一种bstract
Besides the impaired lung diffusion capacity, impairment of exercise endurance in recovered patients with COVID-19 should also be concerned
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我们很感激有机会与Nusair博士进行深入讨论等等。[1Chapman博士等等。[2]我们真诚地欣赏他们对我们关于Covid-19患者肺功能受损的研究的富有洞察力评论[3.那4.], which helps to interpret the parameters of abnormal lung diffusion capacity more accurate.
一种ccording to the algorithm pointed out by Dr. Chapman [2],在我们研究中,患有Covid-19的总,温和,肺炎,严重肺炎患者的平均VA分别为84.9%,85.3%,86.4%,78.5%3.]。最近,Frija-Masson的另一个回顾性研究[5.]显示超过一半的Covid-19肺炎患者在症状发作后30天呈现出异常的肺功能。类似地,总共粗糙度VA,无/温和,中等严重患者的Covid-19分别为85.1%,87.9%,80.2%,78.9%。如果我们将这些数据绘制到DLCO / DLCO的曲线中TLC.和kco / kcoTLC.plotted against volume loss VA/VATLC.由J. Michael提出等等。[6.[我们可以在D1Co和正常情况下看到更大的损伤,但不会增加KCO,特别是在严重的情况下,如果VA的还原是导致肺部扩散异常的唯一因素,则与预期结果不平行。这两项研究都支持认为,肺泡单位的损失不足以导致在DLCO中观察到的损伤。
DLCO depends on both VA and the KCO. The same DLCO may occur with various combinations of KCO and VA, each suggesting different pathologies. Currently, limited data on pathology showed the diffuse alveolar damage (DAD) was the predominant lung pathology, with various levels of progression and severity and residual interstitial abnormalities [7.]。一种dditionally, pulmonary microangiopathy, fibrin clotting within small capillaries around alveoli, small vessel thrombosis and thickening of alveolar capillaries were also found in different post-mortem studies [8.那9.]。从这种观点来看,它表明不仅减少了VA,而且还减少了残留的间质异常,肺血管异常有助于Covid-19患者的异常漫射功能。我们同意Chapman的一点,即“使用更具体的肺泡 - 毛细血管膜,例如组合的DLCO和DLNO测量或晚期成像技术,可能需要确定间质性异常或肺血管异常是否有助于DLCO”。此外,动态胸部CT扫描的组合有助于评估具有异常肺功能的Covid-19患者的状态。
在临床实践中,部分康复患者的Covid-19患者呈现了各种水平的嗜好呼吸困难。除了静态肺功能试验(PFT)的损害之外,应注意氧气吸收或利用的降低能力。因此,我们通过Covid-19的10名康复患者中的心肺运动测试(CPET)进行了动态功能评估(即3.moderate cases, 2 severe cases, 5 critical ill cases) 1-month post-discharge in our center between January to March 2020.
Our result showed the spirometry was within the normal range in all cases and abnormal DLCO (<80% pred) was only found in 3 cases. However, noteworthy, all cases had reduction of the peak oxygen uptake (PeakVO2) and seven cases displayed decreasing oxygen pulse of predicted (VO2/HR%pred). On the contrary, 8 cases displayed normal ventilatory equivalents for carbon dioxide at anaerobic threshold (VE/VCO2@AT). This indicated pulmonary dysfunction and gas transfer inefficiency was not the sole reason for exercise limitation of patients with COVID-19, extrapulmonary factors especially the cardiac dysfunction after long-term bed rest during hospitalisation should be concerned.
Up to date, no data regarding the CPET on patients with COVID-19 was reported. Previous study on SARS by Ong等等。[10.]尽管有一半的恢复患者的SARS具有肺功能缺陷,但大多数病例的损伤是轻微的。许多患者的运动能力下降,不能占肺功能的减值,这与我们的初步结果一致。因此,有必要进一步评估Covid-19患者锻炼耐久性的损伤。
Footnotes
利益冲突:高博士没有披露。
利益冲突:陈博士没有披露。
利益冲突:Geng博士没有任何披露。
利益冲突:莫博士没有披露。
利益冲突:詹博士没有什么可以披露的。
利益冲突:剑博士没有披露。
利益冲突:李博士没有披露。
兴趣冲突:郑博士无需披露。
- R.eceived11月19日2020年11月19日。
- 公认November 24, 2020.
- Copyright ©ERS 2020.
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