未良好控制哮喘慢性持续期患者运动通气功能评价
Evaluation of exercise ventilation function in patients with chronic duration of not well controlled asthma
刘丽君 1黄楠馨 1罗家麒 2祁永健 3刘兰英 4王和生1
作者信息
- 1. 南京中医药大学附属医院江苏省中医院针灸康复科(江苏南京 210029)
- 2. 南京大学医学院附属苏州医院康复医学科(江苏苏州 215153)
- 3. 南京中医药大学附属医院江苏省中医院呼吸与危重症医学科(江苏南京 210029)
- 4. 南京中医药大学附属医院江苏省中医院针灸康复科(江苏南京 210029);南京中医药大学针药结合教育部重点实验室(江苏南京 210023)
- 折叠
摘要
目的 探讨未良好控制哮喘慢性持续期患者运动通气功能特点,以及心肺运动试验相关指标与哮喘持续期患者控制水平、常规肺功能的相关性.方法 纳入南京中医药大学附属医院2021年12月-2022年12月收治的73例哮喘慢性持续期患者,应用哮喘控制测试(asthma control test,ACT)对患者进行哮喘控制水平评定,分为良好控制组和未良好控制组,两组均进行常规肺功能检查(pulmonary function test,PFT)和心肺运动试验(cardiopulmonary exercise testing,CPET),分析两组相关参数差异并观察哮喘慢性持续期患者CPET中运动通气功能指标与PFT指标、ACT评分的相关性.结果 CPET结果显示未良好控制组哮喘患者VE/VCO2斜率、无氧阈时二氧化碳当量(anaerobic threshold carbon dioxide equivalent,EqCO2@AT)、峰值运动时生理无效腔(VD/VTpeak)高于良好控制组(均P＜0.05);未良好控制组患者峰值运动时分钟通气量(peak minute ventilation,VEpeak)、潮气量(peak tidal volume,VTpeak)低于良好控制组(均P＜0.05);两组峰值运动时呼吸频率(peak respiratory rate,BFpeak)、呼吸储备(peak respiratory reserve,BRpeak)差异无统计学意义(均 P＞0.05).相关性分析发现哮喘慢性持续期患者VE/VCO2斜率、EqCO2@AT、VD/VTpeak与ACT评分呈负相关;VEpeak与常规肺功能中用力肺活量(forced vital capacity as a percentage of predicted value,FVC)占预计值百分比、最大呼气中期流量(maximal mid-expiratory flow,MMEF)占预计值百分比呈正相关;BRpeak与常规肺功能中第1秒用力呼气容积(forced expiratory volume in the first second,FEV1)占预计值百分比、FEV1/FVC 占预计值百分比、MMEF 占预计值百分比呈正相关.多因素Logistic回归分析发现VE/VCO2斜率、VD/VTpeak的增加是哮喘未良好控制的独立危险因素(P＜0.05).结论 未良好控制的哮喘慢性持续期患者运动通气功能下降,主要表现为峰值运动时通气量和潮气量减少、生理无效腔增加、通气效率下降.哮喘慢性持续期患者运动通气功能与控制水平、常规肺功能有一定相关性,CPET中通气效率相关指标对未良好控制哮喘具有提示性意义,有必要对哮喘慢性持续期患者行CPET来完善对哮喘病情全面评估.
Abstract
Objective To explore the characteristics of exercise ventilation function in patients with chronic duration of asthma,and the correlation of cardiopulmonary exercise test and control level and conventional lung function in patients with chronic duration of asthma.Methods Seventy-three patients with chronic duration of asthma admitted from December 2021 to December 2022 were recruited in the study.The asthma control level was assessed with the asthma control test(ACT)and the patients were divided into a well-controlled group and a poorly-controlled group.Routine pulmonary function test(PFT)and cardiopulmonary exercise test(CPET)were performed in both groups,to analyze the difference of related parameters between the two groups and observe the correlation between CPET and PFT,ACT score in the patients with chronic persistent asthma.Results CPET results showed that the VE/VCO2 slope,anaerobic threshold carbon dioxide equivalent(EqCO2@AT),and physiologically ineffective peak during exercise(VD/VTpeak)were higher in the poorly-controlled group than those in the well-controlled group(all P＜0.05).The peak minute ventilation(VEpeak)and tidal volume(VTpeak)of the patients in the poorly-controlled group were lower than those in the well-controlled group(both P＜0.05).The peak respiratory rate(BFpeak)and respiratory reserve(BRpeak)of the two groups were not significantly different(both P＞0.05).The results of correlation analysis showed that the VE/VCO2 slope,EqCO2@AT,VD/VTpeak were negatively correlated with ACT score,and VEpeak was positively correlated with FVC％pred and MMEF％pred in the patients with chronic persistent asthma.BRpeak was positively correlated with FEV1％pred,FEV1/FVC％pred,MMEF％pred in routine pulmonary function.Multivariate logistic regression analysis showed that the increase of VE/VCO2 slope and VD/VTpeak were independent risk factors for poor asthma control(P＜0.05).Conclusions Patients with poorly-controlled asthma have decreased exercise ventilatory function,mainly showing decreased ventilation and tidal volume during peak exercise and decreased ventilatory efficiency.There is some correlation between exercise ventilatory function and conventional lung function of control level in patients with chronic duration of asthma.The relevant indicators of ventilation efficiency in CPET have suggestive significance for asthma that is not well controlled,so it is necessary to carry out CPET in patients with asthma to improve the comprehensive evaluation of asthma.
关键词
哮喘/运动通气/心肺运动试验/肺功能/通气效率Key words
Asthma/exercise ventilation/cardiopulmonary exercise test/pulmonary function/ventilation efficiency引用本文复制引用
基金项目
国家自然科学基金面上项目(82274632)
江苏省中医药局专题研究项目(YJZ202310)
南京市科技发展计划(2022)(202205050)
江苏省研究生科研与实践创新计划(2023)(SJCX23_0896)
出版年
2024
NETL
NSTL
万方数据