Dynamic respiratory mechanics and exertional dyspnoea in pulmonary arterial hypertension
Dynamic respiratory mechanics and exertional dyspnoea in pulmonary arterial hypertension
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DOI：
10.1183/09031936.00223611
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发表时间：
2013-03-01
影响因子：
24.3
通讯作者：
Similowski, Thomas
中科院分区：
文献类型：
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作者：
Laveneziana, Pierantonio;Garcia, Gilles;Similowski, Thomas
肺动脉高压（PAH）患者在低肺容量时可能会出现呼气流量减少，这可能会促进运动诱导的动态恶性通货膨胀（DH）。本研究旨在探讨潜在的运动相关DH对PAH患者进行症状限制的增量心肺循环运动试验（CPET）时呼吸困难强度的影响。25名年轻（年龄平均+/- SD 38 +/- 12岁）无肺功能障碍的非吸烟多环芳烃患者和10名年龄匹配的非吸烟健康受试者进行了CPET检测，达到耐受性极限。在整个CPET过程中评估通气模式、操作肺容量（来自吸气量（IC）测量）和呼吸困难强度（博格量表）。在整个CPET过程中，PAH患者的IC（即DH）逐渐降低（平均0.15 L），而所有健康受试者的IC均升高（0.45 L）。在PAH患者中，15例（60%）患者在运动过程中IC降低（平均0.50 L），而其余10例（40%）患者IC增加（平均0.36 L）。在CPET的任何阶段，PAH患者的呼吸困难强度和通气均高于对照组，而吸气储备量较低。我们得出结论，dh诱导的机械约束和过度通气需求发生在这些没有呼吸障碍的年轻非吸烟PAH患者中，并与用力性呼吸困难有关。
Patients with pulmonary arterial hypertension (PAH) may exhibit reduced expiratory flows at low lung volumes, which could promote exercise-induced dynamic hyperinflation (DH). This study aimed to examine the impact of a potential exercise-related DH on the intensity of dyspnoea in patients with PAH undergoing symptom-limited incremental cardiopulmonary cycle exercise testing (CPET).25 young (aged mean +/- SD 38 +/- 12 yrs) nonsmoking PAH patients with no evidence of spirometric obstruction and 10 age-matched nonsmoking healthy subjects performed CPET to the limit of tolerance. Ventilatory pattern, operating lung volumes (derived from inspiratory capacity (IC) measurements) and dyspnoea intensity (Borg scale) were assessed throughout CPET.IC decreased (i.e. DH) progressively throughout CPET in PAH patients (average 0.15 L), whereas it increased in all the healthy subjects (0.45 L). Among PAH patients, 15 (60%) exhibited a decrease in IC throughout exercise (average 0.50 L), whereas in the remaining 10 (40%) patients IC increased (average 0.36 L). Dyspnoea intensity and ventilation were greater in PAH patients than in controls at any stage of CPET, whereas inspiratory reserve volume was lower.We conclude that DH-induced mechanical constraints and excessive ventilatory demand occurred in these young nonsmoking PAH patients with no spirometric obstruction and was associated with exertional dyspnoea.