不同工种石棉肺患者CT肺功能成像指标的差异性研究

目的 采用多层螺旋CT肺功能成像技术评价不同工种石棉肺患者的肺功能指标改变及特点.方法 将30例石棉肺患者按工种分为压型组、梳纺组和原棉组,每组10例.分别于受试者深吸气末和深呼气末屏气行全肺扫描,测定肺容积指标(最大吸气与呼气末肺容积、肺容积差、肺容积比)、平均肺密度指标(吸气与呼气末平均肺密度、肺密度差、肺密度比)和小气道指标(吸气与呼气末壁厚直径比率、吸气末支气管壁面积百分比).结果 压型组、梳纺组和原棉组在性别、年龄、接触史、分期(Ⅰ期)方面差异均无统计学意义(均P＞0.05).肺容积、平均肺密度和小气道指标中,3组间呼气末平均肺密度、呼气末左肺平均肺密度、呼气末右肺平均肺密度、呼气末与吸气末平均肺密度比、吸气末壁厚直径比率、吸气末支气管壁面积百分比和呼气末壁厚直径比率差异均具有统计学意义(均P＜0.05);进一步两两比较发现,梳纺组的上述指标分别与原棉组和压型组比较,差异亦均具有统计学意义(均P＜0.05),而原棉组和压型组间差异均无统计学意义(均P＞0.05);3组间其余指标差异均无统计学意义(均P＞0.05).结论 与压型组和原棉组比较,梳纺组石棉肺患者的肺气肿及小气道壁和肺泡隔纤维性增厚更为明显,应加强对这部分人的保护.     

高位硬膜外麻醉对肺通气和血气的影响

为探讨高平面硬膜外阻滞麻醉对肺通气功能的影响,对29例无明显心肺疾患的择期手术成年病人于硬膜外麻醉前后进行肺功能测试和血气分析。结果:麻醉后肺活量,肺活量占预计值百分比、补呼气量、补吸气量、最大通气量及最大用力呼气流量容积曲线的呼气流量均有显著降低(P<0.05)。提示选择高位硬膜外阻滞时对肺通气功能有一定影响,应用时应有呼吸支持的准备。     

用潮气呼吸流速容量环评价婴幼儿肺炎治疗前后肺功能变化的研究

目的 研究婴幼儿肺炎时小气道阻塞程度及肺功能损害程度。方法 运用潮气呼吸流速容量环（TBFV环）对82例婴幼儿肺炎进行治疗前后肺功能各项指标比较。结果 发现治疗后TBFV环形态有很大的变化，反映小气道功能中到达潮气呼气峰流速时的呼气量／潮气量（％V－PF）及呼出75％潮气量时的呼气流速／潮气呼气峰流速（25／PF），潮气呼气峰流速（PTEF）差异均有显著意义（P＜0．05）。反映通气功能的每公斤潮气量（TV/kg）、呼吸频率（RR）差异有显著意义（P＜0．05）。反映大气道阻塞位置与损害程度的潮气呼吸中期流速与潮气吸气中期流速之比（ME／MI）治疗前后差异无显著意义（P＞0．05）。结论 提示TBFV环可作为评价临床上婴幼儿肺炎的轻重程度，肺功能的损害程度以及观察治疗效果客观的重要依据，值得临床推广应用。     

