Fujii T, Kurihara N, Otsuka T, Tanaka S, Kanazawa H, Kudoh S, Hirata K, Fujimoto S, Yoshikawa J
First Department of Internal Medicine, Osaka City University Medical School, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1997 Sep;35(9):934-41.
In patients with chronic obstructive pulmonary disease (COPD), exercise-induced hypoxemia (EIH) is an important limiting factor of exercise performance, but there are very few reports of the prognostic value of EIH. We therefore examined whether EIH is related to long-term outcome in patients with COPD. We gathered data on survival of 77 patients with COPD who had undergone three-minute incremental treadmill exercise tests between 1979 and 1988. A plastic catheter was placed percutaneously into a brachial artery to measure arterial blood gases at each stage of exercise. Expired gas was analyzed continuously during exercise with a Respiromonitor RM-300 (Minato Medical Science). As an index of the severity of EIH we used the delta PaO2/delta VO2 (mmHg/L/min), PaO2-slope. Patients were assigned to two groups according to PaO2-slope, and actuarial survival curves were plotted for the two groups. The survival data were analyzed by generalized Wilcoxon analysis. Survival was significantly better in the group with low PaO2-slopes (< 20 mmHg/L/min) than in the group with high PaO2-slopes (> or = 20 mmHg/ L/min) (p = 0.0031). Also, among the patients in whom PaO2 during exercise was less than 60 mmHg, there was a significant difference in survival between those who received home oxygen therapy and those who did not. We conclude that the degree of EIH can be used to predict survival in patients with COPD, and that the degree of EIH should be considered when prescribing continuous home oxygen therapy for these patients.
在慢性阻塞性肺疾病（COPD）患者中，运动诱发性低氧血症（EIH）是运动能力的一个重要限制因素，但关于EIH预后价值的报道却非常少。因此，我们研究了EIH是否与COPD患者的长期预后相关。我们收集了1979年至1988年间接受三分钟递增式跑步机运动试验的77例COPD患者的生存数据。经皮将一根塑料导管插入肱动脉，以测量运动各阶段的动脉血气。运动期间使用Respiromonitor RM - 300（Minato Medical Science）连续分析呼出气体。作为EIH严重程度的指标，我们使用了ΔPaO2/ΔVO2（mmHg/L/min），即PaO2斜率。根据PaO2斜率将患者分为两组，并绘制两组的精算生存曲线。生存数据通过广义Wilcoxon分析进行分析。低PaO2斜率组（<20 mmHg/L/min）的生存率显著高于高PaO2斜率组（>或 = 20 mmHg/L/min）（p = 0.0031）。此外，在运动期间PaO2低于60 mmHg的患者中，接受家庭氧疗和未接受家庭氧疗的患者在生存率上存在显著差异。我们得出结论，EIH的程度可用于预测COPD患者的生存情况，并且在为这些患者开具持续家庭氧疗处方时应考虑EIH的程度。
