脉冲振荡肺功能COPD气道阻力参数的评估及优化

目的：评估脉冲振荡（impulse oscillometry system,IOS）肺功能多种IOS阻力参数在慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）和对照人群肺功能评估中的应用价值,并探讨部分参数的优化方法。方法：按时间顺序选择在门诊行肺功能检查的患者153例,其中符合COPD诊断标准的患者47例（COPD组）和非COPD受试者106例（非COPD组）,应用德国耶格公司的Master Screen肺功能仪进行常规肺功能和IOS肺功能测定,比较两组患者常规肺功能和IOS肺功能参数的差异,分析IOS肺功能参数与常规肺功能参数,特别是与FEV1/FVC的相关性。结果：COPD组R5、R5%、R5-R20、（R5-R20）%和（R5-R20）%/R20%均高于非COPD组,差异有统计学意义（P〈0.05）,大气道阻力参数R20和R20%在两组之间差异无统计学意义（P〉0.05）。IOS肺功能参数中与FEV1/FVC相关者,按相关系数由低到高排列,分别为R5、R5%、R5-R20、（R5-R20）%和（R5-R20）%/R20%。非COPD组IOS肺功能参数与常规肺功能参数无显著相关性。结论：COPD患者的IOS小气道阻力参数显著高于非COPD患者,大气道阻力无显著差异。优化的参数（R5-R20）%/R20%对气流阻塞的评估价值高于目前常被使用的（R5-R20）%、R5-R20、R5%和R5。IOS肺功能参数,尤其是（R5-R20）%/R20%在判断是否存在COPD方面具有一定价值,但所有IOS通气参数在定量评估通气功能大小方面作用有限。     

常规肺功能与脉冲振荡肺功能测定在间质性肺疾病病人中的应用

目的探讨常规肺功能与脉冲振荡(IOS)肺功能检测在间质性肺疾病病人中的应用价值。方法单纯肺间质纤维化病人38例,慢性阻塞性肺疾病(COPD)合并肺间质纤维化病人18例和健康人35例分别测定常规肺功能,包括肺活量(VC)、1秒量(FEV1.0)、1秒率(FEV1。0/FVC%);呼气峰流速(PEF)、50%用力呼气流速(FEF50);25%用力呼气流速(FEF25)和一氧化碳弥散量(DLCO)。IOS肺功能测定指标包括脉冲频率5Hz、20Hz下的气道黏性阻力(R5、R20)、呼吸总阻抗(ZrS)、中央气道阻力(Rc)、周围气道阻力(Rp)、脉冲频率5Hz时的弹性阻力及惯性阻力(X5)、共振频率(Fres)。结果单纯肺间质纤维化病人常规肺功能与健康人比较有十分显著性差异(P<0.01),FEV1.0/FVC%与健康人比较无显著性差异(P>0.05);IOS肺功能与健康人比较无显著性差异(P>0.05)。COPD合并肺间质纤维化病人常规肺功能与健康人比较有十分显著性差异(P<0.01);IOS肺功能与健康人比较有显著性差异(P<0.01或P<0.05)。结果显示常规肺功能检查,单纯肺间质纤维化病人存在限制性肺通气功能障碍、小气道功能障碍、肺换气功能障碍;COPD合并肺间质纤维化病人存在混合性通气功能障碍、小气道功能障碍、肺换气功能障碍。IOS肺功能检查提示单纯肺纤维化病人各值均在正常范围;COPD合并肺纤维化患者IOS各值均有所升高。结论常规肺功能检查对于单纯肺间质纤维化及COPD合并肺间质纤维化的诊断、病情评估,仍不失为一项重要敏感指标;IOS肺功能检查在COPD合并肺间质纤维化病人中有一定的临床意义,可以间接反映气道黏性阻力、弹性阻力、中央气道阻力、周围气道阻力、呼吸总阻抗的增高程度,而对单纯肺间质纤维化病人不敏感。     

