动态呼吸力学与肺动脉高压运动性呼吸困难。
Dynamic respiratory mechanics and exertional dyspnoea in pulmonary arterial hypertension.
机构信息
Departementde Physiologie, Faculte de MedecinePierre et Marie Curie, Site Pitie´-Salpetriere, Paris, France.
出版信息
Eur Respir J. 2013 Mar;41(3):578-87. doi: 10.1183/09031936.00223611. Epub 2012 Jul 12.
Patients with pulmonary arterial hypertension (PAH) may exhibit reduced expiratory flows at low lung volumes, which could promote exercise-induced dynamic hyperinflation (DH). This study aimed to examine the impact of a potential exercise-related DH on the intensity of dyspnoea in patients with PAH undergoing symptom-limited incremental cardiopulmonary cycle exercise testing (CPET). 25 young (aged mean±sd 38±12 yrs) nonsmoking PAH patients with no evidence of spirometric obstruction and 10 age-matched nonsmoking healthy subjects performed CPET to the limit of tolerance. Ventilatory pattern, operating lung volumes (derived from inspiratory capacity (IC) measurements) and dyspnoea intensity (Borg scale) were assessed throughout CPET. IC decreased (i.e. DH) progressively throughout CPET in PAH patients (average 0.15 L), whereas it increased in all the healthy subjects (0.45 L). Among PAH patients, 15 (60%) exhibited a decrease in IC throughout exercise (average 0.50 L), whereas in the remaining 10 (40%) patients IC increased (average 0.36 L). Dyspnoea intensity and ventilation were greater in PAH patients than in controls at any stage of CPET, whereas inspiratory reserve volume was lower. We conclude that DH-induced mechanical constraints and excessive ventilatory demand occurred in these young nonsmoking PAH patients with no spirometric obstruction and was associated with exertional dyspnoea.
肺动脉高压(PAH)患者可能在低肺容积时表现出呼气流量降低,这可能导致运动引起的动态过度充气(DH)。本研究旨在检查潜在的与运动相关的 DH 对接受症状限制增量心肺循环运动测试(CPET)的 PAH 患者呼吸困难强度的影响。25 名年轻(年龄均数±标准差 38±12 岁)不吸烟的 PAH 患者,无肺量计阻塞证据,10 名年龄匹配的不吸烟健康受试者进行 CPET 至耐受极限。在整个 CPET 过程中评估通气模式、工作肺容积(从吸气储备量(IC)测量中得出)和呼吸困难强度(Borg 量表)。在 PAH 患者中,IC 在 CPET 过程中逐渐降低(即 DH)(平均 0.15L),而在所有健康受试者中,IC 增加(平均 0.45L)。在 PAH 患者中,15 名(60%)患者在整个运动过程中出现 IC 降低(平均 0.50L),而其余 10 名(40%)患者的 IC 增加(平均 0.36L)。在 CPET 的任何阶段,PAH 患者的呼吸困难强度和通气量都大于对照组,而吸气储备量则较低。我们得出结论,在这些没有肺量计阻塞的年轻非吸烟 PAH 患者中,DH 引起的机械限制和过度通气需求发生,并与运动性呼吸困难有关。