不同指标对老年严重慢性阻塞性肺疾病患者吸入支气管舒张剂疗效的评价  

Alternative methods for assessing bronchodilator reversibility in patients with severe chronic obstructive pulmonary disease

作　　者：陈瑞[1] 陈荣昌[2] 陈炼[3] 郑劲平[2] 

机构地区：[1]中山大学附属二院呼吸内科,广州市510120 [2]广州呼吸疾病研究所 [3]广东省人民医院门诊部

出　　处：《中华老年医学杂志》2008年第9期661-664,共4页Chinese Journal of Geriatrics

基　　金：广东省自然科学基金研究团队项目（04205342）

摘　　要：目的对评价严重慢性阻塞性肺疾病（COPD）患者吸入支气管舒张剂疗效的3种指标进行比较。方法吸入复方异丙托溴胺溶液前后对18例稳定期严重COPD患者行肺通气功能和肺容量测定，并采用呼气负压技术同步检测呼气流速受限（EFL）。结果与安慰剂比较，吸入支气管舒张剂后COPD患者第1秒用力呼气容积占预计值（FEV1）百分比、用力肺活量占预计值（FVC）百分比、深吸气节占预计值（IC）百分比显著改善，残气量占预计值（RV）百分比和功能残气量占预计值（FRC）百分比显著降低，肺总疑占预计值（TLC）百分比无显著改变；Borg呼吸困难评分显著降低；5分法EFL评分尤显著改变；呼吸方式无显著改变。IC、FEV1和5分法EFL评分的平均改善率分别是（20．42±15．02）％、（10．98±7．28）％和（5．15±11．24）。△IC与△Borg呈负相关（r=0．732，P〈0．05），△FEV1与△Borg相关关系无统计学意义（r=0．343，P〉0．05）。应用受试者工作特征曲线方法分析3种不同指标诊断呼吸困难的价值，结果表明．IC、FEV1和5分法EFL评分的曲线下面积分别为0．868、0．681和0．557。结论与FEV1相比，IC评价严重COPD患者支气管舒张剂疗效更为灵敏和准确，5分法EFL评分不宜作为评价严重COPD患者吸入支气管舒张剂疗效的指标。Objective To explore the clinical significence of three alternative ways in assessing bronehodilator reversibility in patients with severe chronic obstructive pulmonary disease （COPD）. Methods 18 clinically stable patients with severe COPD were collected. Pulmonary ventilation function and capacity of lung were measured after inhaling compound ipratropium bromide solution before and after nebulised saline, and at intervals. Expiratory flow limitation （EFL） was detected by negative expiratory pressure technique concurrently. Results Compared with placebo, bronchodilator caused a significant increase in forced expiratory volume in one second （FEV1）% Pred, forced vital capacity （FVC）%Pred and inspiratory capacity （IC）% Pred and a significant decrease in residual volume （RV）% Pred, functional residual capacity （FRC）%Pred and Borg scale. But there were no changes in total lung capacity （TLC）%Pred, 5 point EFL score and breathing pattern variables. The increase of IC was correlated with the reduction of Borg scale, but such correlation did not exist between the increase of FEV1 and the reduction of Borg scale. When ROC curve was applied to assess the significance of IC, 5 point EFL score and FEV1 in evaluating the effects of broneholilator,the area under curve （AUC） of which was 0. 868,0. 681 and 0. 557 respectively. Conclusions Compared with FEV1, IC has higher sensitivity and reliability to evaluate the clinical response of hronchodilator in patients with severe COPD. The 5 point EFL score is not an appropriate measurement of acute bronchodilator response.

关 键 词：肺疾病 慢性阻塞性 呼吸困难 评价研究 支气管舒张药 

分 类 号：R686[医药卫生—骨科学]