慢性阻塞性肺疾病患者和吸烟肺功能正常者体内HIF-1α表达及意义

目的探讨低氧诱导因子-1α(HIF-1α)在慢性阻塞性肺疾病(COPD)患者和吸烟肺功能正常者肺组织和血清中表达及其临床意义。方法肺组织标本取自手术治疗的周围型肺癌患者,共32例,检测术前肺功能,将其分为吸烟COPD稳定期组(COPD组,n=10),吸烟肺功能正常组(n=12),不吸烟肺功能正常组(n=10)。术前清晨空腹取血清,术后取癌旁肺组织,ELISA检测血清和肺组织匀浆HIF-1α含量,免疫组织化学方法检测肺组织HIF-1α的表达,并分析HIF-1α表达水平与肺功能指标的相关关系。结果 COPD稳定期组、吸烟肺功能正常组、不吸烟肺功能正常组患者血清HIF-1α含量分别为(73.25±6.12)pg/mL、(60.30±8.00)pg/mL、(47.03±8.43)pg/mL;吸烟肺功能正常组和COPD组明显高于不吸烟肺功能正常组(P0.01),COPD组明显高于吸烟肺功能正常组(P0.01)。COPD稳定期组、吸烟肺功能正常组、不吸烟肺功能正常组患者肺组织匀浆HIF-1α含量分别为(2.04±0.24)pg/μg、(1.67±0.34)pg/μg、(1.12±0.33)pg/μg;吸烟肺功能正常组和COPD组明显高于不吸烟肺功能正常组(P0.01),COPD组明显高于吸烟肺功能正常组(P0.01)。HIF-1α广泛表达于COPD组肺泡和气道上皮细胞、肺小动脉壁的炎症细胞以及巨噬细胞中。血清和肺组织匀浆中HIF-1α含量均与第1秒用力呼气容积与用力肺活量比(FEV1/FVC)、第1秒钟用力呼气容积占预计值百分比(FEV1%pred)呈显著负相关。结论 COPD患者和吸烟肺功能正常者肺组织和血清HIF-1α的表达增加,与气流受限有关。     

用潮气呼吸流速容量环评价婴幼儿肺炎治疗前后肺功能变化的研究

目的研究婴幼儿肺炎时小气道阻塞程度及肺功能损害程度. 方法运用潮气呼吸流速容量环(TBFV环)对82例婴幼儿肺炎进行治疗前后肺功能各项指标比较. 结果发现治疗后TBFV环形态有很大的变化,反映小气道功能中到达潮气呼气峰流速时的呼气量/潮气量(%V-PF)及呼出75%潮气量时的呼气流速/潮气呼气峰流速(25/PF),潮气呼气峰流速(PTEF)差异均有显著意义(p<0.05).反映通气功能的每公斤潮气量(TV/kg)、呼吸频率(RR)差异有显著意义(p<0.05).反映大气道阻塞位置与损害程度的潮气呼气中期流速与潮气吸气中期流速之比(ME/MI)治疗前后差异无显著意义(p>0.05). 结论提示TBFV环可作为评价临床上婴幼儿肺炎的轻重程度,肺功能的损害程度以及观察治疗效果客观的重要依据,值得临床推广应用.     

慢性阻塞性肺疾病患者深吸气量与运动能力的关系

目的: 探讨慢性阻塞性肺疾病(COPD)患者深吸气量与运动能力的关系。方法: 采用呼气负压技术(NEP)检测42例缓解期COPD患者平静呼吸时呼气气流受限(EFL)情况。将COPD患者分为EFL组和无EFL组,并进行常规肺功能和症状限制递增功率心肺运动测试。结果: 42例COPD患者中29例在平静呼吸时检测到EFL,13例未检测到EFL。与无EFL组相比,EFL组深吸气量占预计值百分比(IC%pred)(P＜0.01)、第1 s用力呼气容积占预计值百分比(FEV₁%pred)(P＜0.01)、第1 s用力呼气容积占用力肺活量百分比(FEV₁/FVC%)(P＜0.01)、比弥散量占预计值百分比(DLCO/V_A%pred)(P＜0.05)和最大摄氧量占预计值百分比(VO₂max%pred)(P＜0.01)均显著下降。多元逐步回归分析结果表明,IC%pred和FEV₁%pred对VO₂max%pred有显著预测意义。在EFL组,IC%pred与VO₂max%pred的相关性最好(r=0.787,P＜0.01);在无EFL组,FEV₁%pred与VO₂max%pred的相关性最好(r=0.625,P＜0.01)。结论: 在平静呼吸时出现EFL的COPD患者,肺过度充气可能是运动能力下降的主要原因;在平静呼吸时无EFL的COPD患者,气流阻塞可能是运动能力下降的主要原因。     

