中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

超声评价膈肌活动度与慢性阻塞性肺疾病患者生活质量及运动能力的相关性研究

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目的应用超声探讨膈肌活动度与慢性阻塞性肺疾病(简称慢阻肺)患者生活质量及运动能力的相关性,并分析影响膈肌活动度的因素。方法选择 2015 年 10 月至 2017 年 3 月在河南中医药大学第一附属医院就诊的男性慢阻肺稳定期患者 48 例。测定患者身高、体重、膈肌活动度[M 型超声测定深呼吸时膈肌运动幅度(ΔM)]、气流阻塞程度[第 1 秒用力呼气容积占预计值百分比(FEV1%pred)]和运动能力[6 分钟步行距离(6MWD)]。采用圣乔治呼吸问卷(SGRQ)评价患者的生活质量。结果48 例慢阻肺患者 ΔM 最小值 1.89 cm,最大值 8.11 cm。ΔM 与患者 SGRQ 评分的总分、症状分、影响分、活动分以及 6MWD 均相关,相关系数分别为–0.474、–0.416、–0.432、–0.502 和 0.536。多元逐步回归分析发现影响 ΔM 的因素是身高(β=0.407,P=0.021)和 FEV1%pred(β=–0.391,P=0.035)。结论慢阻肺患者膈肌活动度与生活质量有密切的关系,身高及 FEV1%pred 对膈肌活动度影响最大。患者膈肌活动度越小,生活质量越差,活动能力越小。

ObjectiveTo investigate the relationship of diaphragmatic mobility (ΔM) evaluated by ultrasonography with quality of life and athletic ability in patients with chronic obstructive pulmonary disease (COPD) , and analyze the factors those affect the diaphragmatic mobility.MethodsA total of 48 male patients with stable COPD were recruited in the study. The body height, body weight, diaphragmatic mobility, airflow obstruction (FEV1%pred), and exercise capacity (6MWD) were measured. The quality of life was assessed using the St. George’s Respiratory Questionnaire (SGRQ).ResultsThe minimum value of ΔM was 1.89 cm and the maximal value was 8.11 cm in the COPD patients. There were significant correlationship between ΔM and the SGRQ score of the total score, symptom score, impact points, activity points and 6MWD, with correlation coefficients of –0.474, –0.416, –0.432, –0.502 and 0.536, respectively. Multivariate stepwise regression analysis showed that the factors influencing ΔM were height (β=0.407, P=0.021) and FEV1%pred (β=–0.391, P=0.035).ConclusionsDiaphragmatic mobility and quality of life are closely related in COPD patients. The height and FEV1%pred have the greatest effect on diaphragmatic activity. The smaller diaphragm mobility is relevant to the worse quality of life and the smaller activity capacity.

关键词: 慢性阻塞性肺疾病; 膈肌活动度; M 型超声

Key words: Chronic obstructive pulmonary disease; Diaphragmatic motion; M-type ultrasound

引用本文: 刘岷, 骈林萍. 超声评价膈肌活动度与慢性阻塞性肺疾病患者生活质量及运动能力的相关性研究. 中国呼吸与危重监护杂志, 2018, 17(6): 548-551. doi: 10.7507/1671-6205.201804041 复制

