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目的探讨慢性阻塞性肺疾病(COPD)患者呼气流速受限(EFL)与呼吸困难严重程度的相关性,并观察吸入支气管扩张剂对 COPD 患者 EFL 的影响。方法采用呼气相气道内负压法(NEP)检测33例 COPD 患者支气管扩张试验前、后(吸入沙丁胺醇400μg)EFL 情况,其中男31例,女2例,年龄46～78岁,平均年龄(63±8)岁。结果 33例 COPD 患者中23例(70%)出现 EFL,其中11例(33%)仅仰卧位出现 EFL,12例(36%)仰卧位及坐位均出现 EFL。无 EFL 患者与 EFL 患者第一秒用力呼气容积占预计值百分比(FEV_1占预计值%)分别为(66±16)%和(31±10)%,差异有统计学意义(t=7.601、P<0.01),仰卧位及坐位均出现 EFL 患者的 FEV_1占预计值%最低[(24±7)%]。3分法和5分法 EFL 均与 FEV_1呈显著负相关(r=-0.836和-0.818,P 均<0.01)。3分法和5分法 EFL 均与医学研究委员会(MRC)推荐的呼吸困难严重程度分级评分标准(简称 MRC 呼吸困难评分)呈显著正相关(r=0.903和0.912,P均<0.01)。多元回归分析结果显示,5分法 EFL 和FEV_1对 MRC 呼吸困难评分的预测性均有统计学意义(标准化偏回归系数分别为0.679、-0.265,P分别为<0.01、0.029),但5分法 EFL 比 FEV_1对 MRC 呼吸困难评分的预测性更强。23例吸入沙丁胺醇前存在 EFL 患者,吸入后全部患者 EFL 仍然存在。结论与 FEV_1比较,EFL 对 COPD 患者呼吸困难严重程度预测性更强,可作为评价 COPD 患者呼吸困难严重程度更可靠的客观指标。COPD 患者的 EFL 不能被吸入支气管扩张剂逆转,即表现为 EFL 的不可逆性。
Objective To investigate the correlation between the limited expiratory flow (EFL) and the severity of dyspnea in patients with chronic obstructive pulmonary disease (COPD) and to observe the effect of bronchodilator inhalation on EFL in COPD patients. Methods EFL of 33 patients with bronchodilation before and after bronchodilation (inhalation of 400 mg of salbutamol) were detected by NEP in 33 patients, including 31 males and 2 females, aged from 46 to 78 years and mean age ( 63 ± 8) years old. Results EFL occurred in 23 of 33 patients (70%) with COPD. Eleven of them (33%) had EFL only in supine position and 12 patients (36%) had EFL in supine position and sitting position. The first second forced expiratory volume of EFL patients and EFL patients were (66 ± 16)% and (31 ± 10)%, respectively, with a statistically significant difference (t = 7.601, P <0.01). FEV 1 in supine position and sitting position had the lowest% of predicted value [(24 ± 7)%]. The 3-point and 5-point EFLs were significantly negatively correlated with FEV_1 (r = -0.836 and -0.818, respectively, P <0.01). The 3-point and 5-point EFLs were both significantly and positively correlated with the grading scale of dyspnea severity (MRC dyspnea score) recommended by the Medical Research Council (r = 0.903 and 0.912, P <0.01). Multivariate regression analysis showed that EFL and FEV_1 of 5-point method were both predictive of MRC dyspnea scores (standardized partial regression coefficients were 0.679 and -0.265, P <0.01 and 0.029 respectively), but the 5-point method EFL is more predictive of MRC dyspnea scores than FEV_1. Twenty-three patients had EFL before inhalation of albuterol, and all patients had EFL after inhalation. Conclusions Compared with FEV_1, EFL is more predictive of the severity of dyspnea in COPD patients and can be used as a more reliable objective index to evaluate the severity of dyspnea in COPD patients. EFL in patients with COPD can not be reversed by inhalation of bronchodilators, ie, the irreversibility of EFL.