慢性阻塞性肺疾病患者深吸气量与生命质量的关系

目的 探讨COPD患者深吸气量等肺功能指标与生命质量的关系.方法 2006年1月至2007年3月北京大学第三医院门诊的COPD稳定期患者62例,其中男55例,女7例;年龄43～79岁,平均年龄(66±8)岁.均进行肺容量、肺通气功能和小气道功能检查,并经圣乔治呼吸问卷(SGRQ)评分,采用Pearson直线相关分析SGRQ的分值与总分、SGRQ评分与肺功能指标之间的相关性.结果 62例COPD稳定期患者的SGRQ总分为(43±17)分,其中呼吸症状分值为(54±23)分,活动受限分值为(54±19)分,疾病影响分值为(33±20)分;肺功能检查结果中FEV_1占预计值%为(43±13)%,FEV_1/FVC为(52±11)%,残气量占预计值%为(194±50)%,残气量/肺总量为(166±31)%,深吸气量占预计值%为(74±21)%.深吸气量占预计值%、残气量占预计值%、残气量/肺总量、FEV,占预计值%、FEV./FVC、呼气峰流量、用力呼出50%肺活量时呼气流量(FEF_(50%))、用力呼出25%肺活量时呼气流量(FE_(25%))和最大呼气中段流量(MMEF)与SGRQ总分均呈负相关,其中通气功能指标的相关系数为-0.336～-0.479,小气道功能指标的相关系数为-0.368～-0.411,而深吸气量占预计值%和SGRQ的3个能区分值和总分相关性最好,相关系数为-0.418～-0.521,均P＜0.05.SGRQ的3个能区分值中呼吸症状和肺功能无显著相关性.结论 肺功能检查中肺容量测定、肺通气功能和小气道功能均与COPD患者的生命质量相关,深吸气量占预计值%和FEV_1占预计值%应联合作为临床评价COPD患者的客观指标.     

慢性阻塞性肺疾病支气管舒张试验后肺容量和呼气流量反应的差别

目的 探讨支气管舒张试验后COPD患者的肺容量和呼气流量反应的差别.方法 2006年1月至2008年6月临床诊断为COPD稳定期无呼吸衰竭及心力衰竭的患者465例,其中男426例,女39例;年龄(42～86)岁,平均(67±8)岁.采用支气管舒张试验比较患者支气管舒张前后FEV_1和FVC的改变值和改变率.统计学分析采用自身配对t检验和配对秩和检验,各组间比较采用独立样本t检验和方差分析(正态分布)以及非参数秩和检验(非正态分布).结果 支气管舒张试验后,COPD患者的FEV_1平均增加117 ml,较基础值平均提高13.2%,舒张试验阳性率为18.7%(87/465);FVC平均增加258 ml,较基础值平均提高14.0%,舒张试验阳性率为44.1%(205/465).随着COPD严重程度的增加,FEV_1改变值逐渐减少,而FVC改变值却逐渐增加.结论 吸入支气管舒张剂后COPD患者的容量反应较流量反应更为明显,FVC改变值较FEV_1更大,且随着COPD的严重程度增加,FVC增加值越大.FVC应该作为COPD患者对支气管舒张剂反应的重要指标.     