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1. GBD 2015 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 2016, 10(8): 1603-1658.
2. Putcha N, Drummond MB, Wise RA, et al. Comorbidities and chronic obstructive pulmonary disease: prevalence, influence on outcomes, and management. Semin Respir Crit Care Med, 2015, 36(4): 575-591.
3. Tomasic I, Tomasic N, Trobec R, et al. Continuous remote monitoring of COPD patients--justification and explanation of the requirements and a survey of the available technologies. Med Biol Eng Comput, 2018, 56(4): 547-569.
4. Polverino F, Laucho-Contreras ME, Petersen H, et al. A pilot study linking endothelial injury in lungs and kidneys in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2017, 195(11): 1464-1476.
5. Hamacher J, Hadizamani Y, Borgmann M, et al. Cytokine-ion channel interactions in pulmonary inflammation. Front Immunol, 2018, 8: 1644.
6. Gea J, Pascual S, Casadevall C, et al. Muscle dysfunction in chronic obstructive pulmonary disease: update on causes and biological findings. J Thorac Dis, 2015, 7(10): E418-E438.
7. Barreiro E, Gea J. Molecular and biological pathways of skeletal muscle dysfunction in chronic obstructive pulmonary disease. Chron Respir Dis, 2016, 13(3): 297-311.
8. Suga K, Tsukuda T, Awaya H, et al. Impaired respiratory mechanics in pulmonary emphysema: evaluation with dynamic breathing MRI. J Magn Reson Imaging, 1999, 10(4): 510-520.
9. Smargiassi A, Inchingolo R, Tagliaboschi L, et al. Ultrasonographic assessment of the diaphragm in chronic obstructive pulmonary disease patients: relationships with pulmonary function and the influence of body composition - a pilot study. Respiration, 2014, 87(5): 364-371.
10. Cancelliero-Gaiad KM, Ike D, Pantoni CB, et al. Respiratory pattern of diaphragmatic breathing and pilates breathing in COPD subjects. Braz J Phys Ther, 2014, 18(4): 291-299.
11. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013 年修订版). 中华结核和呼吸杂志, 2013, 36(4): 255-264.
12. 雷玲, 钟小宁, 何志义. 慢性阻塞性肺疾病患者 BODE 指数与生活质量的相关性研究. 中国呼吸与危重监护杂志, 2007, 6(4): 261-264.
13. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med, 2002, 166(1): 111-117.
14. Jung KJ, Park JY, Hwang DW, et al. Ultrasonographic diaphragmatic motion analysis and its correlation with pulmonary function in hemiplegic stroke patients. Ann Rehabil Med, 2014, 38(1): 29-37.
15. Dal Negro RW, Celli BR. Patient related outcomes-BODE (PRO-BODE): a composite index incorporating health utilization resources predicts mortality and economic cost of COPD in real life. Respir Med, 2017, 131(10): 175-178.
16. Chun EM, Han SJ, Modi HN. Analysis of diaphragmatic movement before and after pulmonary rehabilitation using fluoroscopy imaging in patients with COPD. Int J Chron Obstruct Pulmon Dis, 2015, 27(1): 193-199.
17. Orozco-Levi M, Gea J, Lloreta JL, et al. Subcellular adaptation of the human diaphragm in chronic obstructive pulmonary disease. Eur Respir J, 1999, 13(2): 371-378.
18. Baldi BG, Salge JM. Respiratory muscles in interstitial lung disease: poorly explored and poorly understood. J Bras Pneumol, 2016, 42(2): 82-83.
19. Iwasawa T, Takahashi H, Ogura T, et al. Influence of the distribution of emphysema on diaphragmatic motion in patients with chronic obstructive pulmonary disease. Jpn J Radiol, 2011, 29(5): 256-264.
20. Paulin E, Yamaguti WP, Chammas MC, et al. Influence of diaphragmatic mobility on exercise tolerance and dyspnea in patients with COPD. Respir Med, 2007, 101(10): 2113-2118.
21. Dos Santos Yamaguti WP, Paulin E, Shibao S, et al. Air trapping: the major factor limiting diaphragm mobility in chronic obstructive pulmonary disease patients. Respirology, 2008, 13(1): 138-144.
22. Charususin N, Dacha S, Gosselink R, et al. Respiratory muscle function and exercise limitation in patients with chronic obstructive pulmonary disease: a review. Expert Rev Respir Med, 2018, 12(1): 67-79.
23. Bisca GW, Camillo CA, Cavalheri V, et al. Peripheral muscle training in patients with chronic obstructive pulmonary disease: novel approaches and recent advances. Expert Rev Respir Med, 2017, 11(5): 413-423.