Goldstein S A, Askanazi J, Elwyn D H, Thomashow B, Milic-Emili J, Kvetan V, Weissman C, Kinney J M
Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York 10032.
J Appl Physiol (1985). 1989 Sep;67(3):1048-55. doi: 10.1152/jappl.1989.67.3.1048.
Eight malnourished patients with emphysema (EMPH) and eight malnourished patients without evidence of lung disease (MLAN) received an infusion of 5% dextrose plus electrolytes (D5W) for 48 h and were then randomly assigned to a hypercaloric diet with either 53% of the calories as carbohydrate (CB) or with 55% as fat (FB) for the 1st wk, maintaining a constant protein intake. The alternate diet was given the following week. Ventilation and gas exchange were measured during supine cycle ergometry at 0, 12, and 25 W during the D5W, CB, and FB diet periods. At each exercise intensity, the EMPH group demonstrated a 12-15% greater O2 consumption, a lower respiratory quotient, and an O2 debt larger than that of the MALN group. Resting ventilation was higher during the CB than FB regimen in both groups of patients, but during the CB diet the EMPH group had a more exaggerated ventilatory response than the MALN group. The results demonstrate that EMPH patients have an unusual metabolic pattern during hypercaloric feeding and exercise. Furthermore in EMPH patients a FB regimen does not appear to create the additional stress on the respiratory system during exercise that is generated with a CB regimen.
八名患有肺气肿的营养不良患者（EMPH）和八名无肺部疾病证据的营养不良患者（MLAN）接受了48小时的5%葡萄糖加电解质（D5W）输注，然后在第一周被随机分配到高热量饮食组，其中一组碳水化合物热量占比53%（CB），另一组脂肪热量占比55%（FB），同时保持蛋白质摄入量恒定。下周给予交替饮食。在D5W、CB和FB饮食期间，于仰卧位自行车测力计上分别在0、12和25瓦功率下测量通气和气体交换。在每个运动强度下，EMPH组的耗氧量比MALN组高12 - 15%，呼吸商更低，氧债更大。两组患者在CB饮食期间的静息通气均高于FB饮食期间，但在CB饮食期间，EMPH组的通气反应比MALN组更为夸张。结果表明，EMPH患者在高热量喂养和运动期间具有异常的代谢模式。此外，对于EMPH患者，FB饮食方案在运动期间似乎不会像CB饮食方案那样给呼吸系统带来额外压力。