一口气呼吸法肺弥散功能测试的质量控制及注意事项

本期发表了郑劲平医师关于肺弥散功能测试质量控制问题的专题笔谈，值得从事肺功能测定者及临床医生重视。肺功能检测是呼吸科医生诊断疾病、观察病情、进行临床科学研究不可缺少的重要手段。有些症候群[如慢性阻塞性肺疾病（COPD）、小气道疾病等]就是基于肺功能障碍而命名的。近年来临床肺功能测定的质量控制问题的确十分令人担忧。笔者曾亲见同一患者连续3次测定简单的用力肺活量，其误差竞达25％以上，远远超过药物治疗能起到的作用。也曾看到有个别单位，依据一口气呼吸法肺弥散测定得到的肺泡气代替气体稀释法来报告功能残气量与肺总量。如此报告即使正常人也会有较大的误差，更何况COPD患者？其原因是测试所用氦气等指示气体，在十几秒内不可能在肺内均匀分布。弥散功能测定对肺纤维化（肺一氧化碳弥散量）及肺气肿（肺一氧化碳弥散量／肺泡通气量）的诊断都很重要。郑劲平医师已作了很完整的介绍。还应注意的是除最大屏气时间低于7s外，用力肺活量过小者（〈1．5L）也不适用于一口气呼吸法。另外，孕妇因肺血量增多的代偿作用，其一氧化碳弥散量值会比怀孕前与分娩后有明显的增大。[编者按]     

肺弥散功能减退对肺癌和肺结核患者心功能的影响

本文对１３０例肺癌和肺结核患者的心功能和肺弥散功能进行测定，以观察肺弥散功能减退对心功能的影响。发现：弥散功能正常和轻度减退患者心功能十三项指标的测定值与健康人相接近，而弥散功能中、重度减退患者的ＨＲ增快，ＭＰＡＰ增高，ＲＶＥＴ和ＬＶＥＴ缩短，ＰＥＴ／ＬＶＥＴ和ＲＯ／ＲＶ增加，ＥＦ、ＳＶ和ＳＷＩ降低，但ＰＥＰ、ＲＰＥＰ、ＣＩ和ＣＷＩ无显著性改变。提示：当弥散功能中、重度减退时，都会影响患者的心脏功     

肺通气功能障碍对肺癌患者运动心肺功能的影响

目的：探讨肺癌患者在不同肺通气功能障碍的肺癌患者行静息肺功能和运动心肺功能测定。方法;对20例肺通气功能正常和56例肺通气功能障碍的肺癌患者行静息肺功能和运动心肺功能测定。结果：（1）25％以上的肺通气功能正常的肺癌患者VO2％P、VO2/kg,VO2/HR降低,DY增高和AT提前出现。（2）肺通气功能障碍的肺癌患者上述指标进一步异常,且BR和VTex降低,以混合型通气功能障碍组为著。（3）肺癌患者的VE与VO2／HR相关,通气障碍组运动肺通气指标和VO2／HR（除限制型组）与VO2％P相关,限制型组的VC％、阻塞型和混合型组的MVV％等均与运动肺通气指标相关（P均＜0．05）。结论：肺癌患者存在着运动心肺功能减退,肺功能障碍加重其运动心肺功能的异常,VC％、MVV％降低是通气功能障碍的肺癌患者通气功能受限的主要原因,运动通气功能减退是导致运动心功能异常的主要原因。     

慢性阻塞性肺疾病评估测试与深吸气量相关性研究

目的探讨COPD评估测试（CAT）应用于我国COPD患者生活质量的价值及深吸气量等肺功能指标与生命质量的关系。方法选择稳定期COPD患者62例,均进行功能检查,并进行CAT、SGRQ评分,采用Pearson直线相关分析CAT的评分与肺功能指标和SGRQ总分之间的相关性。结果 62例COPD稳定期患者的CAT评分为（20.5±7.4）分,肺功能检查结果中第1秒用力呼气容积占预计值（FEV1%pred）为（43.4±5.8）%,FEV1/FVC为（51.1±12.3）%,深吸气量占预计值%（IC%pred）为（73.2±19.4）%,SGRQ总分为（39.4±19.0）分。CAT与IC%pred、FEV1/FVC、SGRQ总分,均有相关性,CAT与FEV1%pred相关性差。结论 CAT是评价我国COPD生活质量的简易、有效、可行、标准化测量方法。CAT可与IC和FEV1联合作为临床评价COPD患者的客观指标。     

Spirometric changes in obstructive disease: after all,how much is significant?

