目的研究常规肺功能测试(pulmonary function test, PFT)与脉冲振荡肺功能(impulse oscillometry system, IOS)评价慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)气道阻塞严重程度的一致性。方法对2016年4月-2017年4...目的研究常规肺功能测试(pulmonary function test, PFT)与脉冲振荡肺功能(impulse oscillometry system, IOS)评价慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)气道阻塞严重程度的一致性。方法对2016年4月-2017年4月随访的116例稳定期COPD患者(男性103例、女性13例)依次进行IOS检测和PFT检测,应用统计学分析软件对IOS和PFT参数行一致性与相关性分析。结果 116例受试者中,仅38例(32.8%)受试者气道阻塞严重程度分级结果一致,分级一致性存在较大差异(P<0.05);在78例严重程度不同的受试者中,52例IOS分级重于PFT分级。将52例IOS分级较重的患者与其余患者对比分析发现,这部分患者的PFT参数中,用力肺活量占预计值百分比(forced vital capacity, FVC%pred)、第1秒用力呼气容积占预计值百分比(forced vital capacity in one second, FEV1%pred)、第1秒用力呼气容积与用力肺活量之比(ratio of forced expiratory volume in one second to forced vital capacity, FEV1/FVC)较对照组均有升高(P<0.05);而IOS参数中振荡频率为5Hz时的黏性阻力(respiratory resistance at 5Hz, R5)、振荡频率为20Hz时的黏性阻力(respiratory resistance at 20Hz, R20)、振荡频率为5Hz和20Hz时的黏性阻力差值(difference between respiratory resistance at 5Hz and 20Hz, R5-R20)、共振频率(resonant frequency, Fres)较对照组均升高(P<0.05);IOS与PFT各参数相关性分析中,IOS参数:低频电抗面积(reactance area, AX)、R5-R20、ΔR5-R20、Fres、R5与PFT参数:FEV1%pred、FVC%pred、FEV1/FVC、第3秒用力呼气容积与用力肺活量之比(ratio of forced expiratory volume in three second to forced vital capacity, FEV3/FVC)、50%肺活量时最大呼吸流速(maximal expiratory flow rate at 50%of vital capacity, FEF50)、75%肺活量时最大呼吸流速(maximal expiratory flow rate at 75%of vital capacity, FEF75)呈负相关(P<0.01),与残气与肺总量之比(ratio of residual volume to total lung volume, RV/TLC)呈正相关(P<0.01)。结论 IOS与PFT对COPD气道阻塞严重程度评价存在差异,在早中期气道阻塞患者中,IOS损害程度级别显著高于PFT,IOS在评价小气道功能障碍时敏感性可能高于PFT,在临床应用中将二者相互结合可能可以更好地评价气道功能障碍。展开更多
Background Now lung volume reduction surgery （LVRS） has become one of the most effective methods for the management of some cases of severe chronic obstructive pulmonary disease （COPD）. We evaluated the mid-term e...Background Now lung volume reduction surgery （LVRS） has become one of the most effective methods for the management of some cases of severe chronic obstructive pulmonary disease （COPD）. We evaluated the mid-term effects of LVRS on pulmonary function in patients with severe COPD. Methods Ten male patients with severe COPD aged 38-70 years underwent LVRS and their pulmonary function was assessed before, 3 months and 3 years after surgery. The spirometric and gas exchange parameters included residual volume, total lung capacity, inspiratory capacity, forced vital capacity, forced expiratory volume in one second, diffusion capacity for CO, and arterial blood gas. A 6-minute walk distance （6MWD） test was performed.Results As to preoperative assessment, most spirometric parameters and 6MWD were significantly improved after 3 months and slightly 3 years after LVRS. Gas exchange parameters were significantly improved 3 months after surgery, but returned to the preoperative levels after 3 years. Conclusions LVRS may significantly improve pulmonary function in patients with severe COPD indicating for LVRS. Mid-term pulmonary function 3 years after surgery can be decreased to the level at 3 months after surgery. Three years after LVRS, lung volume and pulmonary ventilation function can be significantly improved, but the improvement in gas exchange function was not significant.展开更多