脉冲振荡法测定慢性阻塞性肺疾病呼吸阻抗与常规肺功能检查指标的相关性分析

目的 探讨呼吸阻抗及肺通气功能检查在慢性阻塞性肺病诊断中的相关性及互补性.方法 对20例肺功能正常人和101例慢性阻塞性肺病患者脉冲振荡肺功能测定指标及常规肺功能检查资料进行比较.结果 慢性阻塞性肺疾病患者与正常人相比,呼吸总阻抗(Z5)、总气道阻力(R5)、周边气道阻力(R5-R20)、共振频率(RF)、周边阻力(RP)均显著增高且与肺通气功能呈负相关;电抗(X5)明显降低,与肺通气功能呈正相关;其中,共振频率(RF)的相关性最为密切,共振频率(RF)、周边阻力(RP)随慢性阻塞性肺疾病严重程度增加而增加.结论 脉冲振荡肺功能测定与常规肺通气功能检查在慢性阻塞性肺疾病的诊断中具有良好的相关性及互补性;共振频率和周边阻力可以作为判断慢性阻塞性肺疾病严重程度的指标.     

脉冲振荡法测定COPD患者静息时呼吸阻抗与运动能力的关系

目的 探讨ＣＯＰＤ患者静息时脉冲振荡法（ＩＯＳ）测得呼吸阻抗指标与最大运动能力的关系。方法 ３０例ＣＯＰＤ患者先用ＩＯＳ法测定呼吸阻抗值（包括共振频率Ｆｒｅｓ、总阻抗Ｚ、中央阻抗Ｒｃｅｎｔｌ、周围阻抗Ｒｐｅｒｉ、电阻Ｒ５至Ｒ３５、电抗Ｘ和至Ｘ３５）后进行自行车增量运动试验,记录最大运动负荷（Ｗｍａｘ）、最大氧耗量（Ｖｍａｘ）、最大ＣＯ２排出量（ＶＣＯ２ｍａｘ）、最大每分通气量（ＶＥｍａｘ）、最大潮     

脉冲振荡法测定南通地区正常吸烟人群120例气道阻力变化

目的:探讨应用脉冲振荡法(IOS)肺功能测定在发现早期气道病变的意义。方法:应用IOS测定240例常规肺功能正常人的呼吸阻抗指标。结果:吸烟组与不吸烟组IOS各指标比较,响应频率(Fres)与周边阻力(Rp)吸烟组升高,组间存在统计学差异(P<0.05),说明部分吸烟患者出现气道病变。结论:IOS指标可以筛选部分慢性阻塞性肺疾病早期患者。     

脉冲振荡法在慢性阻塞性肺疾病中的应用评价

目的 探讨脉冲振荡法(IOS)测定在慢性阻塞性肺疾病(COPD)中的应用价值.方法 选择76例COPD患者(COPD组)和20例健康者(对照组),比较两组常规肺功能检查结果与IOS测定结果.结果 COPD组用力肺活量(FVC)、一秒钟用力呼气容积(FEV_1)、一秒钟用力呼气容积占用力肺活量比值(FEV_1/FVC%)、一秒钟用力呼气容积实测值/预计值(FEV_1/pre%)检测结果均低于对照组,差异有统计学意义(P＜0.05),COPD组呼吸总阻抗(Zrs)、总气道阻力(R_5)、周边黏性阻力(R_5-R_20)、共振频率(Fres)、周边阻力(Rp)均高于对照组,差异有统计学意义(P＜0.05),且与肺通气功能呈负相关(P＜0.05);周边弹性阻力(X5)明显低于对照组,差异有统计学意义(P＜0.05),与肺通气功能呈正相关(P＜0.05);其中Fres的相关性最为密切(P＜0.01),Fres、Zrs、X_5诊断COPD具有较高的敏感度(分别为96.8%、85.2%、66.1%)和特异度(分别为70.7%、77.3%、85.3%).结论 IOS肺功能测定可用于COPD的诊断,与常规肺通气功能检查在COPD的诊断中具有良好的相关性及互补性;Fres为诊断COPD气流受限最敏感的指标.     

