慢性阻塞性肺疾病患者呼吸肌强度与肺功能的关系

目的:探讨慢性阻塞性肺疾病(COPD)患者的呼吸肌强度及其与肺功能的关系。方法:测定30例COPD患者犤男5例,女15例,平均年龄(72+3)岁犦的呼吸肌力犤最大吸气压(MIP)、最大±呼气压(MEP)犦和肺功能犤用力肺活量(FVC)、第1秒用力呼气量(FEV1)、第1秒用力呼气量占第1秒用力呼气量百分比(FEV1/FVC),最大通气量(MVV)犦,计算各个对象实测值占其预计值百分比,并计算呼吸肌力与肺功能的相关性。结果:COPD患者呼吸肌强度和肺功能均明显低于其预计值(慢阻肺患者的MIP仅占其预计值的(56±11)%,MEP仅占预计值的(46±11)%,肺功能仅达到预计值的48%～71%;COPD患者的呼吸肌力与其肺功能指标呈显著相关。结论:COPD患者肺功能减退与其呼吸肌强度衰弱密切关联,改善呼吸肌状态有利于提高COPD患者的呼吸功能。     

以呼吸生理为导向呼吸运动锻炼对慢性阻塞性肺疾病呼吸肌功能及运动耐力的影响

背景:以往报道证实缩唇呼吸可以改善慢性阻塞性肺疾病患者气促症状和运动耐力的非药物治疗方法.目的:试验以缩唇呼吸为对照,拟观察呼吸生理为导向呼吸运动训练对慢性阻塞性肺疾病患者呼吸肌功能及运动耐力的影响.设计、时间及地点:随机对照分组设计,于2006-10/2007-12在湖南省怀化市第二人民医院完成.参试者:按2006年慢性阻塞性肺疾病全球倡议标准选择60例慢性阻塞性肺疾病急性加重期患者,男51例,女9例.方法:采用前瞻、随机、对照的方法将60例患者分为3组,实验组患者给予以呼吸生理为导向的呼吸运动训练8周,3次/d,15min/次;阳性对照组患者给予缩唇呼吸运动训练8周,3次/d,15min/次;阴性对照组患者不给予呼吸运动训练,每组20例.主要观察指标:呼吸困难MRC评分、日常生活活动能力、生存质量、6min步行距离、最大呼气口腔压和最大吸气口腔压.结果:实验组、阳性对照组和阴性对照组在呼吸运动训练过程中退出试验的分别有3,5,5例.①实验组和阳性对照组呼吸运动训练后的MRC评分均比各自呼吸运动训练前下降(P＜0.01);日常生活活动能力评分、6min步行距离、最大呼气口腔压和最大吸气口腔压均比各自呼吸运动训练前增加(P＜0.01, P＜0.05),其中实验组呼吸运动训练后的日常生活活动能力评分、6min步行距离、最大呼气口腔压和最大吸气口腔压比阳性对照组增加(P＜0.05).②实验组和阳性对照组呼吸运动训练前、后各项生存质量评分差异均有非常显著性意义(P＜0.01,P＜0.05).结论:以呼吸生理为导向的呼吸运动训练能明显改善重度至极重度慢性阻塞性肺疾病患者的呼吸困难、提高生活活动能力和生存质量、增加运动耐力和呼吸肌功能.     

Altered pulmonary vascular smooth muscle responsiveness in monocrotaline-induced pulmonary hypertension

Studies were conducted to determine whether experimental pulmonary hypertension is associated with alterations in pulmonary vascular smooth muscle responsiveness. Adult male rats were given a single s.c. injection of monocrotaline (105 mg/kg) or saline and were sacrificed 4, 7 or 14 days later. Segments of the main trunk and right extrapulmonary artery and an intrapulmonary artery were isolated for determination of vascular reactivity to contractile and relaxant agonists. Monocrotaline treatment caused changes in mechanical properties of pulmonary arteries in that vessels isolated from rats 14 days after monocrotaline administration required greater passive loads to achieve maximal active force development. Cumulative concentration-response curves were generated to potassium chloride, angiotensin II, norepinephrine, isoproterenol and acetylcholine. Vascular contractility was enhanced in main pulmonary artery 4 days after monocrotaline injection but no differences in responsiveness between control and monocrotaline exposed vessels were observed 7 days post-treatment. In contrast, significant decreases in contractility with a specific loss in the response to angiotensin II were observed in pulmonary arteries isolated from rats 14 days after monocrotaline administration. These vessels also were less responsive to the relaxant effects of isoproterenol and acetylcholine when compared to control vessels. These results demonstrate that changes in pulmonary vascular smooth muscle responsiveness occur during evolution of pulmonary hypertension induced by monocrotaline. Enhanced contractility may contribute to inappropriate vasoconstriction early in the development of hypertensive pulmonary vascular disease but does not appear to be involved in sustained elevations in pulmonary artery pressure. Diminished relaxation observed after pulmonary hypertension was well established may contribute to the loss in efficacy of vasodilators in the long-term management of pulmonary hypertension.     

