本文選題：肺過度充氣 + 慢性阻塞性肺疾病�。� 參考：《蘇州大學(xué)》2012年碩士論文

【摘要】：第一部分肺過度充氣對(duì)慢性阻塞性肺疾病患者呼吸模式及氣體交換的影響 【目的】探討不同程度肺過度充氣對(duì)穩(wěn)定期中重度慢性阻塞性肺疾�。–OPD）患者在運(yùn)動(dòng)過程中呼吸模式及氣體交換的影響。 【方法】對(duì)54例處于穩(wěn)定期的中重度COPD患者進(jìn)行常規(guī)肺功能測定（PFT）及斜坡式功率遞增癥狀限制性心肺運(yùn)動(dòng)試驗(yàn)（CPET），根據(jù)胸內(nèi)氣體容積占預(yù)計(jì)值的百分比（Vtg%pred）及一氧化碳彌散量占預(yù)計(jì)值的百分比（DLCO%pred）將受試者分為兩組，A組為低肺過度充氣組（Vtg%pred 150%pred且DLco%pred≥80%pred，29人），B組為高肺過度充氣組（Vtg%pred≥150%pred且DLco%pred80%pred，25人）。測定并分析兩組間肺通氣功能、呼吸模式、氣體交換及運(yùn)動(dòng)耐力的差異。 【結(jié)果】 1．靜息期，兩組間潮氣量（VT）及呼吸頻率（BF）差異無統(tǒng)計(jì)學(xué)意義。峰值運(yùn)動(dòng)期，A組的VT顯著高于B組（p0.001），并且兩組間分鐘通氣量（VE）的差異（p0.001）也顯著高于靜息期（p0.05）。 2．峰值運(yùn)動(dòng)期，兩組間吸氣時(shí)間（tI）與呼氣時(shí)間（tE）的比值（tI/tE）、VT/tI及VT/tE均有顯著的統(tǒng)計(jì)學(xué)差異（p0.01），并且B組的呼吸困難程度（VE/MVV）明顯高于A組（p0.001）。 3．CPET測定結(jié)果顯示， B組相較于A組其峰值運(yùn)動(dòng)負(fù)荷（Peak Load）、峰值攝氧量（Peak VO2）、通氣有效性及峰值運(yùn)動(dòng)期氧脈搏（Peak O2pulse）均顯著下降（p0.05）。兩組間終止運(yùn)動(dòng)原因的差異具有統(tǒng)計(jì)學(xué)意義（p0.05），B組中更多的患者由于呼吸困難終止試驗(yàn)。 4．COPD患者的峰值攝氧量占預(yù)計(jì)值的百分比（Peak VO2%pred）與PFT參數(shù)中的Vtg%pred及DLco%pred相關(guān)性最強(qiáng)（分別為r=-0.55及0.68, p0.001）。Peak VO2與Peak VT具有顯著相關(guān)性（r=0.77, p0.001），Peak VT則與靜息時(shí)測定的深吸氣量（IC）具有顯著相關(guān)性（r=0.63, p0.001）。 【結(jié)論】高肺過度充氣COPD患者相較于低肺過度充氣COPD患者，其VT在運(yùn)動(dòng)過程中可增加的彈性幅度更小，峰值運(yùn)動(dòng)期呼氣時(shí)間在呼吸周期中所占的比例明顯增加，并且具有更嚴(yán)重的運(yùn)動(dòng)耐力下降、通氣功能受限、換氣效率下降及呼吸困難程度。 第二部分吸氣分?jǐn)?shù)與穩(wěn)定期中重度COPD患者運(yùn)動(dòng)耐力的相關(guān)性 【目的】探討IC、IC與肺總量之比（IC/TLC）（或稱吸氣分?jǐn)?shù)，IF）及相關(guān)肺功能指標(biāo)與穩(wěn)定期中重度COPD患者運(yùn)動(dòng)耐力的相關(guān)性。 【方法】對(duì)50例處于穩(wěn)定期的中重度COPD患者及34例同年齡段健康志愿者進(jìn)行PFT及斜坡式功率遞增癥狀限制性CPET，測定相關(guān)肺通氣功能參數(shù)、氣體交換參數(shù)，，記錄受試者CPET的終止原因。 【結(jié)果】 1．COPD患者的IF與運(yùn)動(dòng)耐力（Peak VO2%pred）有顯著的相關(guān)性（r=0.52,p0.001）, IF可作為預(yù)估COPD患者運(yùn)動(dòng)耐力減低的獨(dú)立變量，并且其敏感度及特異度均高于第一秒用力呼氣量占預(yù)計(jì)值的百分比（FEV1%pred），多重線性回歸模型方程為：Peak VO2%pred=65.9IF+0.45FEV1%pred+35.8（RC2=0.39,p0.001）， 2．低IF值（＜0.23）的COPD患者（18例）比高IF值（≥0.23）COPD患者（32例）有著更嚴(yán)重的肺過度充氣及運(yùn)動(dòng)耐力下降，峰值運(yùn)動(dòng)時(shí)的兩者的BF無顯著性差異,前者的Peak VE及Peak VT均較后者下降。 【結(jié)論】吸氣分?jǐn)?shù)為反映肺過度充氣的良好指標(biāo)，且較FEV1更好的預(yù)估穩(wěn)定期中重度COPD患者的運(yùn)動(dòng)耐力。
[Abstract]:Part 1 Effect of hyperinflation on respiratory pattern and gas exchange in patients with chronic obstructive pulmonary disease
[Objective] to investigate the effects of pulmonary hyperinflation on breathing patterns and gas exchange in patients with moderate or severe chronic obstructive pulmonary disease (COPD) during exercise.
[Methods] 54 patients with moderate and severe COPD in the stable period were measured by routine lung function test (PFT) and sloped power increasing symptom restrictive cardiopulmonary exercise test (CPET). The percentage of predicted gas volume (Vtg%pred) and percentage of carbon monoxide dispersion (DLCO%pred) were divided into two groups, A group, and group A. For the low lung hyperinflatable group (Vtg%pred 150%pred and DLco%pred > 80%pred, 29 people), B group was hyperinflated Lung Group (Vtg%pred > 150%pred and DLco%pred80%pred, 25 people). The differences in pulmonary ventilation function, breathing pattern, gas exchange and exercise endurance were measured and analyzed between the two groups.
[results]
In the 1. resting period, there was no significant difference between the two groups of tidal volume (VT) and respiratory frequency (BF). The peak exercise period, the VT in group A was significantly higher than that in the B group (p0.001), and the difference in VE (p0.001) between the two groups was significantly higher than that in the rest period (P0.05).