哮喘患儿应用便携式肺功能仪自主监测通气功能的初步研究

目的 分析哮喘患儿应用便携式肺功能仪监测通气功能指标的准确度、日常自主监测的可行性及其影响因素,为探索哮喘患儿进行慢病个体化管理奠定基础。方法 选择在首都医科大学附属北京儿童医院过敏反应科确诊的53例哮喘患儿,其中男性41例（77.4%）,女性12例（22.6%）;年龄5～14岁,平均年龄8.34岁。应用便携式肺功能设备（呼吸家A1型,简称A1）测定肺通气功能,获得用力呼气肺活量占预计值的百分比（FVC%pred）、第1秒用力呼气容积占预计值的百分比（FEV1%pred）、第1秒用力呼气容积占用力肺活量百分比（FEV1/FVC）、最大呼气流量占预计值的百分比（PEF%pred）、最大呼气中期流量占预计值的百分比（MMEF%pred）、用力呼出25%、50%、75%肺活量时的瞬间流量占预计值的百分比（FEF25%pred、FEF50%pred、FEF75%pred）共8项参数;与同日在肺功能检查室经压差传感器肺功能仪（Jaeger-Masterscreen型,简称MS）测定常规肺通气所得的上述参数结果进行一致性比较,获得A1测定肺通气功能的准确度。对以上患儿启用初始哮喘控制治疗,其中27...     

营养支持联合社区全民呼吸操锻炼对老年慢性阻塞性肺疾病患者的影响

目的:探讨社区全民呼吸操锻炼联合营养支持对老年慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)患者呼吸功能影响.方法:抽取社区COPD稳定期患者60例为研究对象,随机分对照组和观察组,各30例.对照组行常规呼吸操锻炼,观察组患者行全民呼吸操锻炼联合营养支持.比较两组干预前及干预后6 m的呼吸功能、营养状况及日常活动能力.结果:干预后观察组第一秒用力呼气容积(Forced expiratory volume in one second,FEV1)/用力肺活量、FEV1占预计值百分比、最大呼气中期流速均高于对照组(P<0.05),观察组营养状况和日常活动能力均优于对照组(P<0.05).结论:社区全民呼吸操锻炼联合营养支持可改善COPD患者肺功能、营养状况及日常活动能力.     

肺泡蛋白沉着症定量CT分析与肺功能相关性研究

目的 探讨定量CT参数与肺功能检杳指标在肺泡蛋白沉着症(PAP)全肺灌洗术前后的相关性及应用价值.方法 对20例PAP患者共37次肺CT及同期肺功能检查结果进行相关性分析.对15例20次(两肺19次,单肺1次)行全肺灌洗前后的CT资料进行对比分析.定量CT参数采用患者的最大吸气末全肺容积、全肺质量、全肺含气体积、平均肺体积、平均肺密度及全肺含气体积/全肺容积.肺功能检查指标采用用力肺活量(FVC)、第1秒用力呼吸量(FEV_1)、1秒率(FEV_1/FVC)、呼吸峰流速(PEF)、肺一氧化碳弥散量(D_LCO)以及肺一氧化碳弥散常数(D_LCO/VA),以中国成人肺功能正常参考值作为正常预计值,分别取其占正常预计值的百分比进行相关性分析.结果 (1)全肺质量与FVC%、FEV_1%具有相关性(均P<0.05);全肺含气体积与FVC%、(FEV_1/FVC)%、D_LCO%、D_LCO/VA%之间存在相关性(均P<0.05);平均肺体积、平均肺密度及全肺含气体积/全肺容积分别与FVC%、FEV_1%、(FEV_1/FVC)%、PEF%、D_LCO%、(DLCO/VA)%之间具有相关性(均P<0.05);在所有指标中以全肺含气体积/全肺容积与D_LCO%、(D_LCO/VA)%关系最密切(r=0.725、0.725,均P=0.000).(2)PAP患者经全肺灌洗术后,定最CT检查全肺质量显著减低[(1613±459)g比(1293±351)g,P=0.000],两肺的平均肺密度明显减低[(0.5178±0.15)g/ml比(0.4312±0.10)g/ml,P=0.000],平均肺体积明显增加[(1.216±0.70)ml/g比(1.573±0.61)ml/g,P=0.001],全肺含气体积/全肺容积升高(0.5110±0.14比0.6005±0.10,P=0.000).全肺灌洗前后的全肺容积与全肺含气体积呈正相关(r=0.911,P=0.000).结论 通过最大吸气末行螺旋CT扫描获得的PAP的定量CT参数与肺功能各项指标之间相关性好,因而本法是一种有效的CT肺功能成像技术.全肺灌洗术后以定量CT结果中的全肺质量、平均肺密度及平均含气肺体积改善明显.     

