慢性阻塞性肺疾病患者运动能力与其呼吸驱动及呼吸肌功能关系的研究

目的探究慢性阻塞性肺疾病（COPD）患者运动能力与呼吸驱动及呼吸肌功能之间的关系。方法对28例COPD患者和26名正常对照者分别检测静息常规肺功能、肺弥散功能（DLCO）、口腔阻断压（P0.1）、最大吸气压（PImax）及最大呼气压（PEmax），并进行运动负荷试验观测氧耗量（VO2）、二氧化碳产生量（VCO2）、分钟通气量（E）、潮气量（T）等气体代谢指标，同时记录受试者运动中的呼吸困难指数（BorgScale）。运动负荷前、后检测动脉血气分析。结果（1）COPD组患者PImax（40±15）mmHg明显低于正常人组（53±19）mmHg（P<0.05），PEmax在两组中差异无显著性（P>0.05），COPD组患者P0.1（2.8±0.9）mmHg明显高于正常人组（2.0±0.7）mmHg（P<0.05），P0.1/PImax（0.069±0.021）也明显高于正常人组（0.037±0.009）（P<0.01）。（2）COPD组患者VO2max与P0.1及PImax未发现明显的相关关系（P>0.05），但与P0.1/PImax明显正相关（r=0.66，P<0.01），BorgScale与P0.1/PImax明显正相关（r=0.49，P<0.05）。结论COPD患者运动能力下降除与气道阻塞程度及气体交换障碍等有关外，呼吸驱动相对增高及呼吸肌功能障碍也是其运动能力的限制因素。

Exercise tolerance in relation to ventilatory drive and respiratory muscle function in COPD

OBJECTIVE: To assess the relationships between exercise tolerance and respiratory drive and respiratory muscle function in COPD. METHODS: 28 patients with COPD and 26 normal subjects were involved in the study. Routine pulmonary function, pulmonary diffusing capacity, P0.1, PImax were measured at rest. Oxygen consumption (VO2), carbon dioxide production (VCO2), minute ventilation (VE) etc were measured during exercise testing. Borg Scale was recorded simultaneously. Arterial blood gases were measured before and after exercise. RESULTS: (1) PImax in COPD group (40 +/- 15 mm Hg) was significantly lower than that in the normal group [(53 +/- 19) mm Hg, P < 0.05]. P0.1 in COPD group [(2.8 +/- 0.9) mm Hg] was significantly higher than that in the normal group [(2.0 +/- 0.7) mm Hg, P < 0.05]. Inspiratory drive efficacy (VT/P0.1) in COPD group [(0.21 +/- 0.04) L/mm Hg] was significantly lower than that in the normal group [(0.28 +/- 0.07) L/mm Hg, P < 0.05]. P0.1/PImax in COPD group was (0.069 +/- 0.021), significantly higher than that in the normal group [(0.037 +/- 0.009), P < 0.01]. (2) VO2max was correlated with P0.1/Pimax and Borg Scale in COPD patients (r = 0.66, P < 0.01, and r = 0.53, P < 0.05 respectively). Borg Scale was also positively correlated with P0.1/PImax in COPD group (r = 0.49, P < 0.05). CONCLUSION: In addition to airway obstruction and the damaged gas exchange, exercise intolerance in COPD may also be related to the increased respiratory drive and dysfunction of respiratory muscle.