呼吸肌锻炼对慢性阻塞性肺疾病缓解期患者肺功能及生活质量的影响

目的:探讨呼吸肌锻炼对慢性阻塞性肺疾病(chronicobstructivepulmonarydisease,COPD)缓解期患者肺功能及生活质量的影响。方法:COPD缓解期患者64例,随机分2组,对照组患者吸入0.25g/L溴化异丙托品气雾剂40μg,2次/d。观察组患者吸入0.25g/L溴化异丙托品并行呼吸肌锻炼,疗程6个月,治疗前及治疗后6个月分别进行肺功能测定及生活质量评分。结果:观察组用力肺活量(forcedvitalcapacity,FVC),FVC占预计值%(FVC%)、第1秒用力呼气容积(forcedexpiratoryvolumeinthefirstsecond,FEV1)、FEV1占预计值%(FEV1%)及FEV1/FVC均明显高于治疗前(t=2.12～2.43,P<0.05)。观察组患者治疗后生活质量较治疗前后明显提高(t=4.72～6.18,P<0.01)。结论:呼吸肌锻炼能改善COPD患者的肺功能及提高生活质量。     

Right heart function and haemodynamics in pulmonary hypertension

The primary challenge in the care of the patient with advanced pulmonary arterial hypertension (PAH) is right ventricular dysfunction with concomitant right heart failure. Right heart function is closely tied to survival in this disease, and there is a growing interest in the study of this unique structure. While echocardiography and cardiac magnetic resonance (CMR) have augmented our ability to image the right ventricle (RV), the primary means of assessing right heart function remains right heart catheterisation. Several of the currently available treatments for PAH have been shown to have effects on the RV, not just the pulmonary vasculature, and, in future, therapies aimed at optimizing right ventricular function may allow better outcomes in this challenging disease. New directions in right ventricular assessment including measurement of pulmonary vascular impedance and more widespread availability of CMR may allow greater knowledge about this little studied, yet highly important, right side of the heart.     

Exercise test and respiratory muscle function test

Dyspnea on exertion is a chief complaint of patients with COPD, and it has a major effect on the quality of their lives. Dyspnea is, by definition, subjective, but objective approaches are needed for a comprehensive understanding of these patients' conditions. Thus, measuring changes in cardiopulmonary variables during exercise can be very helpful when evaluating patients with COPD. The main purpose of exercise testing is to evaluate exercise tolerance and to identify the factors limiting exercise. Although incremental exercise testing is ideal for these purposes, simple walking tests such as 6-minute walking test, are also useful.     

缬沙坦减轻肺高压大鼠肺血管平滑肌细胞增生的研究

目的:探讨缬沙坦降压和对肺高压大鼠肺血管平滑肌细胞增生的影响。方法:对分流组及治疗组大鼠行腹主动脉-下腔静脉分流术,治疗组以缬沙坦40mg/(kg·d)灌胃。术后6周和11周分别测定肺动脉平均压(PAMP)、右心室(RV)/左心室+室间隔(LV+S)比值,观察肺血管壁的变化。结果:治疗组大鼠术后6周和11周PAMP、RV/LV+S及肺血管平滑肌细胞增生程度均比分流组为轻。结论:缬沙坦有降低肺高压大鼠肺动脉压力,减轻肺血管平滑肌细胞增生的作用。     

Underfilling decreases left ventricular function in pulmonary arterial hypertension

The International Journal of Cardiovascular Imaging - To evaluate the association between impaired left ventricular (LV) longitudinal function and LV underfilling in patients with pulmonary...     

