深吸气量在慢性阻塞性肺疾病急性加重期临床疗效评估中的应用

The clinical application of inspiratory capacity in evaluating the therapeutic effect of patients with acute exacerbation of chronic obstructive pulmonary disease

目的：探讨深吸气量（IC）与慢性阻塞性肺疾病急性加重期（AECOPD）患者Borg呼吸困难评分、住院时间、住院费用的相关性,为其疗效评估提供依据。方法：84例AECOPD患者中△IC改善率≥12%或增加≥200 ml作为对照Ⅰ组,△IC改善率〈12%或增加〈200 ml作为观察组,其中继续维持原方案治疗为对照Ⅱ组,加用吸入噻托溴胺粉雾剂18μg/d为对照Ⅲ组;在入院第1、3天及出院前进行肺通气功能和肺容量检查、Borg评分、血气分析测定,计算住院时间、住院费用。结果：3组患者入院第3天和出院前IC均高于入院第1天（P〈0.05-P〈0.01）,且IC在对照Ⅰ组出院前明显高于入院第3天（P〈0.01）。3组患者的△Borg评分、△第1秒用力呼气容积（FEV1）、IC/肺总量（TLC）和对照Ⅰ组与Ⅲ组△FEV1/用力肺活量（FVC）变化差异均有统计学意义（P〈0.05-P〈0.01）,Ⅲ组患者出院前△Pa CO2低于入院第3天（P〈0.05）,Ⅱ组患者△FEV1/FVC和3组功能残气量（FRC）、Pa O2、对照Ⅰ组与Ⅱ组Pa CO2变化差异均无统计学意义（P〉0.05）;且Ⅰ组住院时间为7 d,住院费用6 800元,Ⅱ组住院时间为11 d,住院费用10 600元,Ⅲ组住院时间为9 d,住院费用8 700元。3组患者在入院第3天、出院前的△IC与△Borg评分呈负相关关系（P〈0.05）,而△IC/TLC、△FEV1均与△Borg评分无相关关系（P〉0.05）。3组患者在入院第3天、出院前的△IC与住院时间、住院费用均呈负相关关系（P〈0.01）;而△FRC、△Pa O2与住院时间均呈负相关关系（P〈0.05）,△Pa CO2与住院时间呈正相关关系（P〈0.05）;△IC/TLC与住院费用呈负相关关系（P〈0.01）,△Pa O2、△Pa CO2与住院费用均呈正相关关系（P〈0.01）,△FEV1、△FEV1/FVC与其均无相关关系（P〉0.05）。结论：应用IC对AECOPD患者治疗前后的病情评估,有助于制定治疗方案与疗效判定。

Objective： To investigate the relationship between the inspiratory capacity（ IC） and Borg score,hospitalization time and cost in patients with acute exacerbation of chronic obstructive pulmonary disease（ AECOPD）,and provide the basis in evaluating the clinical effects. Methods： The 84 AECOPD patients with improvement rate ≥ 12% or increasing 200 ml of △IC,and 12% or increasing 200 ml were divided into the control Ⅰ group and observation group. The patients treated with continual treatment using the original scheme or combined with 18 μg / d of tiotropium were divided into the control Ⅱ group and Ⅲ group,respectively. The pulmonary ventilation function and lung capacity,Borg score,blood gas analysis,hospitalization time and cost in all patents were analyzed after 1 and 3 d of admission and before discharge. Results： After 3 d of admission and before discharge,IC in 3 groups were than that in the first day after adnission（ P〈0. 05 to P〈0. 01）,and the IC in Ⅰ group was significantly higher than that in the third day after admission（ P〈0. 01）. The differences of the Borg score,FEV1 and IC / TLC in 3 groups,and the difference of the △FEV1 /FVC between Ⅰ and Ⅲ group were statistically significant（ P〈0. 05 to P〈0. 01）. The △Pa CO2 in Ⅲ group before discharge was lower than that in the third day after admission（ P〈0. 05）. The differences of the △FEV1 / FVC in Ⅱ group,FRC and Pa O2 in 3 groups and the Pa CO2 between Ⅰ and Ⅱ group were not statistical significance（ P〉0. 05）. The hospitalization time and cost in Ⅰ,Ⅱ and Ⅲgroup were 7 d 6 800 yuan,11 d 10 600 yuan and 9 d 8 700 yuan,respectively. Among the 3 groups in the third day of admission and before discharge,the △ IC in 3 groups were negatively correlated with the △Borg score. hospitalization time and cost（ P〈0. 05）,and the △IC / TLC and △FEV1 were not correlated with the △Borg score（ P〉0. 05）. Among the 3 groups in the third day of admission and before discharge,the △FRC and △Pa O2 were negatively correlated with the hospitalization time（ P〈0. 05）,and the △Pa CO2 were positively correlated with the hospitalization cost（ P〈0. 05）,the △IC / TLC was negatively correlated with the hospitalization cost（ P〈0. 01）,the △Pa O2 and △Pa CO2 were positively correlated with the hospitalization cost（ P〈0. 01）,and the△FEV1 and △FEV1 / FVC were not correlated with other factors（ P〉0. 05）. Conclusions： Inspiratory capacity can evaluate the patients with acute chronic obstructive pulmonary disease before and after treatment,which is conducive to judge the clinical effects and formulate the treatment plan.