文摘目的研究常规肺功能测试(pulmonary function test, PFT)与脉冲振荡肺功能(impulse oscillometry system, IOS)评价慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)气道阻塞严重程度的一致性。方法对2016年4月-2017年4月随访的116例稳定期COPD患者(男性103例、女性13例)依次进行IOS检测和PFT检测,应用统计学分析软件对IOS和PFT参数行一致性与相关性分析。结果 116例受试者中,仅38例(32.8%)受试者气道阻塞严重程度分级结果一致,分级一致性存在较大差异(P<0.05);在78例严重程度不同的受试者中,52例IOS分级重于PFT分级。将52例IOS分级较重的患者与其余患者对比分析发现,这部分患者的PFT参数中,用力肺活量占预计值百分比(forced vital capacity, FVC%pred)、第1秒用力呼气容积占预计值百分比(forced vital capacity in one second, FEV1%pred)、第1秒用力呼气容积与用力肺活量之比(ratio of forced expiratory volume in one second to forced vital capacity, FEV1/FVC)较对照组均有升高(P<0.05);而IOS参数中振荡频率为5Hz时的黏性阻力(respiratory resistance at 5Hz, R5)、振荡频率为20Hz时的黏性阻力(respiratory resistance at 20Hz, R20)、振荡频率为5Hz和20Hz时的黏性阻力差值(difference between respiratory resistance at 5Hz and 20Hz, R5-R20)、共振频率(resonant frequency, Fres)较对照组均升高(P<0.05);IOS与PFT各参数相关性分析中,IOS参数:低频电抗面积(reactance area, AX)、R5-R20、ΔR5-R20、Fres、R5与PFT参数:FEV1%pred、FVC%pred、FEV1/FVC、第3秒用力呼气容积与用力肺活量之比(ratio of forced expiratory volume in three second to forced vital capacity, FEV3/FVC)、50%肺活量时最大呼吸流速(maximal expiratory flow rate at 50%of vital capacity, FEF50)、75%肺活量时最大呼吸流速(maximal expiratory flow rate at 75%of vital capacity, FEF75)呈负相关(P<0.01),与残气与肺总量之比(ratio of residual volume to total lung volume, RV/TLC)呈正相关(P<0.01)。结论 IOS与PFT对COPD气道阻塞严重程度评价存在差异,在早中期气道阻塞患者中,IOS损害程度级别显著高于PFT,IOS在评价小气道功能障碍时敏感性可能高于PFT,在临床应用中将二者相互结合可能可以更好地评价气道功能障碍。
文摘Background Now lung volume reduction surgery （LVRS） has become one of the most effective methods for the management of some cases of severe chronic obstructive pulmonary disease （COPD）. We evaluated the mid-term effects of LVRS on pulmonary function in patients with severe COPD. Methods Ten male patients with severe COPD aged 38-70 years underwent LVRS and their pulmonary function was assessed before, 3 months and 3 years after surgery. The spirometric and gas exchange parameters included residual volume, total lung capacity, inspiratory capacity, forced vital capacity, forced expiratory volume in one second, diffusion capacity for CO, and arterial blood gas. A 6-minute walk distance （6MWD） test was performed.Results As to preoperative assessment, most spirometric parameters and 6MWD were significantly improved after 3 months and slightly 3 years after LVRS. Gas exchange parameters were significantly improved 3 months after surgery, but returned to the preoperative levels after 3 years. Conclusions LVRS may significantly improve pulmonary function in patients with severe COPD indicating for LVRS. Mid-term pulmonary function 3 years after surgery can be decreased to the level at 3 months after surgery. Three years after LVRS, lung volume and pulmonary ventilation function can be significantly improved, but the improvement in gas exchange function was not significant.