External respiratory function in stages I and II arterial hypertension

AIM: To examine external respiratory function (ERF) and pulmonary circulatory hemodynamics in patients with Stages I and II arterial hypertension (AH). MATERIALS AND METHODS: 105 patients with AH were examined. In 43 of them, spirography and echocardiography were performed with pulmonary pressure and determined during elevated blood pressure (BP) and antihypertensive therapy. RESULTS: ERF disorders that recovered with BP lowering were detected in 62.8% of patients with AH. There were also signs of elevated pulmonary pressure. CONCLUSION: In patients with HF, pulmonary hemodynamic disorders, changes in ERF, and the degree of AH are closely interrelated.     

呼吸肌功能锻炼对慢性阻塞性肺疾病缓解期患者生活质量及肺功能的影响

目的 探讨呼吸肌功能锻炼对慢性阻塞性肺疾病(COPD)缓解期患者生活质量及肺功能的影响.方法 选取COPD缓解期患者110例,由专科护士指导其进行呼吸肌功能锻炼.记录锻炼前后患者的呼吸及心跳频率变化情况、FEV1％、FEVl/FVC、肺活量、最大通气量、时间通气量以及氧分压.由医护人员及患者共同完成生活质量评定量表的测评.结果 经过呼吸肌功能锻炼,患者的呼吸频率及心跳频率较锻炼前均有所下降,呼吸功能得到有效改善,生活质量得到有效提升.各项指标锻炼前后比较差异显著.结论 呼吸肌功能锻炼可以有效改善COPD缓解期患者生活质量及肺功能,值得临床推广.     

Non-invasive assessment of respiratory muscle function and its relationship to exercise tolerance in patients with chronic obstructive pulmonary disease

Most patients with chronic obstructive pulmonary disease (COPD) have impaired respiratory muscle function. Maximal oesophageal pressure correlates closely with exercise tolerance and seems to predict the distance walked during the 6-min walk test. This study assessed the non-invasive parameters of respiratory muscle function in 41 patients with COPD to investigate their relationship to pulmonary function tests and exercise tolerance. The COPD patients, who demonstrated the full range of airway obstruction severity, had a mean forced expiratory volume in 1 s of 42.5% predicted (range, 20 - 79% predicted). Both the maximal inspiratory muscle strength and non-invasive tension-time index were significantly correlated with the degree of lung hyperinflation, as expressed by the ratio of residual volume to total lung capacity, and the distance walked in 6 min. We conclude that respiratory muscle function was influenced mainly by lung hyperinflation and that it had an important effect on exercise tolerance in COPD patients.     

呼吸训练后老年慢性阻塞性肺疾病患者呼吸功能障碍分级的变化

目的:观察应用规范综合的呼吸训练疗法对老年慢性阻塞性肺疾病患者呼吸功能障碍分级的改善以及对肺功能的影响。方法:选择2002-01/2004-12沈阳市铁西区中心医院呼吸内科接受治疗的老年慢性阻塞性肺疾病患者34例,男20例,女14例,患者均知情同意参加本实验。34例患者在接受常规治疗同时进行呼吸操训练(以缩唇呼气配合肢体动作为主,吸气用鼻,呼气用嘴,第1节双手上举吸气,放下呼气,10～20次;第2节以手放于身体侧面,交替沿体侧上移下滑,上移吸气,下滑呼气,10～20次;第3节双肘屈曲握拳,交替向斜前方击拳,出拳吸气,还原呼气,10～20次;第4节双腿交替抬起,屈膝90°,抬起吸气,放下呼气;第5节吹悬挂的小纸球训练)和运动训练(根据患者的心肺功能不同,步行60～80步/min,10～15min/次,3次/d;上肢做双臂上举运动,2.0～3.0min/次,2次/d或用上肢拉力器训练,质量0.5～2.0kg,连续拉10～20次,训练时配合呼吸进行,拉起呼气)。各项指标分别于功能训练前和功能训练6个月后进行评定。活动受限主观呼吸障碍感受采用6级评定法(0级为无症状;1级为一般劳动后,有气促;2级为速度较快行走,上坡、上下楼有气促;3级为缓慢走不到百米就有所促;4级为说话、穿衣等轻微活动有气促;5级为安静状态下有气促,无法平卧)。肺功能采用用力肺活量,第1秒用力呼出量,第1秒用力呼气量占预测值百分比,第1秒用力呼气量占用力肺活量百分比,最大通气量,一氧化碳弥散量进行评定。结果:34例患者全部进入结果分析。①呼吸功能障碍分级的变化:功能训练前0级1例,1级3例,2级24例,3级3例,4级2例,5级1例。功能训练后分别为2,8,10,12,2,0例。②肺功能指标变化:功能训练后用力肺活量、第1秒用力呼出量、第1秒用力呼气量占预测值的百分比、第1秒用力呼气量占用力肺活量百分比、最大呼气量、一氧化碳弥散量与功能训练前基本一致[(2.61±0.13)L,(2.58±0.12)L;(1.67±0.11)L,(1.62±0.10)L;(73.26±4.54)%,(67.71±4.15)%;(61.44±2.43)%,(61.59±2.30)%;(62.91±3.39)L,(62.05±3.42)L;(13.31±0.72)mL/(min·mmHg),(13.75±0.82)mL/(min·mmHg),(t=0.248～1.741,P>0.05)]。结论:通过半年呼吸康复训练,患者呼吸功能障碍明显减轻,但肺功能各项指标基本无改善。     

