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目的探讨心肺运动试验(CPET)对胸腔闭式引流术(CTD)治疗胸腔积液患者整体功能变化的评估作用。方法选取2012年5月—2014年6月威海市立医院明确诊断有显著胸腔积液,并接受CTD治疗的患者13例,分别在治疗前后进行CPET检查,按照美国加州大学洛杉矶分校医学中心标准连续递增功率方案完成症状限制性极限运动,通过对数据进行标准化分析计算其核心指标,从系统软件导出静息状态、热身状态、无氧阈状态、极限状态时的循环指标及呼吸指标。结果 13例胸腔积液患者CTD治疗后10例患者整体功能显著改善,3例患者整体功能降低。胸腔积液患者CTD治疗前后峰值摄氧量(L/min、ml·min-1·kg~(-1)、%pred)、无氧阈(L/min、ml·min-1·kg~(-1)、%pred)、峰值氧脉搏(ml/次、%pred)、二氧化碳通气当量斜率(slope、%pred)、峰值负荷功率(W)、递增功率运动时间(min)比较,差异均无统计学意义(P>0.05);治疗后摄氧效率平台(比值、%pred)较治疗前升高,二氧化碳通气当量最低值(比值、%pred)较治疗前降低(P<0.05)。胸腔积液患者CTD治疗后静息状态时摄氧量较治疗前降低(P<0.05);静息状态、热身状态、无氧阈状态时心率较治疗前降低,极限状态时心率较治疗前升高(P<0.05);热身状态时氧脉搏较治疗前升高(P<0.05);静息状态、无氧阈状态时摄氧通气效率较治疗前升高(P<0.05);热身状态、无氧阈状态和极限状态时二氧化碳通气当量较治疗前降低(P<0.05)。胸腔积液患者CTD治疗后静息状态、无氧阈状态时分钟通气量较治疗前降低(P<0.05);极限状态时潮气量较治疗前升高(P<0.05);4个状态时呼吸频率较治疗前降低(P<0.05);极限状态时呼吸交换比值较治疗前升高(P<0.05);静息状态、热身状态时潮气末二氧化碳分压较治疗前升高(P<0.05);静息状态时潮气末氧分压较治疗前降低(P<0.05);热身状态、无氧阈状态、极限状态时每呼吸摄氧量、每呼吸二氧化碳排出量较治疗前升高(P<0.05)。结论虽然3例患者整体功能显著降低使得全体患者CTD治疗前后整体功能改善无显著差异,但是,CTD治疗胸腔积液使得10/13的患者整体功能显著改善。使用CPET检查整体功能指标动态变化从临床上实现了CTD治疗胸腔积液患者的客观定量评估,同时还为有效改善循环系统、呼吸系统、循环系统和呼吸系统匹配的治疗机制提供试验研究。
Objective To investigate the assessment of the overall function of cardiopulmonary exercise test (CPET) in the treatment of patients with pleural effusion by closed thoracic drainage (CTD). Methods Thirteen patients with definite pleural effusion and CTD were diagnosed in Weihai Municipal Hospital from May 2012 to June 2014. CPET was performed before and after treatment and continuously increased according to the standard of UCLA Medical Center The power scheme completes the symptom-limited extreme exercise, and calculates its core indicators by standardizing the data and derives the resting state, warm-up state, anaerobic threshold state, and the circulatory index and the respiratory index at the extreme state from the system software. Results The overall function of 10 patients with pleural effusion after CTD treatment was significantly improved, and the overall function of 3 patients was decreased. The peak oxygen uptake (L / min, ml · min -1 · kg -1,% pred) and anaerobic threshold (L / min, ml · min -1 · kg ~ -1),% pred, peak oxygen pulse (ml / time,% pred), carbon dioxide ventilation slope slope (% pred), peak load power (W) and progressive power movement time (P> 0.05). After treatment, the oxygen uptake efficiency platform (ratio,% pred) was higher than before treatment, and the lowest value of carbon dioxide ventilation equivalent (% pred) was lower than that before treatment (P <0.05). In patients with pleural effusion, the oxygen uptake of resting state after CTD treatment was lower than that before treatment (P <0.05). The heart rate of resting state, warm-up state and anaerobic threshold state were lower than those before treatment, (P <0.05). The oxygen pulse rate of warm-up state was higher than that of before treatment (P <0.05). The resting oxygen uptake efficiency at resting state and anaerobic threshold state was higher than that before treatment (P <0.05) Carbon dioxide ventilation equivalent at the anaerobic threshold and at the limit state was lower than before treatment (P <0.05). In patients with pleural effusion, the resting state after CTD treatment and the anaerobic threshold state minute ventilation were lower than those before treatment (P <0.05); in the limit state, the tidal volume increased (P <0.05) (P <0.05). The respiratory exchange ratio in the extreme state was higher than that before treatment (P <0.05), while in resting state and warm-up state, the partial pressure of end-tidal carbon dioxide was higher than that before treatment (P <0.05) (P <0.05). At warm-up state, anaerobic threshold state and limit state, the oxygen uptake per breath and carbon dioxide per breath increased more than before treatment (P < 0.05). Conclusions Although the overall function of the three patients was significantly reduced, there was no significant difference in overall function before and after CTD treatment in all patients. However, CTD treatment of pleural effusion resulted in a significant improvement in the overall function of 10/13 patients. The use of CPET to examine the dynamic changes of overall functional indexes has clinically achieved the objective and quantitative assessment of patients with pleural effusion treated by CTDs and also provided experimental studies on the effective treatment mechanisms of circulatory system, respiratory system, circulatory system and respiratory system.