医护一体化模式下早期进阶式早期肺康复训练对老年呼吸衰竭患者肺功能、血气水平及运动耐力的影响

目的:研究医护一体化模式下早期进阶式早期肺康复训练对老年呼吸衰竭患者肺功能、血气水平及运动耐力的影响.方法:选取本院2021 年1 月至2022 年6 月期间86 例老年呼吸衰竭患者随机分组(n=43),在医护一体化模式的基础上,对照组采用常规训练及健康教育,观察组采用进阶式早期肺康复训练辅助,干预前及干预 8 w 后,采用肺功能检测仪检测两组患者第 1 s 用力呼气容积/用力肺活量(Forced vital capacity in the 1st s/Forced expiratory volume,FEV1/FVC)、用力肺活量(Forced vital capacity,FVC)、第 1 s 用力呼气容积占预计值百分比(Forced expiratory volume in 1 s as a percentage of predicted value,FEV1%)水平;采用血气分析仪检测动脉氧分压(Arterial partial pressure of oxygen,PaO2)与二氧化碳分压(Partial pressure of carbon dioxide in artery,PaCO2)水平;采用6 min步行距离测试(6 min Walking Distance Test,6MWD)、改良Barthel指数(Modified Barthel index,MBI)量表评估患者运动功能.结果:与干预前相比,两组FEV1%、FVC、FEV1/FVC、6MWD、MBI、PaO2水平均升高,PaCO2水平均降低(P＜0.05),其中观察组变化更为显著(P＜0.05).结论:医护一体化模式下早期进阶式早期肺康复训练对老年呼吸衰竭患者效果确切,能够增强患者肺功能,改善血气指标,提高运动耐力.     

Pulmonary adaptations to swim and inspiratory muscle training

Because the anomalous respiratory characteristics of competitive swimmers have been suggested to be due to inspiratory muscle work, the respiratory muscle and pulmonary function of 30 competitively trained swimmers was assessed at the beginning and end of an intensive 12-week swim training (ST) program. Swimmers (n = 10) combined ST with either inspiratory muscle training (IMT) set at 80% sustained maximal inspiratory pressure (SMIP) with progressively increased work-rest ratios until task failure for 3-days per week (ST + IMT) or ST with sham-IMT (ST + SHAM-IMT, n = 10), or acted as controls (ST only, ST, n = 10). Measures of respiratory and pulmonary function were assessed at the beginning and end of the 12 week study period. There were no significant differences (P > 0.05) in respiratory and pulmonary function between groups (ST + IMT, ST + SHAM-IMT and ST) at baseline and at the end of the 12 week study period. However, within all groups significant increases (P < 0.05) were observed in a number of respiratory and pulmonary function variables at the end of the 12 week study, such as maximal inspiratory and expiratory pressure, inspiratory power output, forced vital capacity, forced expiratory and inspiratory volume in 1-s, total lung capacity and diffusion capacity of the lung. This study has demonstrated that there are no appreciable differences in terms of respiratory changes between elite swimmers undergoing a competitive ST program and those undergoing respiratory muscle training using the flow-resistive IMT device employed in the present study; as yet, the causal mechanisms involved are undefined.     

