Botelho A D, Tercé G, Stervinou-Wemeau L, Robin S, Wallaert B
Service de pneumologie et d'immunoallergologie, centre de compétence des maladies pulmonaires rares, hôpital Calmette, CHRU, 1 boulevard Leclercq, Lille cedex, France.
Rev Mal Respir. 2011 Mar;28(3):377-80. doi: 10.1016/j.rmr.2010.09.030. Epub 2011 Feb 22.
The effect of therapy on the modification of a functional parameter is an elegant method for assessing the causal relationship between functional abnormalities and symptoms. We report an analysis of the effects of thromboendarterectomy for post-embolic pulmonary arterial hypertension on exercise functional parameters. A patient (62 years) had post-embolic pulmonary hypertension documented by pulmonary angiography and right heart catheterization (PAP mean: 48 mmHg). Cardiopulmonary exercise testing demonstrated a decreased aerobic capacity (59% predicted), significant hyperventilation (VE/VO(2) at peak 82) and a dead space to tidal volume ratio (VD/Vt) increased at rest (0.55) and remaining high at peak exercise (0.48). Thromboendarterectomy was performed and led to a dramatic improvement in dyspnoea (NYHA class II to I), a gradual improvement in aerobic capacity, and a significant decrease of VD/Vt (0.26) and hyperventilation (VE/VO(2) at peak: 38) on exercise. This observation illustrates the fact that an increase in the physiological dead space on exercise is associated with significant hyperventilation and consequently dyspnoea of effort.
治疗对功能参数改变的影响是评估功能异常与症状之间因果关系的一种精妙方法。我们报告了一项关于血栓内膜剥脱术治疗栓塞后肺动脉高压对运动功能参数影响的分析。一名62岁患者经肺血管造影和右心导管检查确诊为栓塞后肺动脉高压（平均肺动脉压：48 mmHg）。心肺运动试验显示有氧能力下降（预测值的59%）、明显的通气过度（峰值时VE/VO₂为82）以及静息时死腔与潮气量比值（VD/Vt）升高（0.55），运动峰值时仍保持较高水平（0.48）。进行了血栓内膜剥脱术，术后呼吸困难显著改善（纽约心脏协会心功能分级从II级降至I级），有氧能力逐渐改善，运动时VD/Vt显著降低（0.26）且通气过度情况改善（峰值时VE/VO₂：38）。这一观察结果表明，运动时生理死腔增加与明显的通气过度相关，进而导致劳力性呼吸困难。
