慢性阻塞性肺疾病的呼吸肌功能

Respiratory muscle function in chronic obstructive pulmonary disease

慢性阻塞性肺疾病患者常存在呼吸肌收缩力和（或）耐力下降，引起呼吸困难，限制患者活动能力，使患者的运动量减少，日常生活质量降低；如果病情得不到控制，可以导致高碳酸性呼吸衰竭，严重者造成患者死亡。呼吸肌功能评价在慢性阻塞性肺疾病患者临床病情评估和预后判断方面很有应用价值。最大吸气压和最大呼气压测定是临床最常用的、可信的、非创伤性的评价呼吸肌功能的指标。研究结果显示最大吸气压较一秒量敏感。呼吸肌本身的病理改变和肺过度充气导致膈肌的收缩初长度缩短等原因可以引起呼吸肌功能障碍。可以应用抗胆碱药物、β2-受体激动剂、运动训练、营养支持及同化激素、心理支持、患者教育等治疗慢性阻塞性肺疾病呼吸肌功能障碍。蛋白酶抑制剂、过氧化物酶体增殖物激活受体、硫酸镁有希望成为治疗慢性阻塞性肺疾病呼吸肌功能障碍的方法。

The respiratory muscle strength and （or） muscle endurance often decrease in patients with chronic obstructive pulmonary disease （COPD）. Respiratory muscle strength and （or） muscle endurance decrease contribute to dyspnea, limit exercise performance, reduce quality of life. Hypercapnic respiratory failure due to respiratory muscle dysfunction is associated with morbidity in these patients. Respiratory muscle function measurement is useful tool for clinical diagnosis and prognosis of patients with COPD. Maximal inspiratory pressure and maximal expiratory pressure measurement is a simple way to assess inspiratory and expiratory muscle strength. Maximal inspiratory pressure is more sensitive than forced expiratory volume in one second. Respiratory muscle dysfunction ascribed to intrinsic muscle alterations and hyperinflation-induced diaphragm shortening. Patients with respiratory muscle dysfunction should receive treatment such as anticholinergic drugs, β2-adrenergic agonists, exercise （including inspiratory muscle training）, nutritional support, anabolic steroids, psychosocial support,and education. The clinical potential for proteasome inhibitor, peroxisome proliferator-activated receptors, magnesium sulfate therapy in COPD deserves further investigation.