稳定期慢性阻塞性肺疾病患者潮气呼吸肺功能测定的临床意义

Analysis of tidal breathing flow-volume curves in stable COPD patients

目的探讨潮气流速-容积曲线(TBFV)测定对了解稳定期慢性阻塞性肺疾病(COPD)患者的气流阻塞程度的临床意义。方法2002-062004-06对上海交通大学附属第一人民医院的61例中重度COPD患者(COPD组)以及健康体检者68名(正常对照组),进行坐位常规肺通气功能和TBFV测定,其中26例COPD患者在吸入沙丁胺醇干粉剂后重复上述测定。结果COPD患者在TBFV测定中VPTEF/VTE、TPTEF/TE均明显低于18%[分别为(12·8±2·7)%和(11·6±2·4)%],明显低于正常对照组的(25·0±3·1)%和(29·5±3·7)%(均P<0·05),而PTEF和PTIF却无明显变化(P>0·05)。26例COPD患者在吸入沙丁胺醇后重复TBFV测定显示,不仅VPTEF/VTE、TPTEF/TE出现显著增高,TEF50/PTEF和TEF25/PTEF分别增至(47·3±13·9)%和(36·9±12·4)%,接近正常对照组(均P<0·05)。结论通过测定TBFV可了解稳定期中重度COPD患者的肺功能状况,且可用于评价支气管舒张剂的治疗效应,由于无须患者特别配合,TBFV测定易于推广。

Objective To investigate the severity of airflow obstruction in stable COPD patients and to assess the effects of salbutamol by analysis of tidal breathing flow - volmne curves （ TBFV ）. Methods 61 moderate - to - severve COPD patients and 68 normal controls were performed pulmonary function test and TBFV loops in seated position. Measurements of TBFV loops and spirometry were performed at rest after salbutamol 400μg inhalation in 26 COPD patients. Resuits COPD patients exhibited a significant decrease in FEVj% , FEV1/FVC, FEFS0% and FEF75%. The fraction of exhaled volume to achieve PTEF to VTE （ VPTEF/VTE ） and the fraction of exhaled time to achieve PTEF to TE （ TPTEF/ TE） were lower than 18% [ （12.8±2.7）% and （11.6±2.4）%], and much lower thannormals （25.0±3.1）% and （ 29. 5 ± 3.7 ） %. But peak tidal expiratory flow （PTEF） and peak tidal inspiratory flow （PTIF） were decreased slightly. After salbutamol administration, 26 COPD patients exhibited a significant increase in TEFS0% （21.5 ± 6.8）% versus （15.6±4.2）%, P 〈 0.05. Tidal expiratory flow at 50% of the remaining tidal volume/VFEF （TEFSO/PTEF） and tidal expiratory flow at 25% of the remaining tidal volume/PTEF （TEF25/PTEF） had a significant increase [ （47.3 ± 13.9）% and （36.9 ± 12.4）%, P 〈 0. 05 ], which was similar to normal subjects. Conclusion The measurement of TBFV is simple and doesn＇t need special technique. The degree of airflow obstruction and the effect of bronchodilator in stable COPD patients could be known by analysis of TBFV loops.