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目的：探讨运动试验对慢性阻塞性肺病（ＣＯＰＤ）患者并发肺心病的早期诊断价值。方法：ＣＯＰＤ组２０例和健康对照组２０名进行运动肺功能测试，运动前后分别测定平均肺动脉压（ｍＰＡＰ）、肺循环阻力（ＰＶＲ）及心排指数（ＣＩ）等（阻抗法）。结果：运动前两组肺循环动力学参数无差异。运动后，ＣＯＰＤ组的ｍＰＡＰ、ＰＶＲ均显著增高（Ｐ＜０．０１），ＣＩ无明显变化；对照组ｍＰＡＰ、ＰＶＲ下降，ＣＩ增加（Ｐ均＜０．０５）。结论：慢性阻塞性肺病患者运动中肺循环代偿反应能力下降，运动时右心负荷加重；运动前后动态观察肺循环动力学变化对ＣＯＰＤ并发肺心病的早期诊断有重要意义。
Objective: To investigate the early diagnostic value of exercise test in patients with chronic obstructive pulmonary disease (COPD) complicated by pulmonary heart disease. Methods: Twenty patients in COPD group and 20 healthy persons in control group were tested for exercise pulmonary function test. Before and after exercise, mean pulmonary arterial pressure (mPAP), pulmonary resistance (PVR) and cardiac index (CI) were measured respectively. Results: There was no difference in pulmonary circulation kinetic parameters between the two groups before exercise. After exercise, mPAP and PVR in COPD group were significantly increased (P <0.01), while CI did not change significantly. In control group, mPAP, PVR decreased and CI increased (all P <0.05). CONCLUSION: The ability of compensatory pulmonary circulation compensatory reaction during exercise in COPD patients is decreased, and the right heart load is aggravated during exercise. Dynamic changes of pulmonary circulation dynamics before and after exercise are important for the early diagnosis of COPD complicated with pulmonary heart disease.