脉冲振荡肺功能检测在慢性阻塞性肺疾病中的应用

Application of impulsive oscillation system in patients with chronic obstructive pulmonary disease

目的研究新型脉冲振荡肺功能检测（10S）中的各项参数在COPD呼吸周期中的变化和应用价值，评估IOS参数与常规肺功能各参数间的相关性。方法对53例受试者（47例COPD患者，6例健康对照者）分别依次进行IOS和常规肺功能检测。MostGraph-01脉冲震荡检测装置可以绘制脉冲振荡的3D图像，实现呼吸周期依赖性和频率依赖性可视化。结果与健康对照组相比，COPD组患者的5Hz时黏性阻力（R5）、5Hz与20Hz时黏性阻力差值（RS-R20）、共振频率（Fres）均显著增高，且随着COPD级别的增加而显著增加；5Hz时电抗（X5）显著降低，且随着COPD级别的增加而显著下降（P〈0．05）。IOS参数在呼吸过程中呈动态变化，COPD各组呼气相R5、R5-R20、Fres明显大于吸气相R5、R5-R20、Fres（P〈0．05），呼气相X5明显小于吸气相X5（P〈0．05）；呼气相R5、R5-R20、Fres在COPD组间逐渐增高（P〈0．05），呼气相X5在COPD组间逐渐降低（P〈o．05）。COPD患者R5、R5-R20分别与FEV1、FEV1／FVC、FEV1％pred呈负相关（P〈0．05）；Fres与FVC、FEVl、FEV1／FVC、FEV1％pred呈负相关（P〈0．05）IX5分别与FEV1、FEV，／FVC、FEV1％pred呈正相关（P〈0．05）。结论IOS对COPD患者呼吸运动的检测可用于对COPD患者疾病严重程度的评估。IOS参数在呼吸过程中是呈动态变化的，呼气相IOS参数更能反映COPD患者病情。

Objective To investigate the value of the parameters of the within-breath behaviour in chronic obstructive pulmonary disease （COPD） measured by impulsive oscillation system （IOS）,evaluate the differences in parameters during tidal breathlng,and assess the relativity of the parameters between IOS and pulmonary function test. Methods Mild （ n = 4） moderate （ n=15）, severe （ n = 18）, very severe （ n = 10） COPD patient and normal （ n = 6） were recruited to receive IOS and PET at Beijing Friendship Hospital. The parameters of IOS was assessed using MostGraph-01 （Chest MI, Inc, Tokyo, Japan） ,MostGraph-01 could depict the parameters in a frequency-and-respiratory-cycle-dependent manner in 3-D graphics. Results Compared with controls, RS, R5-R20, Fres in COPD groups increased significantly （ P 〈 0.05）, X5 in COPD groups decreased significantly （ P 〈0.05）. In inspiratory- expiratory breath analysis, RS, RS-R20, X5, Fres changed dynamically during tidal breathing in COPD, RS, R5-R20,Fres in expiratory phase increased and X5 fell to a more negative level in a severity-dependent fashion. R5 ,R5-R20,XS, Fres in expiratory phase were positively correlated with disease severity. R5, RS- R20 were negatively correlated with FEV1 , FEV1/FVC, FEV1% pred （ P G 0.05）, Fres was negatively correlated with FVC, FEV1, FEV1/FVC, FEV1% pred （ P 〈0.05）, X5 was positively correlated with FEV1 ,FEV1/FVC,FEV1pred （ P 〈0.05）. Conclusions IOS can assess the within-breath behavior of the oscillatory mechanics, which could be serviceable to evaluating the severity of COPD. They changed dynamically during tidal breathing, the parameters in expiratory phase are suitable for appraising of COPD.