慢性阻塞性肺疾病患者肺功能下降与膈肌功能变化的相关性  

Correlation between decline of pulmonary function and changes of diaphragmatic function in patients with chronic obstructive pulmonary disease

作　　者：秦茵茵[1] 刘鹢倩 张德华[1] 林心情[1] 贺白婷 吴国锋 Qin Yinyin;Liu Yiqian;Zhang Dehua;Lin Xinqing;He Baiting;Wu Guofeng(First Affiliated Hospital of Guangzhou Medical University,Guangzhou Institute of Respiratory Diseases,State Key Laboratory of Respiratory Diseases,National Clinical Research Center for Respiratory Diseases,Guangzhou,Guangdong 510120,China)

机构地区：[1]广州医科大学附属第一医院广州呼吸疾病研究所呼吸疾病国家重点实验室国家呼吸疾病临床研究中心,510120 [2]广州医科大学附属第三医院荔湾医院内科

出　　处：《中华生物医学工程杂志》2017年第5期369-373,共5页Chinese Journal of Biomedical Engineering

基　　金：国家自然科学基金面上项目（81670036）;广东省科技计划（20138021800275、2014A020212562）;广州市科技计划（201607010374）;广州医科大学附属第一医院科研项目（201510gyfyy）

摘　　要：目的探讨慢性阻塞性肺疾病（COPD）患者肺功能下降与膈肌功能变化的相关性。方法收集2012年1月至12月就诊于广州医科大学附属第一医院呼吸科门诊的稳定期COPD患者18例为COPD组，以同期无心肺疾病、年龄与COPD组匹配的门诊患者18例作为对照。进行常规肺功能测定，使用多导食道电极导管记录静息状态、最大用力吸气时的食道压、胃内压、膈肌肌电（EMGdi），分析肺功能指标与膈肌功能指标的相关性。结果肺功能检查显示，COPD组与对照组的第1秒用力呼气量与用力肺活量的比值（FEV1／FVC）、FEV-占预计值的百分比（FEV-％pred）、FVC占预计值的百分比（FVC％pred）组间比较差异均有统计学意义（均P〈0．05）。静息状态下，COPD组的最大食道压（Pes．max）、最大跨膈压（Pdi—max）、EMGdi、EMGdi占最大值百分比（EMGdi％max）分别为（61．0±8．4）cmH20（1cmH20=0．098kPa）、（75．8±11．2）cmH20、（45．1±22．0）uV、（26．1±14．9）％，对照组分别为（73．5±13．0）cmH20、（96．4±10．2）cmH20、（20．2±9．0）μV、（12．0±3．6）％。COPD组Pes—max、Pdi—max明显低于对照组，EMGdi、EMGdi％max明显高于对照组（均P〈0．05）；而最大胃内压（Pga—max）、EMGdi最大值（EMGdi—max）组间比较差异无统计学意义（均P〉0．05）。相关性分析显示，Pes—max与FEV。％pred、FVC％pred、FEVI／FVC呈正相关（r=0．569、0．532、0．533，均P〈0．05），Pdi．ma）（与FEV1％pred、FVC％pred、FEV1／FVC呈正相关（r=0．734、0．657、0．685，均P〈0．05）；EMGdi与FEV1％pred、FVC％pred、FEV1／FVC呈负相关（r=-0．654、-0．671、-0．567，均P〈0．05），EMGdi％max与FEV1％pred、FVC％pred、FEV1／FVC呈负相关（r=-0．591、-0．608、-0．532，均P〈0．05）；而Pga-max、EMGdi．max与肺功能指标无相关性（均P〉0．05）。结论经多导食道电极�Objective To investigate the correlation between the decline of pulmonary function and changes of diaphragmatic function in patients with chronic obstructive pulmonary disease （COPD）. Methods Eighteen patients with stable COPD, who were hospitalized in the Department of Respiratory Medicine,the First Affiliated Hospital of Guangzhou Medical University between January and December 2012, were included in the COPD group. A contemporary cohort of 18 outpatients with no cardiopulmonary diseases and age matched with the COPD group were included as the controls. The conventional pulmonary function test was performed. The multipair esophageal electrode catheter was used to record the esophageal pressure （Pes）, gastric pressure （Pga） and diaphragm electromyogram （EMGdi） in resting condition and maximal forced inspiration. The correlation between the pulmonary function indexes and diaphragmatic function indexes was analyzed. Results The pulmonary function test showed that there were statistically significant differences in the rate of forced expired volume in one second and forced vital capacity （FEVI/FVC）, FEVI percentage of predicted value （FEVl%pred）, and FVC percentage of predicted value （FVC%pred） between the COPD group and the control group （all P〈0.05）. In the resting condition, the maximal esophageal pressure （Pes-max）, maximal transdiaphragmatic pressure （Pdi- max）, EMGdi, and EMGdi percentage of predicted value （EMGdi%max） were （61.0±8.4） cmH20 （ 1 cmH20= 0.098 kPa） vs （73.5±13.0） emH20, （75.8±11.2） cmH20 vs （96.4±10.2） cmH20, （45.1±22.0） tV vs （20.2± 9.0） μV and （26.1±14.9）% vs （12.0±3.6）% in the COPD group and control group, respectively. The Pes-max and Pdi-max in the COPD group were significantly lower than those in the control group, whereas the EMGdi and EMGdi%max were significantly higher than those in the control group （all P〈0.05）. There were no statistically significant differences in the maximal intragastri

关 键 词：肺疾病 慢性阻塞性 呼吸功能试验 膈肌功能 多导食道电极 

分 类 号：R735[医药卫生—肿瘤]