OBJECTIVE:

To establish the upper limits for changes in FEV₁, slow vital capacity (SVC), FVC, and inspiratory capacity (IC) after placebo administration in patients with airflow obstruction.

METHODS:

One hundred and two adults with airflow obstruction (FEV₁ = 62 ± 19% of predicted) were included in the study. All of the participants performed SVC and FVC maneuvers before and after the administration of placebo spray. The changes in FEV₁, SVC, FVC, and IC were expressed as absolute values, percentage of change from baseline values, and percentage of predicted values, 95% CIs and 95th percentiles being calculated. Factor analysis was performed in order to determine how those changes clustered.

RESULTS:

Considering the 95% CIs and 95th percentiles and after rounding the values, we found that the upper limits for a significant response were as follows: FEV₁ = 0.20 L, FVC = 0.20 L, SVC = 0.25 L, and IC = 0.30 L (expressed as absolute values); FEV₁ = 12%, FVC = 7%, SVC = 10%, and IC = 15% (expressed as percentage of change from baseline values); and FEV₁ = 7%, FVC = 6%, SVC = 7%, and IC = 12% (expressed as percentage of predicted values).

CONCLUSIONS:

In patients with airflow obstruction, IC varies more widely than do FVC and SVC. For IC, values greater than 0.30 L and 15% of change from the baseline value can be considered significant. For FVC, values greater than 0.20 L and 7% of change from the baseline value are significant. Alternatively, changes exceeding 0.20 L and 7% of the predicted value can be considered significant for FEV₁ and FVC. On factor analysis, spirometric parameters clustered into three dimensions, expressing changes in flows, volumes, and dynamic hyperinflation.     

Spirometry in primary care: An analysis of spirometry test quality in a regional primary care asthma program

BACKGROUND:

Primary care office spirometry can improve access to testing and concordance between clinical practice and asthma guidelines. Compliance with test quality standards is essential to implementation.

OBJECTIVE:

To evaluate the quality of spirometry performed onsite in a regional primary care asthma program (RAP) by health care professionals with limited training.

METHODS:

Asthma educators were trained to perform spirometry during two 2 h workshops and supervised during up to six patient encounters. Quality was analyzed using American Thoracic Society (ATS) 1994 and ATS/European Respiratory Society (ERS) 2003 (ATS/ERS) standards. These results were compared with two regional reference sites: a primary care group practice (Family Medical Centre [FMC], Windsor, Ontario) and a teaching hospital pulmonary function laboratory (London Health Sciences Centre [LHSC], London, Ontario).

RESULTS:

A total of 12,815 flow-volume loops (FVL) were evaluated: RAP – 1606 FVL in 472 patient sessions; reference sites – FMC 4013 FVL in 573 sessions; and LHSC – 7196 in 1151 sessions. RAP: There were three acceptable FVL in 392 of 472 (83%) sessions, two reproducible FVL according to ATS criteria in 428 of 469 (91%) sessions, and 395 of 469 (84%) according to ATS/ERS criteria. All quality criteria – minimum of three acceptable and two reproducible FVL according to ATS criteria in 361 of 472 (77%) sessions and according to ATS/ERS criteria in 337 of 472 (71%) sessions. RAP met ATS criteria more often than the FMC (388 of 573 [68%]); however, less often than LHSC (1050 of 1151 [91%]; P<0.001).

CONCLUSIONS:

Health care providers with limited training and experience operating within a simple quality program achieved ATS/ERS quality spirometry in the majority of sessions in a primary care setting. The quality performance approached pulmonary function laboratory standards.     