In the 2. peak exercise period, the ratio of tI to expiratory time (tE), VT/tI and VT/tE were statistically significant (P0.01), and the degree of dyspnea (VE/MVV) in the B group was significantly higher than that in the A group (p0.001).
The results of 3.CPET assay showed that the peak exercise load (Peak Load), peak oxygen uptake (Peak VO2), ventilation effectiveness and peak exercise oxygen pulse (Peak O2pulse) in the B group decreased significantly (P0.05). The difference between the two groups was statistically significant (P0.05). More patients in the B group were due to the termination of dyspnea. Test.
The percentage of the peak oxygen uptake of 4.COPD patients (Peak VO2%pred) is the strongest correlation with Vtg%pred and DLco%pred in the PFT parameters (r=-0.55 and p0.001).Peak VO2 and Peak VT have significant correlation.
[Conclusion] COPD patients with hyperinflatable lung hyperinflation compared with low lung hyperinflatable COPD patients, the increase in the elastic amplitude of VT in the exercise process is smaller, the peak exercise period of expiratory time in the respiratory cycle is significantly increased, and has a more serious movement endurance, ventilation function limited, ventilation efficiency decline and respiratory distress. It's difficult.
The second part is the correlation between inspiratory fraction and exercise endurance in moderate and severe COPD patients.
[Objective] to investigate the correlation between IC, IC and the ratio of total lung volume (IC/TLC) (or inhaled fraction, IF) and related lung function indexes with the exercise endurance of moderate and severe COPD patients at stable stage.
[Methods] 50 patients with moderate and severe COPD in stable period and 34 healthy volunteers of the same age group were treated with PFT and ramp power increasing symptom restrictive CPET. The parameters of pulmonary ventilation function and gas exchange parameters were measured, and the cause of CPET termination was recorded.
[results]
The IF of 1.COPD patients has a significant correlation with the exercise endurance (Peak VO2%pred) (r=0.52, p0.001). IF can be used as an independent variable for predicting the decrease of exercise endurance in COPD patients, and its sensitivity and specificity are higher than the percentage of the first second forced expiratory volume (FEV1% PRED), and the multiple linear regression model equation is Peak VO2%pred=65. .9IF+0.45FEV1%pred+35.8 (RC2=0.39, p0.001),
2. COPD patients with low IF value (< 0.23) (18 cases) had more severe pulmonary hyperinflation and lower exercise endurance than high IF (0.23) COPD patients (32 cases), and there was no significant difference in BF in peak exercise. The Peak VE and Peak VT in the former were all lower than those of the latter.
[Conclusion] inspiratory fraction is a good indicator of pulmonary hyperinflation. It is better than FEV1 in predicting exercise tolerance of moderate and severe COPD patients in stable stage.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R563.9

【共引文獻(xiàn)】

相關(guān)期刊論文 前4條

1 劉波;汪俊;李可可;劉曉;;慢性阻塞性肺疾病穩(wěn)定期患者深吸氣量臨床特征性研究[J];華西醫(yī)學(xué);2011年12期

2 王文靜;孫麗華;谷偉;譚焰;;深吸氣量與穩(wěn)定期慢性阻塞性肺病患者運(yùn)動(dòng)耐力的相關(guān)性研究[J];臨床肺科雜志;2009年05期

3 楊志雄;姜維;謝芳英;劉付亮;;深吸氣量測定對(duì)穩(wěn)定期慢阻肺病人吸入支氣管擴(kuò)張劑的臨床意義[J];瀘州醫(yī)學(xué)院學(xué)報(bào);2010年06期

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相關(guān)碩士學(xué)位論文 前1條

1 李冬秀;從呼吸力學(xué)角度探討“六字訣”對(duì)慢性阻塞性肺疾病作用的研究[D];福建中醫(yī)藥大學(xué);2011年

本文編號(hào)：2009147