呼气相气道内负压法检测呼气流速受限在支气管哮喘患者中的应用  

Expiratory flow limitation detected by negative expiratory pressure in patients with bronchial asthma

作　　者：张挪富[1] 陈爱欢[1] 陈荣昌 李俊梅[1] 刘奇[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12期816-820,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

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

摘　　要：目的探讨支气管哮喘(简称哮喘)患者呼气流速受限(EFL)与呼吸困难严重程度的相关性,观察吸入支气管扩张剂对哮喘患者EFL的影响。方法采用呼气相气道内负压法(NEP)检测65例哮喘患者支气管扩张试验前、后(吸入沙丁胺醇400μg)EFL情况。结果65例哮喘患者中有26例(40%)出现EFL,其中11例仅仰卧位时出现,15例仰卧位及坐位均出现。EFL和无EFL者(N-EFL)第一秒用力呼气容积占预计值百分比(FEV1占预计值%)分别为(52±15)%、(77±18)%,两组比较差异有统计学意义(t=5.822,P<0.01)。仅仰卧位有EFL(S-EFL)者和仰卧位、坐位均有EFL(SS-EFL)者FEV1占预计值%分别为(64±10)%、(43±12)%,两组比较差异有统计学意义(t值分别为2.283、6.694,P分别<0.01、<0.05)。3分法和5分法EFL均与FEV1占预计值%呈负相关(r值分别为-0.637、-0.630,P均<0.01)。第一秒用力呼气容积(FEV1)与加拿大医学研究委员会推荐的呼吸困难严重程度分级标准(MRC评分)呈负相关(r=-0.501,P<0.01),3分法和5分法EFL均与MRC评分呈正相关(r值分别为0.627、0.636,P均<0.01)。17例FEV1占预计值%<70%并存在EFL的患者吸入沙丁胺醇后,9例EFL完全消失,5例从SS-EFL变为S-EFL,吸入沙丁胺醇后3分法和5分法EFL评分均较吸入前差异有统计学意义(t值分别为6.769、6.010,P均<0.01)。结论与FEV1比较,EFL与哮喘患者呼吸困难严重程度相关性更强,可作为评价患者呼吸困难严重程度更可靠的客观指标。哮喘患者EFL可被吸入支气管扩张剂逆转,即表现为可逆性EFL。Objective To evaluate the relationship between expiratory flow limitation （EFL）and chronic dyspnea and the effect of bronchodilator on EFL in patients with bronchial asthma. Methods Sixty-five patients with bronchial asthma were treated for pre- and post-bronchodilation of 400μg salbutamol. Results EFL was detected in 26 （40%） of the 65 bronchial asthma patients, 11 only in supine position and 15 in both sitting and supine positions. There was a significant difference in FEV1 percentage of the predicted value （FEV1% pred） between patients with and without EFL（ t = 5. 822, P 〈 0.01 ）; the mean values of FEV1% pred in non-EFL group and EFL group was （77 ± 18） % and （52 ± 15） % respectively, and the value was lowest in patients who showed EFL both in seated and supine positions[ （43 ± 12） % ] ; the mean values of FEV1% pred in those showing EFL only in sitting position （S-EFL） and both in sitting and supine position （SS-EFL） were （64 ± 10）% and （43 ± 12）% respectively （t = 2. 283, 6. 694 respectively,P 〈 0. 01, 〈0.05）. Both three-point EFL and five-point EFL were significantly correlated with FEV1 （r=- 0. 637, - 0. 630 respectively, all P 〈 0.01 ）. There was a significant negative correlation between as proposed by the Canadian Medical Research Council （MRC） dyspnea scale and FEV1 （r = -0. 501, P 〈 0. 01 ）, and a significant positive correlation between dyspnea scale and 3-point EFL and five-point EFL（ r =- 0.627,0. 636 respectively, all P 〈 0.01 ）. After salbutamol, of the 17 patients having EFL and 〈 70% pre FEV1 at baseline, EFL completely reversed in 9, and changed from SS-EFL to S-EFL in 5, with significant improvements in 3-point and 5-point EFL as compared with before salbutamol （t = 6. 769, 6. 010 respectively,all P 〈 0. 01 ）. Conclusions EFL as measured by NEP （negative expiratory pressure） technique may be more useful in the evaluation of dyspnea in bronchial asthma patients than routine lung function measurements

关 键 词：哮喘 呼吸困难 呼吸功能试验 呼吸道疾病 

分 类 号：R562.25[医药卫生—呼吸系统]