强迫振荡肺功能测定新技术在COPD中的应用

目的：探讨脉冲振荡法（ＩＯＳ）在慢性阻塞性肺疾病中（ＣＯＰＤ）的应用,对早期判断气道阻塞的意义。方法：采用ＩＯＳ对１５例ＣＯＰＤ患者,１５例对照组测定其呼吸阻力及相关指标,并作相关分析。结果：ＣＯＰＤ组与对照组比较气道阻力有显著差异（Ｐ〈０．０５）及频率依赖性。反映小气道阻塞的ＩＯＳ值同ＥＦＶ１％、ＥＦＶ１／ＦＶＣ、ＰＥＦ２５～７５有显著相关（Ｐ〈０．０１～０．０５）。结论：强迫振荡法可以早期反映     

动脉硬化状况对COPD高龄患者气道阻塞病情影响的研究

目的 探讨动脉硬化状况对老年慢性阻塞性肺疾病(COPD)患者气道阻塞程度的影响.方法 回顾性分析2015年1月至2019年12月河南省人民医院呼吸内科收治的90例高龄COPD患者作为研究对象.根据第1秒用力呼气容积(FEV1)所占预计值的百分比(FEV1％)进行分组,对两者比值≥50％作为轻中度组55例,两者比值＜50...     

脉冲振荡肺功能对10例吸烟者气道阻力检测分析

<正> 脉冲振荡法是强迫振荡技术(FOT)用于肺功能检测的一种方法,1996年耶格公司率先推出采用脉冲振荡肺功能仪测定气道阻力。最近笔者对10例吸烟者使用脉冲振荡法检测气道阻力。现将结果报告如下。     

Assessment of respiratory impedance during deep-slow breathing with impulse oscillometry in patients with chronic obstructive pulmonary disease

Objective: To observe the relationship of deep-slow respiratory pattern and respiratory impedance(RI) in patients with chronic obstructive pulmonary disease (COPD).Methods: RI under normal respiration and during deep-slow respiration was measured one after the other with impulse oscillometry for 8 patients with COPD and for 9 healthy volunteers as control.Results: When respiration was changed from normal pattern to the deep-slow pattern, the tidal volume increased and respiratory frequency significantly decreased in both groups (P < 0. 01), the total respiratory impedance (Z respir) showed a decreasing trend in COPD group, but with no obvious change in the control group. No change in the resonant frequency (fres) was found in both groups, and the respiratory viscous resistance obviously decreased in the COPD group(R5: P=0.0168; R20: P=0.0498; R5-R20: P=0.0388), though in the control group it was unchanged.Conclusion: IOS detection could reflect the response heterogeneity of different compartments of respiratory system during tidal breathing. During deep-slow respiration, the viscous resistance in both central airway and peripheral airway was decreased in patients with COPD. RI measurement by impulse oscillometry may be a convenient pathophysiological method for studying the application of breathing exercise in patients with COPD.     

脉冲振荡法在慢性阻塞性肺疾病中的应用和临床意义

目的: 探讨脉冲振荡法(IOS)在慢性阻塞性肺疾病(COPD)中的特征性改变及临床应用价值。方法: 用IOS测定50名健康人、110例COPD患者的呼吸阻抗及参数结构图,与传统肺量计法肺功能检测中FEV₁/FVC%、FEV₁/Pred%等指标比较。结果: 与健康组相比,COPD组周边气道阻力和共振频率明显增加,周边电抗下降明显,中心气道阻力部分增加,IOS输出图形有特征性改变。结论: IOS检测可较好的反映出气道阻力尤其是小气道阻力变化和肺顺应性的变化,对COPD有较大的临床诊断价值。     

Relationship between 6-minute walk test and pulmonary function test in stable chronic obstructive pulmonary disease with different severities

Background  The relationship between the 6-minute walk test (6MWT) and pulmonary function test in stable chronic obstructive pulmonary disease (COPD) remains unclear. We evaluate the correlation of 6MWT and spirometric parameters in stable COPD with different severities. 6MWT data assessed included three variables: the 6-minute walk distance (6MWD), 6-minute walk work (6MWORK), and pulse oxygen desaturation rate (SPO₂%).