The influence of nutrition on neonatal respiratory muscle function

Advances in neonatal intensive care have resulted in increasing survival of very small babies, who often require prolonged periods of mechanical ventilation. These babies have limited nutritional reserves, and are difficult to feed by either parenteral or enteral routes. This review article discusses the interaction between undernutrition and respiratory muscle function in the critically ill preterm baby.     

慢性阻塞性肺疾病患者呼吸肌功能的测定

应用自行研制的ＲＭＳＥ－１型呼吸肌功能测定仪对健康正常人和缓解期ＣＯＰＤ患者的岂功能进行测定。结果表明，缓解期ＣＯＰＤ患者呼吸肌肌力指标如ＭＩＰ和ＭＥＰ与正常人无明显差别，而呼吸肌耐力指标如最大吸气贡荷、最大负荷时平均口腔压和最大负荷时最大持续吸气压占ＭＩＰ的百分数较正常人明显降低，差异非常显著。认为呼吸肌功能测定作为呼吸肌功能评定的客观方法，对于观察ＣＯＰＤ患者呼吸肌功能锻炼的效果和旨导呼吸康复     

Pulmonary capillary endothelial metabolic function in chronic thromboembolic pulmonary hypertension

Summary.  Background:  Chronic thromboembolic pulmonary hypertension (CTEPH) causes physical plugging of large pulmonary arteries as well as a distal micro-vasculopathy. Pulmonary endothelium is an active metabolic tissue in normal humans. The effects of CTEPH on pulmonary endothelial metabolism are unknown. Objectives:  We studied pulmonary capillary endothelium-bound angiotensin converting enzyme (ACE) activity as an index of endothelial metabolism in patients with CTEPH. Patients/methods:  We measured single-pass transpulmonary per cent metabolism (%M) and hydrolysis of an ACE synthetic substrate and calculated functional capillary surface area (FCSA), normalized to body surface area (BSA), in 13 patients with CTEPH and 23 controls. Results:  Mean %M for CTEPH (71.6 ± 4.0% SE) was similar to controls (74.7 ± 2.7%). Substrate hydrolysis ( v ) was similar for CTEPH (1.47 ± 0.22) and controls (1.51 ± 0.11). However, FCSA/BSA was reduced ( P  < 0.01) for CTEPH (1530 ± 218 mL min⁻¹*m⁻²) as compared with controls (2948 ± 245). Conclusions:  The metabolically functional pulmonary capillary bed is reduced in CTEPH. However, because %M and hydrolysis are preserved, this points to a reduction in functional capillary surface area rather than reduced ACE activity on the pulmonary capillary endothelial cell. The reduction in functional capillary surface area may just be a result of decreased capillary recruitment because of upstream vascular plugging by chronic organized thrombus.     

呼吸训练队缓解期慢性阻塞性肺病患者肺功能的影响

目的观察呼吸训练对缓解期慢性阻塞性肺病（COPD）患者肺功能的影响。 方法将74例缓解期COPD患者随机分为对照组和治疗组,治疗组进行6个月呼吸训练,包括缩唇呼吸、腹式呼吸、呼吸操,对照组不进行呼吸训练。比较2组治疗前、后肺功能指标。 结果治疗组呼吸训练后肺活量（VC）、用力肺活量（FVC）、第一秒用力呼出量（FEV1）、用力呼气高峰流速（PEFR）、25％肺活量最大呼气流量（V25）增加,残气量（RV）、残气/肺总量％（RV/TLC）减低,与对照组比较,差异有统计学意义（均P<0.05）,与治疗前比较,差异有统计学意义（均P<0.05）。 结论呼吸训练能够改善COPD缓解期患者的肺功能。