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標題: | 原發性肺動脈高血壓與次發性肺高壓患者之運動能力與生活品質 The Exercise Capacity and Quality of Life in the Patients with Idiopathic Pulmonary Arterial Hypertension and Secondary Pulmonary Hypertension |
作者: | Ling-Wei Chen 陳玲崴 |
指導教授: | 簡盟月(Meng-Yueh Chien) |
關鍵字: | 肺動脈高壓,心肺運動測試,血液動力學,運動能力,生活品質, Pulmonary arterial hypertension,Cardiopulmonary exercise testing,Hemodynamics measurements,Exercise capacity,Quality of life., |
出版年 : | 2016 |
學位: | 碩士 |
摘要: | 研究背景與目的:肺動脈高壓是一種會持續惡化的肺部血管性疾病,病程進展快速,致死率極高。目前由於藥物治療發展,已使肺動脈高壓存活率增加,但患者仍存在運動能力及生活品質下降的問題。過去研究顯示原發性及次發性肺動脈高壓病患的病因和預後都不相同,但少有研究探討這兩類患者的運動能力及生活品質差異,因此本研究目的為比較原發性及次發性肺動脈高壓患者的運動能力及生活品質差異,並分析相關因素。研究方法:共13位符合收案條件的肺高壓患者,5位原發性和8位次發性患者。測試項目包括身體組成、運動能力(六分鐘行走測試、心肺運動測試)、血液動力學(非侵入性心輸出量測試儀)、日常身體活動量、疲勞嚴重程度及生活品質(36題簡短生活品質量表)。使用SPSS19.0版本進行資料分析,以Mann-Whiteny U檢定或Chi-squared檢定分析原發性組與次發性組肺動脈高壓各項測試結果的組間差異,並以Spearman's rank correlation檢定運動能力及生活品質的因素與各項測試參數間的相關性,最後再以迴歸分析影響運動能力的主要因素。研究結果:原發性肺動脈高壓與次發性肺動脈高壓的最大攝氧量年齡預測百分比(64.26±7.12 vs 50.23±12.93 %,p<0.05)、二氧化碳換氣當量斜率(33.90±5.84 vs 51.61±20.97,p<0.05)、無氧閾值時潮氣末二氧化碳(PETCO2@AT)(34.88±3.38 vs 27.62±10.97 毫米汞柱,p<0.05)及無氧閾值時二氧化碳換氣當量(VE/VCO2@AT)(33.56±3.08 vs 41.96±4.74 公升/分鐘,p<0.05)兩組相較有顯著差異。原發性組的六分鐘行走測試距離顯著高於次發性組(565.38±29.61 vs 486.26±70.91公尺,p<0.05)。原發性組與次發性組在血液動力學參數雖無顯著差異,但次發性組有較佳的趨勢。迴歸分析顯示影響肺動脈高壓患者運動能力的主要因素為潮氣末二氧化碳分壓。結論:原發性肺動脈高壓患者的運動能力及運動測試參數與次發性患者存在顯著差異。但原發性及次發性族群運動中血液動力學參數的變化,仍需更多的研究。建議未來須分開探討原發性及次發性肺動脈高壓族群的運動能力與運動反應,且須考慮患者是否具有運動時引起心臟右至左分流。 Background and purpose: Pulmonary arterial hypertension (PAH) is a progressive pulmonary vascular disease with high mortality rate. Along with the pharmaceutical development, the prognosis of the disease has improved. However, subsequent poor exercise capacity and decrease of the quality of life still remain as a problem. Previous studies have shown that idiopathic and secondary PH were different in etiology and prognosis, but few studies examined the differences in the exercise capacity and quality of life between these two types of patients. Therefore, the purposes of this study were to compare the exercise capacity and quality of life, and analyzed the factors affecting them in idiopathic and associated PAH. Methods: There were 5 patients diagnosed with idiopathic PAH, and 8 with associated PAH included in the study. Outcome measures included body composition, exercise capacity (six minutes walking test, cardiopulmonary exercise testing), hemodynamics measurements (by non-invasive cardiac output test instrument), regular physical activity, fatigue severity, and quality of life (SF-36). SPSS version 19.0 was used for data analysis. Mann-Whitney U test and X2 were used to analyze between-group differences according to continuous variables or categories. Spearman correlation coefficient was used to test the correlations between the outcome parameters. Multiple linear regression analyses were used to examine the factors associated with maximal oxygen consumption and 6-minute walking distances. Result: There were significant differences between idiopathic and associated PAH in VO2 age pred% (64.26±7.12 vs 50.23±12.93 %, p<0.05)、VE/VCO2 slope (33.90±5.84 vs 51.61±20.97, p<0.05)、VE/VCO2@AT (33.56±3.08 vs 41.96±4.74 l/min, p<0.05)、PETCO2@AT (34.88±3.38 vs 27.62±10.97 mmHg, p<0.05) and 6-minute walking distances (565.38±29.61 vs 486.26±70.91 m, p<0.05). There was no significant in hemodynamics parameters between idiopathic and associated PAH group. The regression model showed the PETCO2@AT was significant associated with exercise capacity. Conclusions: There were significant differences of exercise capacity and cardiopulmonary exercise testing parameters between idiopathic and associated PAH. Future studies should further analyze the differences of characteristics and features between these two groups, and should consider if patient has exercise induce right-left shunt. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/3905 |
DOI: | 10.6342/NTU201603751 |
全文授權: | 同意授權(全球公開) |
顯示於系所單位: | 物理治療學系所 |
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