Noseda A, Carpiaux J P, Schmerber J, Yernault J C
Service de Médecine Interne, Hôpital Universitaire Brugmann, Bruxelles, Belgique.
Rev Mal Respir. 1993;10(6):537-43.
The aim of this work was to study the relationship between dynamic hyperinflation and dyspnoea perception on exercise in patients with chronic obstructive pulmonary disease (COPD). Seven men and three women with COPD (mean FEV1 45.9 +/- 9.8% predicted) were studied. The upper end of the visual analogue scale was anchored on a preliminary test on a cycle ergometer (day 1). On the study day (day 2) the relationship between dyspnoea and ventilatory indices during high intensity exercise was evaluated, using within-subject linear regression analysis. On a repeat study (day 3), the addition of inspiratory capacity (IC) manoeuvres allowed to monitor the end expiratory lung volume. The highest degree of within-subject correlation was observed between dyspnoea and the tidal peak inspiratory flow (PIFT), as well without (median r2 = 0.920, day 2) as with (median r2 = 0.880, day 3) IC manoeuvres. At maximal exercise, IC decreased in 8 out of 10 subjects (delta IC range -150 to -900 ml). A negative relationship was found between delta IC and the rate of increase in dyspnoea on exercise, measured as the dyspnoea/PIFT slope (r = 0.844, p < 0.01). Our results suggest that dynamic hyperinflation on exercise observed in most patients with COPD allows these subjects to minimize the rate of increase in dyspnoea on exercise.
这项研究的目的是探讨慢性阻塞性肺疾病（COPD）患者运动时动态肺过度充气与呼吸困难感知之间的关系。研究对象为7名男性和3名女性COPD患者（预计FEV1平均值为45.9±9.8%）。视觉模拟量表的上限基于在自行车测力计上的初步测试（第1天）确定。在研究日（第2天），采用受试者内线性回归分析评估高强度运动期间呼吸困难与通气指标之间的关系。在重复研究（第3天）中，增加吸气容量（IC）操作以监测呼气末肺容积。在呼吸困难与潮气量峰值吸气流量（PIFT）之间观察到受试者内最高程度的相关性，无论是否进行IC操作（第2天，中位数r2 = 0.920；第3天，中位数r2 = 0.880）。在最大运动时, 10名受试者中有8名的IC下降（IC变化范围为-150至-900 ml）。发现IC变化与运动时呼吸困难增加率之间呈负相关，运动时呼吸困难增加率以呼吸困难/PIFT斜率衡量（r = 0.844，p < 0.01）。我们的结果表明，大多数COPD患者运动时的动态肺过度充气使这些受试者能够将运动时呼吸困难的增加率降至最低。
