AUGMENTED VENTILATORY RESPONSE TO EXERCISE IN PULMONARY-HYPERTENSION
AUGMENTED VENTILATORY RESPONSE TO EXERCISE IN PULMONARY-HYPERTENSION
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DOI：
10.1378/chest.89.1.39
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发表时间：
1986-01-01
期刊：
影响因子：
9.6
通讯作者：
SHUMWAY, NE
中科院分区：
文献类型：
--
作者：
THEODORE, J;ROBIN, ED;SHUMWAY, NE
在12名正常受试者、10名心肺移植前后的肺动脉高压患者和8名心脏移植后的患者中测定了对次最大运动的缓解反应，其定义为每分钟通气量相对于二氧化碳产生的斜率（≥ VE/≥ VCO 2）。与正常受试者相比，肺动脉高压患者表现出增强的呼吸反应（肺动脉高压[平均值，57.7 ± 0.001]）。6.8（SE）ml/ml ≥ VCO 2;正常受试者，22.3 ±。1.4 ml/ml·vrhdot.VCO2; p < 0.001]）。在心肺移植后，VE/VCO 2斜率下降到24.7 ± 0.05。1.6 ml/ml ≥ VCO 2，该值与正常受试者的值没有显著差异。心脏移植后的患者显示平均斜率值为25.3 ± 0.5。1.3 ml/ml ≥ VCO 2，其与正常值或心肺移植后发现的值没有显著差异。对运动的增强的呼吸反应与通气的常用化学调节剂（动脉pH值、动脉二氧化碳张力或动脉氧张力）无关。这些结果提示：（a）肺动脉高压患者存在一种神经系统，它导致运动时的兴奋性冲动增强：（B）兴奋性冲动增强反映了运动时肺传入神经的过度活动;（c）在正常受试者中对运动的呼吸反应的狭窄调节，其保存在去神经肺中，表明肺传入神经对正常受试者在运动期间的呼吸控制并不重要;以及（d）可能使用对运动的呼吸反应的测量作为肺动脉高压的非侵入性筛选测试。
The ventilatory response to submaximal exercise, defined as the slope of minute ventilation over carbon dioxide production (.ovrhdot.VE/.ovrhdot.VCO2), was determined in 12 normal subjects, ten patients with pulmonary hypertension before and after heart-lung transplantation, and eight patients following heart transplantation. Patients with pulmonary hypertension show an augmented ventilatory response compared to normal subjects (pulmonary hypertension [mean, 57.7 .+-. 6.8 (SE) ml/ml .ovrhdot.VCO2; normal subjects, 22.3 .+-. 1.4 ml/ml .ovrhdot.VCO2; p < 0.001]). Following heart-lung transplantation, .ovrhdot.VE/.ovrhdot.VCO2 slope fell to 24.7 .+-. 1.6 ml/ml .ovrhdot.VCO2, a value which is not significantly different than the value in normal subjects. Patients after heart transplantation show a mean slope value of 25.3 .+-. 1.3 ml/ml .ovrhdot.VCO2, which is not significantly different than the normal value or the value found after heart-lung transplantation. The augmented ventilatory response to exercise did not correlate with the usual chemical modulators of ventilation (arterial pH, arterial carbon dioxide tension, or arterial oxygen tension). These results suggest the following: (a) the existence of a neural system in patients with pulmonary hypertension which results in an augmentation of ventilatory drive in response to exercise; (b) the augmented ventilatory response reflects excessive neural activity of pulmonary afferents during exercise; (c) narrow regulation of the ventilatory response to exercise in normal subjects which is preserved in the denervated lung, indicating that pulmonary afferents are not critical to ventilatory control during exercise in the normal subject; and (d) the possible use of measurements of the ventilatory response to exercise as a noninvasive screening test for pulmonary hypertension.