作者：南淑良 ，姚筱 ，刘博 ，刘富强 ，温红侠 ，刘莉 ，穆靓

单位：

1.710068陕西省西安市，陕西省人民医院超声科　2.710068陕西省西安市，陕西省人民医院医务处　3.710068陕西省 西安市，陕西省人民医院心血管内一科　4.710068陕西省西安市，陕西省人民医院呼吸与危重症科

Units：

1.Department of Ultrasound, Shaanxi Povincial People's Hospital, Xi'an 710068, China 2.Department of Medical, Shaanxi Povincial People's Hospital, Xi'an 710068, China 3.The First Department of Cardiovascular Medicine, Shaanxi Povincial People's Hospital, Xi'an 710068, China 4.Department of Respiratory and Critical Care, Shaanxi Povincial People's Hospital, Xi'an 710068, China

关键词：

肺疾病，慢性阻塞性；呼吸衰竭；膈肌移动度

Keywords：

Pulmonary disease, chronic obstructive; Respiratory failure; Movement amplitude in diaphragm

CLC：

R 563.9

DOI：

10.12114/j.issn.1008-5971.2023.00.292

Funds：

陕西省重点研发计划项目（2020SF-110）；陕西省人民医院科技发展孵化基金资助项目（2021YJY-10）；陕西省人 民医院科技人才支持计划资助项目（2022JY-12）

摘要：

目的　分析慢性阻塞性肺疾病（COPD）患者膈肌移动度。方法　选取2022年1月 至2023 年1月陕西省人民医院呼吸与危重症科收治的COPD患者76例作为病例组。根据第1秒用力呼气容积占预计 值的百分比（FEV1%pred）评估患者气流受限程度，并将其分为轻度亚组（FEV1%pred≥80%，15例）、 中度亚组（50%≤FEV1%pred＜80%，21例）、重度亚组（30%≤FEV1%pred＜50%，19例）、极重度亚组 （FEV1%pred＜30%，21例）。根据患者合并呼吸衰竭情况，将其分为呼吸衰竭亚组（28例）和无呼吸衰竭亚组（48 例）。选取同期于陕西省人民医院体检中心体检且性别、年龄、BMI与病例组接近的健康者50例作为对照组。比较病 例组和对照组一般资料、超声检查指标〔平静呼吸时膈肌移动度（DCB）和用力呼吸时膈肌移动度（DDB）〕，比 较对照组、轻度亚组、中度亚组、重度亚组、极重度亚组超声检查指标，比较对照组、无呼吸衰竭亚组、呼吸衰竭 亚组超声检查指标。结果　病例组FVC、FEV1/FVC、FEV1%pred低于对照组，DCB、DDB小于对照组（P＜0.05）。 极重度亚组DCB小于对照组、轻度亚组（P＜0.05）；中度亚组、重度亚组、极重度亚组DDB小于对照组、轻度亚组 （P＜0.05）；重度亚组、极重度亚组DDB小于中度亚组（P＜0.05）；极重度亚组DDB小于重度亚组（P＜0.05）。 呼吸衰竭亚组DCB小于对照组、无呼吸衰竭亚组（P＜0.05）；无呼吸衰竭亚组、呼吸衰竭亚组DDB小于对照组 （P＜0.05）；呼吸衰竭亚组DDB小于无呼吸衰竭亚组（P＜0.05）。结论 COPD患者膈肌移动度变小，且随着气流受 限程度的加重，其DDB逐渐变小；此外，合并呼吸衰竭的COPD患者膈肌移动度较未合并呼吸衰竭的患者小。

Abstract：

Objective To analyze the movement amplitude in diaphragm in patients with chronic obstructive pulmonary disease (COPD) . Methods A total of 76 COPD patients admitted to the Department of Respiratory and Critical Care of Shaanxi Povincial People's Hospital from January 2022 to January 2023 were selected as the case group. According to forced expiratory volume in one second as percentage of predicted volume (FEV 1% pred) , the degree of airflow limitation of patients was evaluated, and they were divided into mild subgroup (FEV 1% pred ≥ 80% , 15 cases) , moderate subgroup (50 % ≤ FEV1%pred < 80%, 21 cases) , severe subgroup (30% ≤ FEV1%pred < 50 % , 19 cases) , and extremely severe subgroup (FEV1%pred < 30%, 21 cases) . According to the patients' concurrent respiratory failure, they were divided into respiratory failure subgroup (28 cases) and non respiratory failure subgroup (48 cases) . Fifty healthy subjects who underwent physical examination in the physical examination center of Shaanxi Provincial People's Hospital at the same period and whose gender, age and BMI were similar to the case group were selected as the control group. The general data and ultrasound examination indexes [movement amplitude in diaphragmatic calm breathing (DCB) and movement amplitude in diaphragmatic deep breathing (DDB) ] were compared between the case group and the control group. The ultrasound examination indexes were compared among control group, mild subgroup, moderate subgroup, severe subgroup and extremely severe subgroup. The ultrasound examination indexes were compared among control group, respiratory failure subgroup and non respiratory failure subgroup. Results FVC, FEV1/FVC and FEV1%pred in case group were lower than those in control group, and DCB and DDB were smaller than those in control group (P < 0.05) . DCB in extremely severe subgroup was smaller than that in control group and mild subgroup (P < 0.05) . DDB in moderate subgroup, severe subgroup and extremely severe subgroup was smaller than that in control group and mild subgroup (P < 0.05) . DDB of severe subgroup and extremely severe subgroup was smaller than that of moderate subgroup (P < 0.05) . DDB in extremely severe subgroup was smaller than that in severe subgroup (P < 0.05) . DCB in respiratory failure subgroup was smaller than that in control group and non respiratory failure subgroup (P < 0.05) . DDB in respiratory failure subgroup and non respiratory failure subgroup was smaller than that in control group ( P < 0.05) . DDB in respiratory failure subgroup was smaller than that in non respiratory failure subgroup (P < 0.05) . Conclusion The movement amplitude in diaphragm in COPD patients decreases, and as the degree of airflow restriction worsens, the DDB of the patients gradually decreases. In addition, the movement amplitude in diaphragm of COPD patients complicated with respiratory failure is smaller than that of patients without respiratory failure.

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