M型超声观察膈肌运动与肺功能的相关性研究

Correlation study of the diaphragmatic motion and lung function with M-mode ultrasound

目的应用M型超声评价健康成年人和慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者膈肌运动的可行性,探讨膈肌运动与肺功能的相关性及M型超声在观察膈肌运动中的应用价值。方法收集2011年5月至2011年10月于首都医科大学附属北京朝阳医院呼吸科确诊COPD患者43人,其中,男性21例,女性22例,选取年龄、身高、体质量与之接近的并且健康条件符合的43人作为对照组。应用M型超声观察COPD组和正常对照组双侧膈肌运动幅度、加速时间、加速度等。肺功能的观察指标主要包括用力肺活量(forced vital capacity,FVC)、第1秒用力呼气容积(article 1 second forced expiratory volume,FEV1)、1秒用力呼气容积占用力肺活量百分比(forced vital capacity rate of one second,FEV1/FVC)等。结果正常对照组平静呼吸时双侧膈肌运动幅度无明显差异,深吸气时左侧膈肌运动幅度与右侧比较,差异有统计学意义(P<0.05)。COPD组与正常对照组肺功能指标FEV1、FVC、FEV1/FVC差异具有统计学意义(P<0.05)。平静呼吸及深吸气时,正常对照组和COPD组除左侧加速时间外,双侧膈肌运动幅度、右侧加速时间、双侧加速度差异具有统计学意义(P<0.05)。正常对照组及COPD组深吸气时膈肌运动幅度与FEV1、FVC、FEV1/FVC具有良好的相关性。结论本研究表明M型超声可以实时动态非侵入性的观察膈肌的呼吸运动,对于呼吸运动能够进行直接、准确、客观的量化评价,具有潜在临床应用价值。

Objective To evaluate the feasibility of detecting the diaphragmatic motion in the healthy adults and the chronic obstructive pulmonary disease（ COPD） patients by using M-mode ultrasound and to explore the correlation of the diaphragmatic motion and lung function and the value of using M type ultrasound in observing the diaphragmatic motion. Methods The study enrolled 43 COPD patients of whom 21 were male and 22 female in Beijing Chaoyang Hospital from May 2011 to October 2011. This study also selected 43 healthy persons who were age, height and weight matched with the patients as the normal control group. M-mode ultrasonography was used to observe bilateral diaphragmatic moving range, time, acceleration in the COPD group and the normal control group. The pulmonary function tests including forced vital capacity（FVC）, first second forced expiratory volume（FEV1） and their ratio FEV1/FVC were the main variables of observation. Results ① For the normal control group, during quiet breathing the bilateral diaphragmatic moving range had no significant difference, while on deep inspiration the left diaphragmatic motion had a significantly larger magnitude as compared with the right side. ② For COPD group and the normal control group, the lung function parameters, FEV1, and FEV1/ FVC had a significant difference. ③ For COPD group and the normal control group, except the left acceleration time, the bilateral diaphragmatic muscle moving range, the right acceleration time, the bilateral acceleration had statistically significant differences during the quiet and deep breathing. ④For COPD group and the normal control group, the diaphragmatic moving range had good correlation with FEV1, FVC and FEV1/FVC. Conclusion The application of M-mode ultrasound can sensitively show diaphragmatic motion. The ultrasound observation was real-time, noninvasive and dynamic which may have potential value of clinical application.