SARS患者3年康复期肺功能变化的临床研究

Changes in pulmonary function in SARS patients during the three -year convalescent period

目的观察严重急性呼吸综合征（SARS）患者3年康复期肺功能的状态,进一步探讨SARS对患者肺功能的中远期影响及其动态变化规律。方法对37例SARS治愈出院患者进行1个月、3个月、1年及3年期4次肺功能检查,并以15例健康人的肺功能作为对照进行比较分析。结果与健康对照者比较,3年康复期SARS患者肺功能指标中用力肺活量（FVC）、肺活量（VC）、1秒用力呼气容积（FEV1）、25%～75%用力呼气瞬时流量（25%～75%FEF）均显著降低,差异均有显著性（P均〈0.05）;FEV1/FVC、肺总量（TLC）、一氧化碳弥散量（DLCO）差异无显著性（P均〉0.05）。与出院1个月时比较,3年恢复期DLCO异常率显著降低（32.4%比5.4%,P〈0.05）,FVC、VC、25%～75%FEF异常病例数差异无显著性,但有好转趋势;3年时SARS患者肺功能检查仍然有10例患者FVC降低（9例为轻中度,1例为重度异常）,仅2例患者存在DLCO轻度异常。结论SARS患者3年期肺弥散功能基本恢复正常,但20%～30%的患者仍然存在轻中度限制性通气功能及小气道功能障碍;大部分患者肺功能逐渐改善,少数患者肺功能进一步恶化。

Objective To investigate the patterns of pulmonary function in severe acute respiratory syndrome （SARS） patients during three -year convalescent period, and to investigate the changes and the medium and long term effects on pulmonary function of SARS patients. Methods Pulmonary function tests were conducted for four times in 37 SARS patients during three - year convalescent period. They were discharged from hospital within one month, three months, one year and three years respectively. At the same time, pulmonary function of 15 healthy persons was examined as controls to be used for comparison. Results Compared with the healthy controls, there were significant decrease in forced vital capacity（FVC）, vital capacity（VC）, one second forced expiratory volume （FEV1）, 25%- 75% forced expiratory flow （25%-75%FEF ） of SARS patients within three years after their discharge from hospital （all P〈0. 05）. There were no significant differences in FEV1/FVC, total lung capacity （TLC）, diffusing capacity of the lung for carbon monoxide （DLCO） between the two groups（all P〉0.05）. Abnormality rate of DLCO in the SARS patients within three years after discharge was significantly decreased （32.4% vs. 5.4%, P〈0. 05）, but no significant differences in FVC, VC, 25%- 75%FEF among SARS patients discharged one month and three years from the hospital （all P〉0. 05）. Ten SARS patients showed lower FVC （mild degree in 9 cases, severe degree in 1 case） three years later, 2 patients showed mildly lowered DLCO. Conclusion The lung diffusion function of the SARS patients had recovered after they were discharged from hospital within three years, but in 20%-30% patients there is still mild or moderate restrictive ventilation function abnormality and small airway function impairment. The lung functions of most patients have recovered gradually, but in a minority of patients they may be impaired.