Tschernko E M, Gruber E M, Jaksch P, Jandrasits O, Jantsch U, Brack T, Lahrmann H, Klepetko W, Wanke T
Departments of Clinical Pharmacology, Cardiothoracic Anesthesia and Critical Care Medicine, University of Vienna, General Hospital, Vienna, Austria.
Am J Respir Crit Care Med. 1998 Nov;158(5 Pt 1):1424-31. doi: 10.1164/ajrccm.158.5.9702086.
Many patients with emphysema are able to meet ventilatory demands during resting conditions, but they show severe limitations during exercise. To examine the effect of lung volume reduction (LVR) surgery on exercise performance and the mechanism of possible improvement, we measured ventilatory mechanics (pulmonary resistance [RL], work of breathing [WOB], dynamic intrinsic positive end-expiratory pressure [PEEPi,dyn], peak expiratory flow rate [PEFR]), breathing pattern, oxygen uptake (V O2), and carbon dioxide removal (V CO2) at rest and during cycle ergometry in eight patients before and 3 mo after LVR surgery. Ventilatory mechanics were evaluated assessing esophageal pressure and air flow. Three months after LVR surgery, the tolerated workload was doubled when compared with the preoperative value (p < 0.0005), associated with a reduction of RL (p < 0.05), PEEPi,dyn (p < 0.005), and WOB (p < 0. 005) at comparable workloads. Maximal ventilatory capacity and maximal tidal volume (VT) increased significantly (p < 0.01). Maximal V O2 increased from 474 +/- 23 to 601 +/- 16 ml/min (p < 0. 005) and maximal V CO2 from 401 +/- 13 to 558 +/- 21 ml/min (p < 0. 005), though no significant difference at comparable workloads could be observed. In conclusion, emphysema surgery leads to an improvement of ventilatory mechanics at rest and during exercise. Higher maximal VT and minute ventilation were observed, resulting in improvement of maximal V O2 and V CO2 and exercise capacity.
许多肺气肿患者在静息状态下能够满足通气需求，但在运动时则表现出严重受限。为了研究肺减容（LVR）手术对运动表现的影响以及可能的改善机制，我们在8例患者LVR手术前及术后3个月，测量了静息状态和蹬车运动时的通气力学指标（肺阻力[RL]、呼吸功[WOB]、动态内源性呼气末正压[PEEPi,dyn]、呼气峰值流速[PEFR]）、呼吸模式、摄氧量（V O2）和二氧化碳排出量（V CO2）。通过评估食管压力和气流来评价通气力学。LVR手术后3个月，与术前值相比，耐受工作量增加了一倍（p < 0.0005），在相当的工作量下，RL（p < 0.05）、PEEPi,dyn（p < 0.005）和WOB（p < 0.005）降低。最大通气能力和最大潮气量（VT）显著增加（p < 0.01）。最大V O2从474±23增加到601±16 ml/min（p < 0.005），最大V CO2从401±13增加到558±21 ml/min（p < 0.005），尽管在相当的工作量下未观察到显著差异。总之，肺气肿手术可改善静息和运动时的通气力学。观察到更高的最大VT和分钟通气量，从而改善了最大V O2和V CO2以及运动能力。
