手臂曲柄运动在低海拔地区患者异常肺气体交换检测中的应用。

Use of arm crank exercise in the detection of abnormal pulmonary gas exchange in patients at low altitude.

作者信息

Martin T W, Zeballos R J, Weisman I M

机构信息

Department of Clinical Investigation, William Beaumont Army Medical Center.

出版信息

Chest. 1992 Jul;102(1):169-75. doi: 10.1378/chest.102.1.169.

DOI:10.1378/chest.102.1.169

PMID:1623747

Abstract

BACKGROUND

The measurement of arterial blood gases, P(A-a)O2 and VD/VT, during cycle ergometry is the "gold standard" for the assessment of pulmonary gas exchange. However, some patients are unable to perform cycle ergometry because of other medical problems.

STUDY OBJECTIVE

To determine whether arm crank exercise could be used to reliably detect gas exchange abnormalities compared to cycle ergometry.

PARTICIPANTS

Fifteen patients with a variety of pulmonary disorders, who were referred for exertional dyspnea.

DESIGN

All patients performed maximal arm crank and cycle exercise. Arterial blood gases, VO2, VCO2, and VE were measured at rest and during exercise.

RESULTS

Compared to peak cycle exercise (mean +/- SD), PaO2 (85 +/- 14 vs 75 +/- 13 mm Hg), SaO2 (94 +/- 2 vs 91 +/- 4 percent), VD/VT (0.21 +/- 0.07 vs 0.19 +/- 0.08), and pH (7.37 +/- 0.04 vs 7.34 +/- 0.03) were significantly higher during peak arm crank exercise. The P(A-a)O2 (18 +/- 13 vs 29 +/- 12 mm Hg) was narrower, and PaCO2 (29 +/- 3 vs 29 +/- 4 mm Hg) and PAO2 (104 +/- 4 vs 103 +/- 4 mm Hg) were similar. Six patients had normal gas exchange during cycle exercise at low altitude (P[A-a]O2 less than or equal to 27 mm Hg, PaO2 greater than or equal to 65 mm Hg, VD/VT less than or equal to 0.18) and nine were abnormal. Utilizing criteria specific for arm crank at low altitude, the same six patients had normal gas exchange (P[A-a]O2 less than or equal to 13 mm Hg, PaO2 greater than or equal to 85 mm Hg, VD/VT less than or equal to 0.26), and the remaining nine were abnormal. The P(A-a)O2 during peak arm crank was the most useful criterion in identifying patients with abnormal gas exchange.

CONCLUSION

Proposed criteria for arm crank exercise testing accurately identified all patients with normal and abnormal pulmonary gas exchange during cycle exercise. The data from the present study suggest that arm crank can be an acceptable alternative exercise testing modality for the assessment of pulmonary gas exchange.

摘要

背景

在蹬车测力试验期间测量动脉血气、肺泡-动脉血氧分压差（P[A-a]O2）和死腔/潮气量（VD/VT）是评估肺气体交换的“金标准”。然而，一些患者由于其他医疗问题无法进行蹬车测力试验。

研究目的

确定与蹬车测力试验相比，手摇曲柄运动是否可用于可靠地检测气体交换异常。

参与者

15名因运动性呼吸困难前来就诊的患有各种肺部疾病的患者。

设计

所有患者均进行最大程度的手摇曲柄运动和蹬车运动。在静息状态和运动期间测量动脉血气、耗氧量（VO2）、二氧化碳排出量（VCO2）和每分通气量（VE）。

结果

与蹬车运动峰值相比（平均值±标准差），在手摇曲柄运动峰值期间，动脉血氧分压（PaO2）（85±14 vs 75±13 mmHg）、动脉血氧饱和度（SaO2）（94±2 vs 91±4%）、VD/VT（0.21±0.07 vs 0.19±0.08）和pH值（7.37±0.04 vs 7.34±0.03）显著更高。肺泡-动脉血氧分压差（P[A-a]O2）（18±13 vs 29±12 mmHg）更窄，动脉血二氧化碳分压（PaCO2）（29±3 vs 29±4 mmHg）和肺泡氧分压（PAO2）（104±4 vs 103±4 mmHg）相似。6名患者在低海拔蹬车运动期间气体交换正常（P[A-a]O2≤27 mmHg，PaO2≥65 mmHg，VD/VT≤0.18），9名患者异常。采用低海拔手摇曲柄运动的特定标准，同样这6名患者气体交换正常（P[A-a]O2≤13 mmHg，PaO2≥85 mmHg，VD/VT≤0.26），其余9名患者异常。手摇曲柄运动峰值期间的P[A-a]O2是识别气体交换异常患者最有用的标准。