用力肺功能检查的不良反应观察及安全性探讨

目的 观察用力肺功能检查的不良反应及探讨其安全性.方法 采用问卷调查方式对996例行用力肺功能检查的受试者进行不良反应评价.调查内容主要包括:不良反应的症状、程度、处理措施和恢复情况.结果 270例(27.1％)出现了294个不良反应,其中有24例受试者同时出现2～3个不良反应.以呼吸症状发生率最高,其次为神经肌肉和咽喉部症状,其中呼吸困难129例,咳嗽79例,头晕43例,发生率分别为13.0％、7.9％、4.3％.气道阻塞组的呼吸困难发生率为33.4％,显著高于无气道阻塞组(P=0.000),并随着通气障碍的程度加重,呼吸困难的发生率逐渐增高,以极重度组发生率最高,达75.4％.轻度和中度不良反应分别占81.0％和19.0％,无重度不良反应.结论 用力肺功能检查可引起不良反应的出现,但只要临床上应严格掌握检查指征,及时恰当地处理不良反应,用力肺功能检查是安全的.     

心肺康复在重度支气管扩张症患者中的应用价值

目的:探讨应用简易器材进行系统的心肺康复在重度稳定期支气管扩张症患者中的应用价值。方法:本研究为前瞻性队列研究。采用单纯随机抽样法选取2019年6月至10月就诊于济南市第八人民医院和济南市莱芜人民医院呼吸科的支气管扩张症患者125例,采用随机数字表法分为常规治疗组( n＝58)和心肺康复组( n...     

心肺功能综合评估预测肺癌术后呼吸衰竭危险

目的探讨心肺功能综合评估预测肺癌病人手术后呼吸衰竭（呼衰）危险。方法260例原发性肺癌病人于术前行静息肺功能、心电图、运动心肺功能检测．将常用指标分别组合为静息肺功能、运动肺功能、心功能进行评分，并计算心肺功能综合评分。结果①全肺切除术后呼衰组运动肺功能、心功能、心肺功能综合评分均高于非呼衰组（P〈0．01），Logistic分析显示运动肺功能评分〉3分、心功能评分〉2分与术后呼衰的发生密切相关，其OR值、预测术后呼衰的敏感性、特异性和阳性结果预计值均高于VO2/kg，②肺叶切除术后呼衰组仅静息肺功能评分高于非呼衰组（P〈0．05），Logistic分析显示静息肺功能评分〉2分与其术后呼衰的发生密切相关。③FEV10〈60％、行肺叶切除术（低肺功能组）术后呼衰组运动肺功能评分和心肺功能综合评分高于非呼衰组（P〈0．01），Lositic分析显永心肺功能综合评分〉6分与其术后呼衰的发生密切相关，其OR值、预测术后呼衰的敏感性和阴性结果预计值高于VO2/kg。结论心肺功能综合评估较单项肺功能指标能更全面、准确地预测术后呼衰发生危险．尤其适于全肺切除和低肺功能、行肺叶切除术病人。     

The effect of Ramadan fasting on spirometry in healthy subjects

OBJECTIVES: Lung function tests are an important investigative tool in diagnosing respiratory diseases, judging their severity and assessing prognosis. The primary aim of the present study was to assess whether Ramadan fasting affected normal lung function values. METHODOLOGY: Forty-six non-smoking healthy males, with a mean age of 24.2 years (SD 6.4 years) were investigated. Spirometry was performed according to the recommendations of the American Thoracic Society. Days between the 15th and 25th of three Islamic months (pre-Ramadan, Ramadan and post-Ramadan) were selected for spirometry. On all three occasions, FVC, FEV(1), FEV(1)/FVC%, maximum voluntary ventilation (MVV(indirect)), PEF, FEF(25--75%) and body mass were measured. Pre- and post-Ramadan readings were compared with the readings during Ramadan fasting. The results were analysed by repeated measures analysis of variance. RESULTS: No significant change was seen in lung function during Ramadan as compared to the pre-Ramadan period. FVC was decreased significantly in the post-Ramadan period compared to Ramadan and this period was associated with a significant increase in body mass. CONCLUSION: Relative to pre-Ramadan baseline values, there was no change in spirometry during Ramadan fasting in these subjects.