呼气相气道内负压法检测呼气流速受限在慢性阻塞性肺疾病中的应用  

Expiratory flow limitation detected by negative expiratory pressure in patients with chronic obstructive pulmonary disease

作　　者：陈爱欢[1] 陈荣昌 李俊梅[1] 钟南山[1] 

机构地区：[1]广州医学院第一附属医院广州呼吸疾病研究所,510120

出　　处：《中华结核和呼吸杂志》2006年第4期236-239,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：广东省科学技术厅资助项目(C31106);广州市科学技术局资助项目(2000038);广东省卫生厅资助项目(A2000267)

摘　　要：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 evaluate the relationship between expiratory flow limitation （EFL） and chronic dyspnea and the effect of bronchodilator on EFL in patients with chronic obstructive pulmonary disease（COPD）. Methods Thirty-three ambulatory patients with COPD（46-78 yrs;male 31,female 2） were included in this study. The severity of chronic dyspnea was rated according to the dyspnea scale proposed by the Medical Research Council（MRC）. EFL was measured by applying negative pressure at the mouth during tidal expiration before and after bronchodilation test（ inhalation of 400 p.g salbutamol）. Results EFL was detected in 12 （36%） of the 33 COPD patients in both seated and supine positions and in 11 （33%） only in supine position. There was a significant difference in the percent predicted forced expired volume in one second （ FEVt % pred） between subgroups of the patients with or without EFL（ t = 7.601,P 〈 0.01）. The mean values of FEVt%pred in non-EFL group and EFL group was （66±16）% and （31±10） % ,respectively,and the value was lowest in patients who showed EFL both in seated and supine positions [ （24±7 ） % ]. Both three-point EFL and five-point EFL were significantly correlated with FEV1 （ r = -0. 836 and -0. 818, respectively, all P 〈 0. 01 ）. There was a significant correlation between MRC dyspnea scale and three-point EFL and five-point EFL （r =0. 903 and 0. 912 ,respectively,all P 〈0. 01 ）. In the multiple regression analysis, five-point EEL was a better predictor of dyspnea than FEV, （ regression coefficient was 0. 679 and - 0. 265, respectively, P 〈 0. 01 and 0. 029, respectively ）. EFL persisted after salbutamol in all of the 23 patients with EFL under baseline conditions. Conclusions EFL as measured by negative expiratory pressure （NEP） technique may be more useful in the evaluation of dyspnea in COPD patients than routine lung function measurements. The EFL in COPD patients is irreversible after bronchodilator administration.

关 键 词：肺疾病 慢性阻塞性 呼吸困难 肺量测定法 气道内负压 呼气流速受限 

分 类 号：R563.9[医药卫生—呼吸系统]