肺移植围术期膈肌运动与肺功能和运动耐量相关性的初步研究

Study on the relationship between diaphragm movement and pulmonary function and exercise tolerance during perioperative period of lung transplantation

目的:探讨肺移植围术期膈肌运动与肺功能和运动耐量之间的关联性,并进一步分析可能的影响因素,为肺移植围术期膈肌功能、肺功能等恢复提供参考。方法:以无锡市惠山区康复医院肺移植康复中心从2020年6月—2021年7月收治入院的61例肺移植围术期患者为研究对象(其中术前37例,术后24例)。入院进行病历书写,获取患者一般信息,完善相关检查,包括膈肌超声、常规肺功能(PFT)、6min步行试验等。采用独立样本t检验比较术前术后两组患者膈肌运动功能、肺功能和运动耐量的差异,Pearson相关性检验和典型相关性分析方法比较两组膈肌运动与肺功能和运动耐量相关性。结果:两组患者肺功能指标(FVC、FEV1)差异有显著性意义(P<0.05);在双变量相关性中,两组膈肌厚度之间、用力呼吸幅度和平静呼吸幅度之间呈极强或强正相关性(0.8<r<1.0或0.6<r<0.8);术前组,两侧膈肌增厚分数呈中等程度正相关性(r=0.575);FVC和右侧膈肌用力幅度呈中等程度正相关性(r=0.413);FEV1和右侧膈肌增厚分数呈弱正相关性(r=0.329);6min步行距离(6MWD)和左侧膈肌用力幅度呈弱正相关性(r=0.329);且均具有显著性意义(P<0.05)。术后组,FVC和左侧用力幅度呈中等程度正相关性(r=0.409);6MWD和左侧膈肌增厚分数呈中等程度正相关性(r=0.440);且均具有显著性意义(P<0.05)。在典型性相关分析中,膈肌功能指标与肺功能、6MWD有2对典型变量之间相关性具有显著性意义(P<0.05),相关系数分别为0.641、0.589。结论:肺移植围术期膈肌运动功能影响肺功能和运动耐量,超声检测膈肌运动功能对肺移植围术期间接评价肺功能和运动耐量有一定的临床价值。

Objective:To explore the correlation between diaphragm movement,lung function and exercise tolerance during perioperative period of lung transplantation,and further analyze the possible influencing factors,so as to provide reference for the recovery of diaphragm function and lung function during perioperative period of lung transplantation.Method:Sixty-one perioperative patients with lung transplantation admitted to the lung transplantation rehabilitation center of Wuxi Huishan District Rehabilitation Hospital from June 2020 to July 2021 were studied(including 37 cases before operation and 24 cases after operation).After the patient was admitted to hospital,the medical record was written,the general information was obtained,and the relevant examinations was completed,including diaphragmatic ultrasound,routine pulmonary function(PFT),six minute walk test(6MWT),etc.Independent sample t-test was used to compare the differences of diaphragm motor function,lung function and exercise tolerance between the two groups before and after operation.Pearson correlation test and canonical correlation analysis were used to compare the correlation between diaphragm exercise and lung function and exercise tolerance between the two groups.Result:There was significant difference in pulmonary function indexes(FVC and FEV1)between the two groups(P<0.05);In the bivariate correlation,there was a strong positive correlation between diaphragm thickness,forced breathing amplitude and calm breathing amplitude between the two groups(0.8<r<1.0 or 0.6<r<0.8);In the preoperative group,there was a moderate positive correlation between the thickening scores of bilateral diaphragms(r=0.575);FVC was positively correlated with the force amplitude of the right diaphragm(r=0.413);FEV1 was weakly positively correlated with the thickening fraction of the right diaphragm(r=0.329).There was a weak positive correlation and a significant difference between 6MWD and the force amplitude of left diaphragm(r=0.329,P<0.05).In the postoperative group,FVC was positively correlated with the amplitude of left force(r=0.409).There was a moderate positive correlation and a significant difference between 6MWD and left diaphragm thickening score(r=0.440,P<0.05).In the canonical correlation analysis,there were two pairs of canonical variables of diaphragm function,lung function and 6MWD,which had significant correlation(P<0.05),and the correlation coefficients were 0.641 and 0.589 respectively.Conclusion:The diaphragm motor function influences the pulmonary function and exercise tolerance during perioperative period of lung transplantation.Ultrasonic detection of diaphragm motor function has a certain clinical value for the evaluation of pulmonary function and exercise tolerance during perioperative period of lung transplantation.