慢性阻塞性肺疾病患者支气管舒张试验前后FEV_1、FVC及呼吸困难程度的变化特点

Changes of FEV_1,FVC and the degree of dyspnea before and after the bronchial diastolic test in patient with COPD

目的探讨慢性阻塞性肺疾病(COPD)患者在支气管舒张试验前后第一秒用力呼气容积(FEV_1)、用力肺活量(FVC)、呼气峰流速(PEF)以及呼吸困难程度的变化特点。方法选择2013年2月—2014年12月接受治疗的COPD患者186例。根据COPD严重程度分级:轻度组47例、中度组89例以及重度组50例(包括极重度患者)。比较不同分级之间FEV_1、FVC、PEF的水平及变化率。结果吸药后,所有患者的FEV_1、FVC及PEF均有所提高,且随着COPD严重程度增加而降低(P<0.05)。FEV_1及FVC变化量、变化率在不同分级中差异有统计学意义(P<0.05)。在轻、中、重度等级中改善率、支气管舒张试验阳性率均呈下降趋势,差异均有统计学意义(P均<0.05)。ΔFEV_1%、ΔFVC%、ΔFEV_1%与ΔPEF%在轻、中度组中存在相关性,在重度组中不存在相关性。ΔFVC%与ΔPEF%只在轻度患者中体现出相关性,在中、重度组中均不存在相关性。结论将FEV_1作为观察COPD患者支气管舒张试验前后改善状况的指标存在明显的优势,结合FVC、PEF能对呼吸困难程度的改善作出准确的分析,尤其是在重度并极重度患者中,具有较高的应用价值。

Objective To investigate the forced expiratory volume in first second （ FEV1 ） , forced vital capacity （ FVC） and the degree of difficulty in breathing changes before and after bronchial dilation test in chronic obstructive pulmona-ry disease （ COPD） patients.Methods One hundred and eighty-six COPD patients were selected from 2013 February to 2014 December.According to the severity of COPD, mild group was 47 cases;moderate group and severe group were 50 cases re-spectively, and 89 cases.The changes of FEV1 , FVC, PEF rate between different grade levels were compared.Results After the medicine was absorbed, all patients’ FEV1 , FVC, and PEF were improved and increased with the severity of chronic ob-structive pulmonary disease （COPD） decreased （ P 〈0.05）.There are differences of the changes in the rate of FEV1 and FVC variation in different grade （ P 〈0.05）.In light, medium and severe grade, the improvement rate, bronchial dilation test positive rate showed a declining trend, the differences were statistically significant （ P 〈0.05）.ΔFEV1%andΔFVC%,ΔFEV1%andΔPEF%existed correlation in light, moderate group, but no correlation in severe group.Delta FVC%and del-ta PEF%only reflects the correlation in mild patients, but there were no correlation in the severe group.Conclusion The FEV1 as indicator to observe the improvement before and after bronchial diastolic test in COPD patients has advantages, com-bined with FVC and peak expiratory flow （ PEF） can improve the analysis of the degree of difficulty in breathing, especially in the severe and very severe patients, has greater application value.