的运动心肺功能指标有:VO2max /kg、VO2max;部分患者手术后运动心肺功能指标较术前有不同程度改善,根据术前、后肺功能差值及手术切除肺段数,建立各个肺功能指标差值A的回归方程(P＜0.05). 结论:肺切除术后肺功能损害主要是以限制性通气功能障碍为主,运动心肺功能指标亦有不同程度下降,术后运动心肺功能与所患疾病严重程度及肺切除范围有关.本研究建立的线性回归方程将有利于指导临床胸外科更安全、有效地开展胸外科手术.     

老年冠状动脉旁路移植术患者呼吸道的管理

目的 总结老年冠状动脉旁路移植术患者围术期呼吸道的护理措施。方法 对18例行该手术患者术前进行针对性的心理护理,饮食指导,协助戒烟,雾化吸入,呼吸功能训练。术后加强生命体征监护,重视机械通气护理,尽早施行肺部体疗。结果 本组术后发生低心排综合征4例,呼吸衰竭和肺不张各3例,心律失常3例,除2例因多器官功能衰竭死亡外,余16例痊愈出院。结论 冠心病外科治疗手术风险极大,而老年患者术前存在不同程度的心肺功能减退,认为做好围术期患者的呼吸道护理至关重要,是确保手术成功,使患者平稳恢复的重要措施。