过度动态气道塌陷对COPD患者临床症状及生活质量的影响

Effect of excessive dynamic airway collapse on the clinical symptoms and quality of life of COPD patients

目的了解过度动态气道塌陷(EDAC)对COPD患者临床症状及生活质量的影响。方法共141例COPD患者进入研究,对所有入选患者进行纤维支气管镜检查,确定有无合并EDAC。合并EDAC的COPD患者为EDAC组,在无合并EDAC的COPD患者中随机选取20例为单纯COPD组。各组患者均完成咳嗽和咳痰评估问卷(CASA-Q)、呼吸困难VAS评分及圣乔治呼吸问卷。对两组的临床症状及生活质量进行比较分析。结果 141例COPD患者中合并EDAC者18例,EDAC组在咳痰症状及咳痰影响的评分低于COPD组,差异有统计学意义(P值分别为0.003,0.028),而咳嗽症状及咳嗽影响无统计学差异(P均>0.05)。EDAC组的呼吸困难VAS评分显著高于COPD组。EDAC组SGRQ评分中患者症状、对日常生活的影响及SGRQ总分显著高于单纯COPD组(P值分别为0.003,0.022,0.003)。在活动能力方面两组差异无统计学意义(P均>0.05)。结论与单纯COPD患者相比,合并EDAC的COPD患者存在更严重的咳痰症状、呼吸困难及生活质量的下降。

Objective To evaluate the impact of excessive dynamic airway collapse （EDAC, excessive dynamic airway collapse） on the clinical symptoms and quality of life of COPD patients. Methods One hundred and forty-one COPD patients were investigated. Fiberoptic bronchoscopy was performed on all selected patients to determine whether there was a combination of EDAC. The COPD patients with EDAC were selected as group EDAC, and 20 COPD patients without EDAC were randomly selected as group COPD. All the patients completed the cough and expectoration Assessment Questionnaire （CASA-Q）, the VAS score of dyspnea and the St Georges respiratory questionnaire. The clinical symptoms and quality of life of the two groups were compared and analyzed. Results 18 cases were combined with EDAC in 141 cases of COPD patients. The score of cough expectoration and expectoration effect in group EDAC was lower than that in group COPD, the difference was statistically significant （P=0.003, 0.028）, while cough symptoms and coughing effects had no significant difference （P 〉 0.05）. The VAS score of dyspnea in group EDAC was significantly higher than that in group COPD. The symptoms, the impact on daily life and the total score of SGRQ in the SGRQ score of group EDAC were significantly higher than those in the simple COPD group （P value was 0.003, 0.0006, 0.022, respectively）..There was no statistically significant difference between the two groups in the activity ability （P 〉 0.05）. Conclusion＇ Compared with patients with simple COPD, COPD patients with EDAC have more severe phlegm symptoms, dyspnea and a decline in quality of life.