Methods  6MWT and pulmonary function test were assessed for 150 stable COPD patients with different severities. Means and standard deviations were calculated for the variables of interest. Analysis of variance was performed to compare means. Correlation coefficients were calculated for 6MWT data with the spirometric parameters and dyspnea Borg scale. Multiple stepwise regression analysis was used to screen pulmonary function-related predictors of 6MWT data.

Results  The three variables of 6MWT all varied as the severities of the disease. The 6MWD and 6MWORK both correlated with some spirometric parameters (positive or negative correlation; the absolute value of r ranging from 0.34 to 0.67; P <0.05) in severe and very severe patients, and the SPO₂% correlated with the dyspnea Borg scale in four severities (r= -0.33, -0.34, -0.39, -0.53 respectively; P <0.05). The 6MWD was correlated with the 6MWORK in four severities (r=0.56, 0.57, 0.72, 0.81 respectively, P <0.05), and neither of them correlated with the SPO₂%. The percent of predicted forced expiratory volume in 1 second (FEV₁% predicted) and residual volume to total lung capacity ratio (RV/TLC) were predictors of the 6MWD, and the maximum voluntary ventilation (MVV) was the predictor of the 6MWORK.

Conclusions  6MWT correlated with the spirometric parameters in severe and very severe COPD patients. 6MWT may be used to monitor changes of pulmonary function in these patients.

     

The applicable value of respiratory impedance for the stage 0 of chronic obstructive pulmonary disease

Objective ：To evaluate the applicable value of respiratory impedance for the stage 0 of chronic obstructive pulmonary disease （COPD）. Methods：Respiratory impedance was measured by impulse oscillometry （lOS） in 41 cases at stage 0 of COPD （NHLBI/WHO, 2001 Standard） and their conventional pulmonary function values were compared with 42 healthy subjects. Both groups had no significant deviation in age, stature and avoirdupois, etc. Master-Screen pulmonary function test system （Jaeger Co, Germany） were used to determine IOS parameters including viscous resistance of 5Hz, 20 Hz and 35Hz （R5, R20, R35）, reactance of 5Hz, 35 Hz （X3, X35）, resonant frequency （Fres） ,total respiratory impedance （Zrs） and routine pulmonary function values including forced expiratory volume in one second to predicted value （FEV1 % ）, forced expiratory volume in one second to forced vital capacity ratio（ FEV1/ FVC% ）, maximal mid expiratory flow （MMEF%）,V23% and V50%. Results：Both groups had no significant deviation in FEV1%, FEV1/FVC% and X35（P〉0.05）. It was increased significantly in viscous resistance of 5Hz, 20 Hz and 35Hz （R5, R20, R35） in COPD group than that in healthy group （P〈0.01）. So were Fres and Zrs （P〈0.01）. MMEF%,V25%,V50% and reactance of 5Hz （X5） in COPD group were marked lower than that in healthy group （P〈0.01）. The sensitivity of MMEF%, V25%,V50% was higher than others, but its specificity was lower. In parameters of IOS, Fres was the most sensitive index for diagnosis of the small airway function and its specificity was higher than that of MMEF%, V25% ,V50%. Conclusion：In the risk case at the stage 0 of COPD, MMEF%, V25% and V50% could be decreased, but Fres, R5 ,R5-20 could be increased in spite of FEV1% and FEV1/FVC% in normal range.     

Association between body mass index and pulmonary function of patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease （COPD） is a major cause of chronic morbidity and mortality throughout the world. It is a preventable and treatable disease with significant extra pulmonary effects that may contribute to the severity in individual patients. It is characterized by airflow limitation that is not fully reversible. The diagnosis of COPD should be confirmed by spirometry. Body mass index （BMI） is an important indicator that can well reflect nutritional status of patients, and low BMI is an independent risk factor for mortality in patients with COPD.     

