Gochicoa-Rangel Laura, Hernández-Morales Aloisia Paloma, Salles-Rojas Antonio, Madrid-Mejía Wilmer, Guzmán-Valderrábano Carlos, González-Molina Amaury, Salas-Escamilla Isabel, Durán-Cuellar Adela, Silva-Cerón Mónica, Hernández-Morales Víctor, Reyes-García Alejandro, Alvarado-Amador Irlanda, Lozano-Martínez Luis, Enright Paul, Pensado-Piedra Lya Edith, Torre-Bouscoulet Luis
Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas," Mexico City, Mexico.
Department of Image, National Institute of Respiratory Diseases "Ismael Cosío Villegas," Mexico City, Mexico.
Respir Care. 2021 Oct;66(10):1610-1617. doi: 10.4187/respcare.09114. Epub 2021 Aug 31.
Persistent impairment of pulmonary function and exercise capacity has been known to last for months or even years in the survivors who recovered from other coronavirus pneumonia. Some reports showed that subjects with coronavirus disease 2019 pneumonia after being discharged could have several sequelae, but there are few studies on gas exchange and exercise capacity complications in these subjects.
To describe residual gas exchange abnormalities during recovery from coronavirus disease 2019 pneumonia.
In an observational study, ∼90 d after onset of disease, we scheduled almost 200 subjects for an out-patient visit with pulmonary function testing and computed tomography of the lungs. Lung mechanics by using body plethysmography, gas exchange with diffusing lung capacity for carbon monoxide determined by the single-breath technique (D) and diffusing lung capacity for nitric oxide determined by the single-breath technique (D), and exercise ability by using the 6-min walk test (6MWT) were measured in the subjects. The results were compared between those who required invasive mechanical ventilation and those who did not.
A total of 171 subjects were included, the majority (96%) had signs of residual pneumonia (such as an excess of high attenuation areas) on computed tomography of the lungs. The D results were below the lower limit of the normal range in 29.2% of the subjects; during the 6MWT, 67% experienced oxygen desaturation ([Formula: see text]) > 4%; and, in 81 (47%), the dropped below 88%. Subjects who required invasive mechanical ventilation (49.7%) were more likely to have lower lung volumes, more gas exchange abnormality, less exercise capacity and more radiologic abnormality.
Subjects who recovered from severe COVID-19 pneumonia continued to have abnormal lung function and abnormal radiologic findings.
从其他冠状病毒肺炎康复的幸存者中，肺功能和运动能力的持续损害已知会持续数月甚至数年。一些报告显示，2019冠状病毒病肺炎患者出院后可能会出现多种后遗症，但关于这些患者气体交换和运动能力并发症的研究较少。
描述2019冠状病毒病肺炎康复过程中的残余气体交换异常情况。
在一项观察性研究中，发病约90天后，我们安排了近200名受试者进行门诊肺功能测试和肺部计算机断层扫描。通过体容积描记法测量肺力学，采用单次呼吸技术测定一氧化碳弥散肺容量（D）和一氧化氮弥散肺容量（D）评估气体交换，并通过6分钟步行试验（6MWT）测量运动能力。对需要有创机械通气的患者和未进行有创机械通气的患者的结果进行比较。
共纳入171名受试者，大多数（96%）在肺部计算机断层扫描上有残余肺炎的迹象（如高衰减区域过多）。29.2%的受试者D结果低于正常范围下限；在6MWT期间，67%的受试者出现氧饱和度下降（[公式：见原文]）>4%；81名（47%）受试者的低于88%。需要有创机械通气的受试者（49.7%）更有可能肺容积较小、气体交换异常更多、运动能力更差且放射学异常更多。
从重症COVID-19肺炎康复的受试者肺功能和放射学检查结果持续异常。
