应用超声技术评价慢性阻塞性肺疾病急性加重期患者膈肌功能障碍的研究  

Evaluation of diaphragm dysfunction in patients with AECOPD by ultrasonography

作　　者：刘瑞 徐长松[1] 徐明[1] LIU Rui;XU Chang-song;XU Ming(Department of Ultrasound,Huaian First Hospital Affiliated to Nanjing Medical University,Huaian,Jiangsu 223001,China)

机构地区：[1]南京医科大学附属淮安第一医院超声科,江苏南京223001

出　　处：《临床肺科杂志》2020年第10期1538-1541,共4页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨使用超声技术评价慢性阻塞性肺疾病急性加重期(AECOPD)患者膈肌功能障碍的价值。方法AECOPD患者,其中根据2019版GOLD COPD指南中,收集≥2次中度急性加重或一次导致入院患者共计40例,根据mMRC及CAT评分,将患者分为C组及D组,其中C组患者24例,D组患者16例。以超声测量膈肌吸气末及呼气末厚度、膈肌吸气末及呼气末幅度,并计算出膈肌增厚分数(DTF)、膈肌移动度、膈肌收缩速度。测量患者的第一秒用力呼气量(FEV 1)、用力肺活量(FVC)并计算(FEV 1/FVC)。结果C组与D组膈肌增厚分数比较有统计学意义(P<0.01),C组与D组膈肌移动度比较无统计学意义(P>0.05)。FVC与膈肌移动度(r=0.42,P<0.01)、膈肌收缩速度(r=0.35,P<0.01)呈正相关性、与膈肌增厚分数呈负相关(r=-0.25,P<0.05);FEV 1与膈肌收缩速度呈正相关(r=0.30,P<0.05);FEV 1/FVC与膈肌增厚分数呈正相关(r=0.29,P<0.05)。应用膈肌增厚分数鉴别C、D组AECOPD的效果最好,AUC曲线下面积为0.86,当DTF为29.80%,敏感度及特异度最高,分别为76.40%,85.40%。结论应用超声技术可以用来评价AECOPD患者膈肌的功能学变化,可以更好的进行下一步治疗。Objective To explore the value of ultrasonography in the evaluation of diaphragm dysfunction in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Patients with AECOPD were divided into the group C and the group D according to the score of mMRC and CAT.There were 24 patients in the group C and 16 patients in the group D according to the guideline of GOLD COPD 2019.The thickness of the diaphragm at the end of inspiration and exhalation,and the amplitude of the diaphragm at the end of inspiration and exhalation were measured by ultrasonography,and the diaphragamtic thickening fraction(DTF),diaphragmatic mobility and diaphragmatic contraction velocity were calculated.The first second forced expiratory volume(FEV 1),and forced vital capacity(FVC)were measured and calculated(FEV 1/FVC).Results There was significant difference in the diaphragamtic thickening fraction between the two groups(P<0.01),but there was no significant difference in the diaphragmatic mobility between the two groups(P>0.05).FVC was positively correlated with diaphragmatic mobility(r=0.42,P<0.01),diaphragm contraction speed(r=0.35,P<0.01),and negatively correlated with diaphragmatic thickening fraction(r=-0.25,P<0.05).FEV 1 was positively correlated with diaphragm contraction speed(r=0.30,P<0.05).FEV 1/FVC was positively correlated with diaphragm thickening fraction(r=0.29,P<0.05).The diaphragmatic thickening score was the best method to identify AECOPD in the group C and D.The area under the AUC curve was 0.86.When the DTF was 29.80%,the sensitivity and specificity were the highest,which were 76.40%and 85.40%,respectively.Conclusion Ultrasound can be used to evaluate the functional changes of diaphragm in patients with AECOPD,and the next treatment can be better.

关 键 词：膈肌 功能障碍 慢性阻塞性肺疾病 超声技术 

分 类 号：R445.1[医药卫生—影像医学与核医学] R563.9[医药卫生—诊断学]