无创辅助通气对慢性阻塞性肺疾病患者膈肌功能的影响  

Effects of non-invasive ventilation on the treatment of diaphragmatic function of chronic obstructive pulmonary disease

作　　者：张志萍 胡显凤 毛昌立 ZHANG Zhi-ping;HU Xian-feng;MAO Chang-li(Department of Pulmonary and Critical Care Medicine,the People's Hospital of Jiangmen,Jiangmen 529100,Guangdong,China)

机构地区：[1]江门市人民医院呼吸与危重症医学科,广东江门529100

出　　处：《广东医学》2023年第6期760-765,共6页Guangdong Medical Journal

基　　金：江门市医疗卫生领域科技计划项目(2022YL02018)。

摘　　要：目的探讨无创辅助通气(non-invasive ventilator,NIV)对中度以上肺功能下降的慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者膈肌功能的影响。方法选取60例肺功能中度以上下降,病情分级为B级,无合并慢性Ⅱ型呼吸衰竭的COPD患者。随机分两组,对照组(n=30)予常规治疗;治疗组(n=30)予常规治疗及NIV治疗(>8 h/d);比较两组患者治疗前后MMRC评分、CAT评分、疲劳严重性度量表(fatigue severity scale,FSS)、用力肺活量(forced vital capacity,FVC),1秒用力呼气量容积(forced expiratory volume in one second,FEV1),FEV1/FVC(%),FEV1/预计值(FEV1/Pred),最大分钟通气量(maximum minute ventilation,MVV)、呼吸功能[最大吸气压(maximum inspiratory pressure,MIP)、最大呼气压(maximal expiratory pressure,MEP)]及膈肌功能状况并分析相关性。结果治疗后,两组患者MMRC评分、CAT评分、FSS评分治疗组改善较对照组明显(P<0.05);治疗后,肺功能FEV1、MVV、MIP和MEP治疗组较对照组改善明显(P<0.05);治疗后,肺功能FEV1/FVC、FEV1/Pred两组均有改善,但组间数据对比差异无统计学意义(P>0.05);治疗后,吸气末膈肌厚度(DTei)、呼气末厚度(DTee)、膈肌增厚分数(DTF)、膈肌移动度(DD)各项指标治疗组改善较对照组明显(P<0.05);治疗后,DTF与CAT评分、MEP、DD改善呈正相关(r>0,P<0.05);治疗前后差值比较,DTei差值与DTee差值呈正相关,两者与DTF差值呈正相关,MIP差值与DD差值呈正相关(r>0,P<0.05)。结论在COPD早期阶段开始长期使用NIV治疗,能改善此类患者膈肌功能状态,改善患者通气功能,改善此类患者呼吸疲劳及生存状态,值得临床推广。Objective To investigate the effects of non-invasive ventilation(NIV)on the treatment of diaphragm function in patients with chronic obstructive pulmonary diseases(COPD)with pulmonary function declined more than moderate.Methods Sixty patients with COPD and pulmonary function declined more than moderate,classified Grade B,and without chronic respiratory failure were included.The patients were divided into two groups according to random number table method.The control group(n=30)received routine healthcare,and the study group(n=30)received routine healthcare and NIV(>8 h/d).The treatment effect,MMRC score,CAT score,fatigue severity scale(FSS),forced vital capacity(FVC),forced expiratory volume in one second(FEV1),FEV1/FVC,FEV1/Pred,maximum minute ventilation(MVV),respiratory function[maximum inspiratory pressure(MIP)and maximal expiratory pressure(MEP)] and diaphragmatic function screening scales were calculated and compared.Results After treatment,MMRC score,Cat Score,and FSS score were significantly improved in both groups,which were significantly more prominent in the study group(P<0.05).After treatment,FEV1,MVV,MIP and MEP were significantly improved in both groups,which were significantly more prominent in the study group(P<0.05);FEV1/FVC and FEV1/Pred were all improved,but there was no significant difference between the two groups(P>0.05).After treatment,diaphragmatic thickness at the end of inspiratory(DTEi),diaphragmatic thickness at the end of expiratory(DTee),diaphragmatic thickening fraction(DTF)and diaphragmatic displacement(DD)were significantly improved in both groups,which were significantly more prominent in the study group(P<0.05).After treatment,there was positive correlations between DTF and CAT score,and MEP and DD(r>0,P<0.05).The difference between after and before treatment,△DTEi was positively correlated with ADTEe,ADTF was positively correlated with ADTEi and ADTEe,and AMIP was positively correlated with ADD(r>O,P<0.05).Conclusion NIV is the effective in the treatment of COPD,especially a

关 键 词：慢性阻塞性肺疾病 肺功能 无创辅助通气 膈肌功能 

分 类 号：R562[医药卫生—呼吸系统] R563[医药卫生—内科学]