超声监测慢性阻塞性肺病患者膈肌对合角度及灰阶值的临床价值

Clinical value of ultrasonic monitoring of diaphragm involute Angle and gray scale in patients with COPD

目的通过超声监测慢性阻塞性肺病(COPD)患者膈肌的对合角度及灰阶值变化,评估COPD病情严重程度。方法随机纳入来我院就诊的COPD患者64例和同期来院查体的16例健康志愿者,根据肺功能将COPD患者分为轻度组、中度组、重度组和极重度组;使用高频线阵探头分别对COPD组和健康对照组在平静及用力呼气末时膈肌与胸壁的对合角度差(△A)和膈肌直方图的灰阶差值(△G)进行测量和分析。结果与健康对照组比较,轻度、中度、重度、极重度组COPD患者的△A变化依次为-3.48%,-24.00%,-30.17%,-37.83%;轻度、中度、重度、极重度组COPD患者的△G变化依次为-3.15%,-20.63%,-25.52%,-29.20%,COPD中度组患者的△A及△G显著降低(P<0.05),重度、极重度组的降低更为明显(P<0.01)。结论COPD患者膈肌对合角度及灰阶值变化可初步判定COPD病情的严重程度,有助于COPD的早期分级干预。

Objective To evaluate the severity of COPD patients by monitoring the diaphragm alignment Angle and the change of gray scale value by ultrasound.Methods Sixty-four patients with COPD and 16 healthy volunteers who came to our hospital for physical examination were randomly enrolled.Depending on the severity of lung function of COPD patients,they were divided into the mild group,the moderate group,the severe group and the very severe group.High frequency linear array probe was used to measure and analyze the Angle difference between diaphragm and chest wall(△A)and the gray scale difference of diaphragm histogram(△G)of calm and forced expiratory end between the COPD group and the healthy control group.Results Compared with those in the healthy control group,the changes of △A in patients with mild,moderate,severe and very severe COPD were -3.48%,-24.00%,-30.17%and -37.83%,respectively.The change of △G in mild,moderate,severe and extremely severe COPD patients were -3.15%,-20.63%,-25.52%,-29.20%,respectively.△A and △G in moderate COPD patients were significantly decreased(P<0.05),and the changes of severe and extremely severe groups were more obvious(P<0.01).Conclusion The changes of the Angle of diaphragmatic contractility and the gray scale value in patients with COPD can preliminarily determine the severity of COPD,which is helpful for the early stage intervention of COPD.