PT -期刊文章AU -科斯塔,卡米拉·m·内德盟——j·阿尔贝托AU -谢谢你,卡洛斯·g . AU - Paula-Ribeiro玛塞尔AU -拉莫斯,罗伯塔非盟-费雷拉,Eloara m . AU -打破传统,路易斯e . AU - O ' donnell,丹尼斯·e . AU -佩雷拉,卡洛斯交流盟——Ota-ArakakiJaquelina TI -揭露劳力性呼吸困难的机制结合肺纤维化和肺气肿援助- 10.1183/13993003.01319 -2019 DP - 2020年1月01 TA -欧洲呼吸杂志》第六PG - 1901319 - 55 IP - 1 4099 - //www.qdcxjkg.com/content/55/1/1901319.short 4100 - //www.qdcxjkg.com/content/55/1/1901319.fullEur Respir J2020 1月1日;55 AB -普遍的观点是，特发性肺纤维化(IPF)和肺气肿(CPFE)合并患者的劳动性呼吸困难在很大程度上可以解释为严重的低氧血症。然而，几乎没有证据支持这些假设。我们前瞻性地对比了42例CPFE和16例IPF患者对运动的感觉和生理反应，这些反应与低氧血症的严重程度相匹配。肺气肿和肺纤维化用计算机断层扫描进行量化。吸气限制评估在恒定工作速率试验:毛细血管血气在一个子集的病人。与IPF相比，CPFE患者尽管广泛纤维化程度较低，但运动能力较低(p=0.004和0.02)。24例CPFE患者的转移因子、动脉血二氧化碳张力和通气效率(分钟通气量(V 'CO2)/二氧化碳输出量(V 'CO2)比值明显低于呼吸困难较少的患者，劳力性呼吸困难是关键限制症状。然而，超声心动图显示肺动脉高压的可能性组间无差异(p=0.44)。 High dead space/tidal volume ratio, low capillary carbon dioxide tension emphysema severity (including admixed emphysema) and traction bronchiectasis were related to a high V′E/V′CO2 ratio in the more dyspnoeic group. V′E/V′CO2 nadir >50 (OR 9.43, 95% CI 5.28–13.6; p=0.0001) and total emphysema extent >15% (2.25, 1.28–3.54; p=0.01) predicted a high dyspnoea burden associated with severely reduced exercise capacity in CPFEContrary to current understanding, hypoxaemia per se is not the main determinant of exertional dyspnoea in CPFE. Poor ventilatory efficiency due to increased “wasted” ventilation in emphysematous areas and hyperventilation holds a key mechanistic role that deserves therapeutic attention.Exertional dyspnoea is related to poor ventilatory efficiency rather than hypoxaemia or inspiratory constraints in CPFE. Lessening patients' excessive ventilation might prove particularly beneficial to mitigate the burden of this disabling symptom. http://bit.ly/2MRn6az