长期氧疗对慢性阻塞性肺疾病患者骨骼肌代谢影响的研究

摘要

Obejective: To study the effects of long-term oxyen therpy(LTOT) on the pulmonary function, blood gas analysis , hemodynamics and the skeletal muscle metabolism. Methods:64 COPD patients were randomly devicled into two groups(LTOT group and control group ). Both groups received regular treatment and LTOT group were underwent LTOT for 3 years. The pulmonary function, blood gas, hemodynamics and the skeletal muscle metabolism were measured in all cases. Results: The MVV, TV, FVC, FEVi of pulmonary function and the PaO2 and SaO2of blood gas in LTOT group were obviously increased and the PaCO2 was obviously decreased after LTOT. The index of hemodynamics sPAP, mPAP, dPAP, PVR were decreased 41. 18%, 45. 71%, 47. 43% and 21. 88% while CI and SVI were increased 19. 04% and 35%, respectively after LTOT. The muscle strength, the transverse area of skeletal muscle, the ratios of type I and the vitality of oxidative enzyme were increased 50% , 17. 47% , 7. 87% and 28. 08% while the ratios of type I(a,b,c) , the glycolysis and the catablism rate of skeletal muscle protein were decreased 20. 50%, 42. 85%, 34. 66%, 37. 70%, respectively after LTOT. The index between two group all reached significant level. Conclusions: The data indicate that the LTOT can improved pulmonary function and relieved hypoxemic in the patients with COPD. The pulmonary blood vessel in COPD can be dilated immediately and selectively. The muscle strength, the transverse area of skeletal muscle and the ratios of type I in COPD can be improved immediately. The reasonable use of LTOT may achieve a good therapitic effects in patients with COPD and thus improve their quality of life.%目的:探索长期氧疗对慢性阻塞性肺疾病患者呼吸功能、血气以及骨骼肌代谢的影响.方法:将68例住院的COPD患者随机分为观察组和对照组.两组都接受常规治疗,观察组另外给予24个月的氧疗.测量记录两组治疗前后COPD患者肺功能、血气分析、血流动力学以及骨骼肌代谢指标.结果:长期氧疗组COPD患者的肺功能和血气指标MVV、TV、FVC,FEV1明显增加,PaO2和SaO2较氧疗前有明显的提高,而PaCO2较氧疗前明显下降；血流动力学指标sPAP、mPAP、dPAP、PVR分别降低了41.18％、45.71％、47.43％、21.88％,CI和SVI较氧疗前分别提高了19.04％和35％；骨骼肌肌力、骨骼肌横断面积、Ⅰ型肌纤维比例、氧化酶活力较氧疗前分别提高了50％、17.47％、7.87％、28.08％,而Ⅱ(a、b、c)型肌纤维比例、糖酵解、骨骼肌蛋白分解代谢速率较氧疗前分别减低了20.50％、42.85％、34.66％、37.70％.两组各指标差异均达到显著或极显著水平,具有统计学意义.结论:LTOT能改善COPD患者肺功能、减轻低氧症状；降低肺血管阻力和肺动脉压降低,稳定肺动脉压,避免了肺动脉压的不断继续恶化；改善肌力,增加骨骼肌横断面积；提高Ⅰ型肌肉纤维比例以及氧化酶活力下降,最终改善COPD患者临床症状,扩大病患活动范围和生活质量.