慢性阻塞性肺疾病患者静息能量与呼吸力学及气体交换关系的研究

目的　探究慢性阻塞性肺疾病 (COPD)患者静息能量消耗 (REE)与肺通气功能、呼吸驱动及呼吸肌功能间的关系。方法　用canopy法间接测定 2 6例COPD患者和 2 1例健康对照者的REE、氧耗量 ( VO2 )、二氧化碳产生量 ( VCO2 )及呼吸商 (RQ)。同时测静息肺通气功能、口腔阻断压(P0 1)、最大吸气压 (PIMAX)及最大呼气压 (PEMAX) ,并进行动脉血气分析。结果　 (1)COPD组患者REE实测值 (15 77 6 9± 311 31)kcal/d]较健康对照组 (1388 2 9± 194 89)kcal/d]高 (P <0 0 5 ) ;PIMAX(44 5 3± 10 6 0 )mmHg]较健康对照组 (71 4 3± 2 2 34)mmHg]低 (P <0 0 1) ,P0 1/PIMAX(0 0 6 8± 0 0 2 6 )较健康对照组 (0 0 39± 0 0 14 )高 (P <0 0 5 ) ;第 1秒钟用力呼气容积 (FEV1)占预计值的百分比 (5 0 4 6± 2 1 35 ) % ]、动脉血氧分压 (PaO2 ) (77 72± 8 84 )mmHg]、动脉血氧饱和度(SaO2 ) (92 5 4± 2 5 5 ) % ]均较健康对照组低 (P <0 0 1) ;心率 (83 4 6± 11 36 )次 /min]较健康对照组 (6 9 71± 5 73)次 /min]高 (P <0 0 5 )。 (2 )相关分析显示 ,COPD组REE实测值与身高、体重、体重指数、P0 1/PIMAX及心率呈正相关 (r分别为 0 5 7、0 6 5、0 6 2、0 4 1、0 5 1) ,与FEV1占预计

Relation of resting energy expenditure to respiratory mechanics and arterial blood gases in chronic obstructive pulmonary disease patients

OBJECTIVE: To investigate the relationships of the rest energy expenditure to the respiratory mechanics and arterial blood gases in chronic obstructive pulmonary disease (COPD) patients. METHODS: Twenty six patients with COPD and 21 healthy subjects were involved in the study. The rest energy expenditure (REE), oxygen consumption (VO(2)), carbon dioxide production (VCO(2)) and respiratory quotient (RQ) were measured with indirect energy measurements of canopy test; the arterial blood gases were measured soon after energy measurements; then routine pulmonary function, P(0.1) and P(IMAX) were measured at rest. RESULTS: (1) The REE/day, P(0.1)/P(IMAX) and heart rate (HR) in the COPD group (1,577.69 +/- 311.31) kcal, 0.068 +/- 0.026 and (83.46 +/- 11.36) BPM, respectively] were significantly higher than those in the healthy control group (1,388.29 +/- 194.89) kcal, 0.039 +/- 0.014 and (69.71 +/- 5.73) BPM, respectively, P < 0.05 for all]; the forced expiratory volume in one second (FEV(1))% of predicted, partial pressure of oxygen in artery (PaO(2)) and arterial oxygen saturation (SaO(2)) in the COPD group (50.46 +/- 21.35)%, (77.72 +/- 8.84) mm Hg and (92.54 +/- 2.55)%, respectively] were significantly lower than those in the control group (92.29 +/- 11.91)%, (92.50 +/- 3.82) mm Hg and (96.29 +/- 1.87)%, respectively, P < 0.01 for all]. (2) In COPD group, the REE/day was positively correlated with body height, body weight, body mass index, P(0.1)/P(IMAX) and HR (r = 0.57, 0.65, 0.62, 0.41 and 0.51, respectively, P < 0.05 for all), negatively correlated with FEV(1)%, PaO(2) and SaO(2) (r = -0.43, -0.47 and -0.32, respectively, P < 0.05 for all); the P(0.1) was negatively correlated with PaO(2) and SaO(2) (r = -0.62 and -0.53, respectively, P < 0.01). CONCLUSION: The rest energy expenditure of COPD patients was significantly higher than that of healthy subjects. This increase in REE was not only attributed to the airway obstruction and the damaged gas exchange, but may be related to the elevated respiratory drive and dysfunction of respiratory muscles as well.