COPD病人NPPV治疗中膈神经传导检测的作用

THE ROLE OF DETECTION OF PHRENIC NERVE CONDUCTION IN COPD PATIENTS UNDERGOING NPPV TREATMENT

目的探讨膈神经传导检测在慢性阻塞性肺疾病(COPD)病人无创正压通气(NPPV)治疗阶段中的作用。方法选取COPD病人68例,随机分为2组,各34例。观察组给予常规药物联合NPPV治疗,对照组给予常规药物治疗。分别于治疗前及治疗第8天观察两组辅助呼吸肌动用评分、呼吸困难评分、膈神经运动传导、最大通气量(MVV)、用力肺活量(FVC)、第1秒钟用力呼气容积(FEV1)及其占预计值百分比。结果两组治疗第8天辅助呼吸肌动用评分和呼吸困难评分均较治疗前降低,差异有显著性(t=-11.048^-3.399,P<0.05);观察组治疗第8天辅助呼吸肌动用评分和呼吸困难评分均明显低于对照组,差异有统计学意义(t=-4.848、-7.264,P<0.05)。观察组治疗第8天肺功能均有所改善,其中观察组MVV、FEV1及FEV1占预计值百分比和FVC均明显高于对照组,差异有统计学意义(t=2.002~2.911,P<0.05)。观察组治疗第8天左右侧膈神经动作电位波幅明显高于对照组,差异有统计学意义(t=3.794、3.594,P<0.05)。结论 NPPV能有效缓解COPD急性加重期病人呼吸肌疲劳,改善气体交换,而膈神经运动传导检测可作为COPD病人呼吸肌疲劳诊断及疗效评价指标。

Objective To investigate the role of phrenic nerve conduction （PNC） detection in patients with chronic obstructive pulmonary disease （COPD） during treated with noninvasive positive pressure ventilation （NPPV）. Methods Sixty-eight patients with COPD were evenly randomized to observation group and control group. Patients in the observation group were treated with conventional drugs combined with NPPV, and those in the control group received only conventional drug treatment. Auxiliary respiratory muscle use score, dyspnea score, phrenic nerve motor conduction, maximal ventilatory volume （MVV）, forced vital capacity （FVC）, the first-second forced expiratory volume （FEV1） and its percentage of estimated value in the two groups were observed-before therapy and on day 8 after treatment. Results On day 8 after the treatment, the scores of auxiliary respiratory muscle use and dyspnea in both groups were lower versus that before treatment （t=-11.048--3.399,P〈0.05）, and that in the observation group on day 8 after treatment were lower than that in the control group, the difference was significant （t=-4.848,-7.264;P〈0.05）. On day 8 after therapy, lung function in the observation group improved, in which, MVV and FEV1, FEV1 percentage of estimated value and FVC were all higher than that in the control group （t=2.002-2.911,P〈0.05）, the action potential amplitude was significantly higher than that in the control group （t=3.794,3.594;P〈0.05）. Conclusion NPPV can effectively relieve respiratory muscle fatigue and improve gas exchange in COPD patients in their acute exacerbation stage, and the detection of phrenic nerve conduction can be used as an evaluating indicator for diagnosis and efficacy assessment of respiratory muscle fatigue in patients with COPD.