利用脉冲振荡技术评价慢性阻塞性肺病患者肺功能

目的　评价脉冲振荡法 (IOS)在慢性阻塞性肺病 (COPD)肺功能诊断中的价值。　方法　随机对 2 96例COPD缓解期患者和 171例健康者进行包括IOS及常规肺通气在内的肺功能测定 ,比较两组IOS测试结果 ,评价IOS与常规肺通气检测的一致性。　结果　与健康组比较 ,COPD组IOS测试值差异有显著性 (P <0 .0 5 ) ,且差异呈频率依赖性。共振频率 (Fres)、不同脉冲频率下黏性阻力 (R5 R2 0 )、R5、周边弹性阻力 (X5 )等IOS值与呼气容积百分比 (FEV1% )、1秒种用力呼气容积 (FEV1) /用力肺活量(FVC)、最大流速 (PEEF)、5 0 %肺活量呼气流量 (FEF5 0 % )等有显著相关性 (P <0 .0 5 )。　结论　脉冲振荡法与常规通气试验具有较好的一致性 ,可以反映早期气道阻塞情况。     

脉冲振荡法测定呼吸阻抗对慢性阻塞性肺疾病的诊断价值

目的探讨脉冲振荡法(IOS)测定呼吸阻抗对慢性阻塞性肺疾病(C0PD)的诊断价值.方法测定32例COPD患者和30名健康者的各项IOS指标及其常规肺功能,对IOS主要结果作出比较.结果COPD患者总气道阻力、中心及周边通气阻力、呼吸总阻抗、共振频率显著高于健康者(P＜0.01),周边弹性阻力显著低于健康者(P＜0.01);COPD组共振频率(Fres)与一秒钟用力呼气容积(FEV1)相关性较强,(r=-0.64,P＜0.01).结论IOS法测定呼吸阻抗是判断气道阻塞的敏感指标,可以代替FEV1判断COPD患者的气道阻塞程度.     

慢性阻塞性肺疾病患者6 min步行试验与肺功能及生活质量的相关性

目的探讨慢性阻塞性肺疾病（COPD）患者6min步行试验与肺功能及生活质量的相关性。方法将38例COPD患者和38例健康志愿者分为COPD组与对照组,对两组进行6 min步行试验,测量试验步行距离,试验前、后指脉氧饱和度,并计算指脉氧饱和度下降率;所有受试者均测定肺功能,COPD患者进行圣乔治呼吸问卷评分。结果 COPD组6 min步行距离（422.76+88.61）m,较对照组（557.82±89.61）m明显缩短（P<0.01）,指脉氧饱和度下降率3.13%±6.18%,较对照组0.46%±1.07%增高（P<0.05）。Pearson相关性分析示COPD组中6min步行距离与第1秒用力呼气量占预计值百分比（FEV₁%）、第1秒用力呼气量占用力肺活量百分比（FEV₁/FVC）呈显著正相关,与圣乔治呼吸问卷总得分及其活动受限得分、疾病影响得分呈显著负相关;指脉氧饱和度下降率与FEV₁/FVC呈显著负相关。多元线性回归分析显示COPD组中年龄、身高、体重、FEV₁%、圣乔治呼吸问卷总得分及其活动受限得分可综合预测6 min步行距离。结论 6 min步行试验可作为COPD患者确诊后长期治疗中病情评估的方法之一,评估其肺功能及生活质量的变化。     

The Diagnosis Value and Its Implication of Impulse Oscillometry in Obstructive Sleep Apnea Syndrome Patients

Obstructlvesleepapneasyndrome(OSAS)isaverycommondisease,butitspathogeneslswasun-clear.ltwasreportedthatupperairwayanatomicnarrowingplayedanimportantrole.Unfortunately,thetechniqueofmeasuringupperairwaydiameterwasstillunder-matured,sotheupperairwayanatomicnarrowingwasnotwellevaluated.Impulseosclllometry(IOS)wasanew--developedtechniqueofmeasuringlungfunctionandrespiratoryimpedance,whichanalyzedthefrequencyspectrumofrespirationatrestbasedonforcedoscillationprinciple,tomea-surethedifferentcompon…