RT期刊文章SR电子T1揭露劳力性呼吸困难的机制结合肺纤维化和肺气肿摩根富林明欧洲呼吸杂志乔和J FD欧元欧洲呼吸学会SP 1901319 10.1183/13993003.01319 -2019签证官55 1 A1科斯塔,卡米拉·m·内德A1 J . Alberto A1 Verrastro卡洛斯·g·A1 Paula-Ribeiro188bet官网地址Marcelle A1 Ramos, Roberta A1 Ferreira, Eloara M. A1 Nery, Luiz E. A1 O'Donnell, Denis E. A1 Pereira, Carlos A.C. A1 Ota-Arakaki，Jaquelina YR 2020 UL //www.qdcxjkg.com/content/55/1/1901319.abstract AB普遍认为，特发性肺纤维化(IPF)和肺气肿(CPFE)合并患者的劳力性呼吸困难在很大程度上可以由严重低氧血症解释。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患者的运动性低氧血症严重程度对运动的感觉和生理反应。用计算机断层扫描对肺气肿和肺纤维化进行量化。在恒定工作速率试验中评估了吸气限制:在一组患者中获得了毛细血管血气。CPFE患者与IPF相比，尽管广泛纤维化程度较低，但运动能力较低(p=0.004和0.02)。劳力性呼吸困难是24例CPFE患者的关键限制症状，这些患者的转移因子、动脉二氧化碳张力和呼吸效率(分钟通气(V 'E)/二氧化碳输出(V 'CO2)比呼吸困难较少的患者高)显著降低。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)。呼吸困难组的高死腔/潮气量比、低毛细血管二氧化碳张力性肺气肿严重程度(包括混合性肺气肿)和牵引性支气管扩张与高V 'E /V 'CO2比值相关。 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