慢性阻塞性肺疾病212例支气管舒张试验

Analysis of bronchodilation test in 212 patients with chronic obstructive pulmonary disease

目的:探讨慢性阻塞性肺疾病(COPD)病人支气管舒张试验后的肺功能指标变化及意义。方法:回顾性分析212例COPD病人临床资料,采用肺功能仪进行肺功能检查,支气管舒张试验对病人肺通气功能进行检查,并以改良英国医学研究学会呼吸困难指数(mMRC)评估呼吸困难严重程度。结果:随COPD程度加重,病人mMRC值明显增加(P<0.01);重度组和极重度组病人年龄均明显大于轻度和中度组(P<0.01)。支气管舒张试验后COPD病人第1秒用力呼气容积(FEV1)和用力肺活量(FVC)均有不同程度增加,其中重度组和极重度组病人FVC改变值则均明显大于轻度和中度组(P<0.01),病人FEV1和FVC改变率均随COPD程度加重而增加(P<0.05~P<0.01),而不同程度COPD病人FEV1改变值间差异无统计学意义(P>0.05)。COPD病人mMRC与年龄、FVC改变值及FVC改变率均呈明显正相关关系(r=0.267、0.825、0.330,P<0.01),与FEV1呈明显负相关关系(r=-0.804,P<0.01)。结论:FEV1是评价COPD病人气流受限程度的指标,而支气管舒张试验前后FVC的变化可用于评估气体陷闭状态,气体陷闭与病人呼吸困难症状相关。

Objective:To investigate the changes and significance of pulmonary function indexes in patients with chronic obstructive pulmonary disease(COPD)after bronchodilation test.Methods:The clinical data of 212 patients with COPD were retrospectively analyzed.The pulmonary function was assessed using pulmonary function meter,the lung ventilation was assessed using bronchodilation test,and the severity of dyspnea was assessed using modified British Medical Research Council dyspnea scale(mMRC).Results:With the increasing of COPD grade,the mMRC value of patients significantly increased(P<0.01).The age of patients in severe and extremely severe groups were significantly higher than that in mild and moderate groups(P<0.01).After bronchodilation test,the forced expiratory volume in one second(FEV1)and forced vital capacity(FVC)in COPD patients increased to some extent,the FVC change value in severe and extremely severe groups were significantly greater than that in mild and moderate groups(P<0.01).The change rates of FEV1 and FVC increased with the exacerbation of COPD(P<0.05 to P<0.01),but there was no statistical significance in the change of FEV1 among patients with different degrees of COPD(P>0.05).The mMRC in COPD patients was positively correlated with the age,FVC change value and FVC change rate(r=0.267,0.825,0.330,P<0.01),and negatively correlated with FEV1(r=-0.804,P<0.01).Conclusions:The FEV1 is an indicator of airflow limitation in patients with COPD,and the changes of FVC between before and after bronchodilation test can be used to evaluate gas entrapment,and the gas entrapment is associated with symptoms of dyspnea.