老年慢性阻塞性肺疾病急性加重期病人膈肌形态改变及相关因素分析  

Morphological changes of diaphragm and related factors in elderly patients with AECOPD

作　　者：李艳 王肖潇 孙莉[1] 南淑良 霍树芬[1] 任小平[1] 王水利[3] 温红侠[1] LI Yan;WANG Xiao-xiao;SUN Li;NAN Shu-liang;HUO Shu-fen;REN Xiao-ping;WANG Shui-li;WEN Hong-xia(Department of Geriatric Respiration Medicine;Center of Ultrasonic Diagnosis,Shaanxi Provincial People′s Hospital,Xi′an 710068,China;The First Department of Respiratory Medicine,Shaanxi Provincial People′s Hospital,Xi′an 710068,China)

机构地区：[1]陕西省人民医院老年呼吸科,陕西省西安市710068 [2]陕西省人民医院超声诊断中心 [3]陕西省人民医院呼吸与危重症一科

出　　处：《实用老年医学》2022年第11期1101-1105,共5页Practical Geriatrics

基　　金：陕西省重点研发计划项目(2022SF-108)。

摘　　要：目的分析老年慢性阻塞性肺疾病急性加重期(AECOPD)病人膈肌形态变化及相关因素分析。方法收集老年AECOPD病人58例为AECOPD组,49例健康体检者为对照组。使用超声检查测量膈肌平静呼气末膈肌厚度(Tdi)、尽力吸气末膈肌厚度(Tdi)、尽力呼气末膈肌厚度(Tdi)、平静呼吸时膈肌移动度(DD)、用力呼吸时膈肌移动度(DDmax),计算膈肌增厚分数(TF),采用多重线性回归分析TF和DD的相关因素。结果依据慢性阻塞性肺疾病全球倡议(GOLD)分级将AECOPD组分为轻-中度组和重-极重度组。老年重-极重度AECOPD病人的Tdi、Tdi、DD、DDmax、TF与轻-中度组、对照组比较,差异均有统计学意义(均P<0.05);轻-中度组与对照组比较,Tdi、DDmax及TF差异均有统计学意义(均P<0.05)。多元线性回归分析结果显示,TF与FEV1%pred呈正相关(β=0.547,P<0.05),与病程时间、近1年急性加重次数呈负相关(分别β=-0.959、-5.978,P<0.05),而DD与病程时间、1年内急性加重次数呈负相关(β=-0.027、-0.150,P<0.05)。结论AECOPD病人的TF与DDmax均出现明显下降,引起病人膈肌形态改变的因素主要在于疾病本身,积极控制疾病进展和减少急性加重次数至关重要。Objective To analyze the morphological changes of diaphragm and the related factors in the elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 58 elderly AECOPD inpatients admitted to Shaanxi Provincial People′s Hospital were collected as the AECOPD group,and 49 healthy subjects were collected as the control group.The diaphragm thickness at function residual capacity(Tdi),diaphragm thickness at forced vital capacity(Tdi),diaphragm thickness at residual volume(Tdi),diaphragmatic displacement during tidal breathing(DD)and diaphragmatic displacement during forced breathing(DDmax)were measured by using Ultrasonography,then the thickening fraction(TF)was calculated.All the indicators between the two groups were compared and multiple linear regression was used to analyze the influencing factors of TF and DD.Results The AECOPD patients were divided into two groups according to GOLD classification:mild-moderate group and severe-very severe group.Compared with the control group and the mild-moderate group,the severe-very severe group showed significantly difference in Tdi,Tdi,DD,DDmax and TF values(all P<0.05);And mild-moderate group showed lower level in Tdi,DDmax and TF than those in the control group(all P<0.05).TF was positively correlated with forced expiratory volume in 1 second percentage predicted(FEV1%pred)(β=0.547,P<0.05),and negtively correlated with the duration of COPD(β=-0.959,P<0.05)and the number of acute exacerbations in the past 1 year(β=-5.978,P<0.05),while DD was lowly negatively correlated with the duration of COPD(β=-0.027,P<0.05)and the number of acute exacerbations within 1 year(β=-0.150,P<0.05).Conclusions Both TF and DDmax in the elderly patients with AECOPD decrease significantly,which are mainly affected by the disease itself,and it is necessary to actively control the progression of COPD and reduce the frequency of exacerbation.

关 键 词：慢性阻塞性肺疾病急性加重 超声检查 膈肌 

分 类 号：R563[医药卫生—呼吸系统]