Jounieaux V, Mayeux I
Service de Pneumologie et Unité de Réanimation Respiratoire, Centre Hospitalier Universitaire Sud, Amiens, France.
Am J Respir Crit Care Med. 1995 Dec;152(6 Pt 1):2181-4. doi: 10.1164/ajrccm.152.6.8520795.
This study compared the oxygen cost of breathing (VO2 resp) in 19 patients with severe chronic obstructive pulmonary disease intubated for acute respiratory failure. Ten patients showed radiologic (X-ray and/or computed tomographic scan) evidence of emphysema. The remaining ones were considered as having chronic bronchitis. Measurements were made just before extubation. Despite similar expiratory airflow obstruction, patients with emphysema exhibited significantly higher VO2 resp than patients with chronic bronchitis (109 +/- 61 versus 42 +/- 26 ml/min/m2, respectively; p < 0.006). Moreover, emphysema was associated with nutritional depletion assessed through decreases in body mass index (emphysema: 17.9 +/- 3.5 kg/m2; chronic bronchitis: 28.8 +/- 8.2 kg/m2; p < 0.005). This seemed to affect somatic stores (significant decreases in arm muscular circumference and triceps skin-fold thickness, whereas visceral stores were preserved (no decreases in serum albumin, serum prealbumin, and retinol binding protein). Malnutrition appeared to be the consequence of a hypermetabolic state of the respiratory muscles, with a significant negative correlation between VO2 resp and body mass index, arm muscular circumference, and triceps skinfold thickness (p < 0.05). Total oxygen consumption normalized for body surface was similar in the two groups. Thus, in emphysematous patients, the oxygen available for tissues other than respiratory muscles was significantly reduced (emphysema: 124 +/- 51 ml/min/m2; chronic bronchitis: 207 +/- 78 ml/min/m2; p < 0.02). This could explain nutritional differences observed between patients with emphysema and those with chronic bronchitis.
本研究比较了19例因急性呼吸衰竭而插管的重度慢性阻塞性肺疾病患者的呼吸氧耗（VO2 resp）。10例患者有肺气肿的影像学（X线和/或计算机断层扫描）证据。其余患者被认为患有慢性支气管炎。测量在拔管前进行。尽管呼气气流阻塞情况相似，但肺气肿患者的VO2 resp显著高于慢性支气管炎患者（分别为109±61与42±26 ml/min/m2；p<0.006）。此外，肺气肿与通过体重指数下降评估的营养消耗有关（肺气肿：17.9±3.5 kg/m2；慢性支气管炎：28.8±8.2 kg/m2；p<0.005）。这似乎影响了身体细胞内储存（手臂肌肉周长和三头肌皮褶厚度显著下降），而内脏储存得以保留（血清白蛋白、血清前白蛋白和视黄醇结合蛋白无下降）。营养不良似乎是呼吸肌高代谢状态的结果，VO2 resp与体重指数、手臂肌肉周长和三头肌皮褶厚度之间存在显著负相关（p<0.05）。两组的体表面积标准化总氧耗相似。因此，在肺气肿患者中，呼吸肌以外组织可利用的氧显著减少（肺气肿：124±51 ml/min/m2；慢性支气管炎：207±78 ml/min/m2；p<0.02）。这可以解释肺气肿患者与慢性支气管炎患者之间观察到的营养差异。
