论文部分内容阅读
目的探讨深吸气量测定对稳定期慢性阻塞性肺疾病(COPD)患者气流阻塞变化和呼吸困难严重程度的临床意义。方法对61例中度稳定期 COPD 患者进行常规肺功能检测,以 Borg指数判断受试者呼吸困难的严重程度。所有患者在吸入400μg沙丁胺醇后重复检测肺功能和呼吸困难分级,36例在进行6 min 步行试验(6MWT)后重复肺功能检测和呼吸困难分级。结果吸入沙丁胺醇后,COPD 患者的深吸气量和第一秒用力呼气容积(FEV_1)分别为(1.6±0.5)和(1.3±0.4)L,均显著高于吸入前的(1.4±0.5)和(1.1±0.4)L,深吸气量平均改善率为(20±16)%,FEV_1平均改善率为(11±4)%,差异有统计学意义(t=-3.970,P<0.01);其中深吸气量改善率≥10%的占75.4%(46/61),FEV_1改善率≥10%的占39.3%(24/61),差异有统计学意义(X~2=16.190,P<0.01)。治疗后 Borg 指数(3.0±0.7)显著低于治疗前(3.9±0.8)。6MWT 后,COPD 患者深吸气量为(1.1±0.4)L,FEV_1为(1.0±0.4)L,均显著低于6MWT 前的(1.4±0.5)和(1.1±0.4)L,深吸气量平均恶化率为(26±8)%,FEV_1平均恶化率为(14±6)%,差异有统计学意义(t=-7.279,P<0.01),其中深吸气量恶化率≥10%的占100%(36/36),FEV_1恶化率≥10%的占72.2%(26/36),差异有统计学意义(X~2=11.613,P<0.01)。运动后 Borg 指数(5.6±1.0)显著高于运动前(3.9±0.9)。治疗前后深吸气量差值与治疗前后 Borg 指数差值、运动前后深吸气量差值与运动前后 Borg指数差值均呈显著正相关。静息状态未吸人沙丁胺醇时深吸气量与功能残气量、治疗前后深吸气量差值与治疗前后功能残气量差值、运动前后深吸气量差值与运动前后功能残气量差值均呈显著负相关。结论与 FEV_1比较,深吸气量检出稳定期 COPD 患者气流阻塞变化的敏感性比较高,能较准确地反映患者呼吸困难的严重程度。
Objective To investigate the clinical significance of deep inspiration measurement in obstructive airway obstruction and severity of dyspnea in patients with stable chronic obstructive pulmonary disease (COPD). Methods Sixty-one patients with moderate-to-stable COPD underwent routine pulmonary function tests. The severity of dyspnea was assessed by Borg index. All patients were repeatedly tested for lung function and dyspnea classification after inhalation of 400 μg of salbutamol, and 36 patients were followed up for pulmonary function tests and dyspnea classification after a 6-min walk test (6MWT). Results After inhaled salbutamol, the deep inspiratory volume and forced expiratory volume in the first second (FEV_1) were (1.6 ± 0.5) and (1.3 ± 0.4) L, respectively, significantly higher than those before inhalation (1.4 ± 0.5) And (1.1 ± 0.4) L respectively. The average rate of deep inspiratory volume improvement was (20 ± 16)% and the average improvement rate of FEV_1 was (11 ± 4)%, the difference was statistically significant (t = -3.970, P <0.01) ; Among them, 75.4% (46/61) of improvement rate of deep inspiration≥10%, 39.3% (24/61) of FEV_1 improvement rate≥10%, the difference was statistically significant (X ~ 2 = 16.190, P <0.01). After treatment Borg index (3.0 ± 0.7) was significantly lower than before treatment (3.9 ± 0.8). After 6MWT, deep inspiratory volume was (1.1 ± 0.4) L in COPD patients and (1.0 ± 0.4) L in FEV_1 patients, both of which were significantly lower than those of 1.4MWD and (1.1 ± 0.4) L before 6MWT. The average rate of worsening was (26 ± 8)% and the average rate of worsening of FEV_1 was (14 ± 6)%, with a significant difference (t = -7.279, P <0.01) Accounting for 100% (36/36), and 72.2% (26/36) of FEV_1 worsening rate ≥10% (X 2 = 11.613, P <0.01). The Borg index after exercise (5.6 ± 1.0) was significantly higher than that before exercise (3.9 ± 0.9). Before and after treatment, the difference between deep inspiratory volume and Borg index before and after treatment, before and after exercise, inspiratory volume difference was significantly positive correlation with Borg index difference before and after exercise. Resting state was not inhaled salbutamol deep inspiratory capacity and functional residual capacity, before and after treatment, the difference between the deep inspiratory capacity and functional residual capacity before and after treatment, the difference between before and after exercise deep inspiratory capacity and functional residual capacity before and after exercise All showed a significant negative correlation. Conclusions Compared with FEV_1, the deep inspiratory volume is more sensitive to detect changes of airflow obstruction in patients with stable COPD, which can accurately reflect the severity of dyspnea in patients.