Role of small airways in asthma: investigation using high-resolution computed tomography

BACKGROUND: Small airways may have an important role in asthma but are more difficult to assess pathologically than central airways. Computed tomographic indices of lung density are assumed to reflect air trapping and may be a useful noninvasive measure of small airways disease, but their pathophysiological relevance remains undetermined. OBJECTIVE: To evaluate lung density on high-resolution computed tomography and examine its correlations with clinical and physiologic variables in 29 patients with stable asthma. METHODS: Both lungs were scanned at full-inspiratory and full-expiratory phases to quantify percentage of lung field occupied by low attenuation area (LAA%; < -960 Hounsfield units) and mean lung density. Asthma severity, pulmonary function, methacholine airway sensitivity and reactivity, and sputum eosinophil counts were evaluated. RESULTS: The mean lung density increased and LAA% decreased in all patients at expiratory phase compared with inspiratory phase. The inspiratory density indices and expiratory mean lung density correlated only with FEV(1)/forced vital capacity (FVC). Expiratory LAA% correlated more strongly than other variables with FEV(1)/FVC and with indices of peripheral airflow obstruction. Expiratory/inspiratory ratios of LAA% and mean lung density correlated, the former more strongly, with disease severity, residual volume/total lung capacity, and airway sensitivity, as well as with indices of global (FEV(1) and FEV(1)/FVC) and peripheral airflow obstruction. CONCLUSION: Expiratory/inspiratory high-resolution computed tomography is useful for assessing small airways disease in asthma. Small airways involvement is associated with airflow obstruction, airway hypersensitivity, and more severe disease. CLINICAL IMPLICATIONS: Small airways are an important therapeutic target in asthma.     

1-2岁和-3岁肺炎支原体肺炎肺功能的前瞻性对照研究

目的观察1～3岁肺炎支原体（MP）肺炎患儿的肺功能改变情况并探讨其临床意义。方法前瞻性选择2005年1月至2006年12月在广州市妇女儿童医疗中心儿童医院住院治疗的1～3岁MP肺炎患儿为研究对象,按年龄分为1～2岁和～3岁组。采用凝集法检测患儿血清特异性抗体MP-IgM的浓度,滴度≥1：160为阳性,提示MP现症感染。采用美国森迪公司2600幼儿肺功能仪测定MP肺炎患儿急性期肺功能,并以120名1～3岁（1～2岁组62例,～3岁组58例）健康儿童的肺功能数据作为正常对照组。结果研究期间77例MP肺炎患儿入组,1—2岁43例、～3岁34例。1～2岁和～3岁MP肺炎亚组急性期潮气呼吸流速-容量（TBFV）环形态特点均表现为TBFV环变窄,呼气曲线升支陡、高峰提前、峰值增高,降支凹陷;1～2岁MP肺炎亚组急性期呼吸频率（RR）、潮气呼气峰流速（PTEF）较同龄正常对照亚组增加（P〈0．05）;吸气时间／总呼吸时间（Ti／Tt）、到达PTEF时的呼出气量／潮气量（％V—PF）、呼出75％潮气量时的呼气流速／PTEF（25／PF）、潮气呼气中期流速／潮气吸气中期流速（ME／MI）、每千克体重功能残气量（FRC／kg）和每千克体重顺应性（Crs／kg）较同龄正常对照亚组减少（p〈0．05）。～3岁MP肺炎亚组急性期PTEF较同龄正常对照亚组增加（P〈0．05）,Ti／Tt、％V—PF和25／PF较同龄正常对照亚组减少（P〈0．05）。1～2岁和～3岁MP肺炎亚组的临床表现与其肺功能检测的结果较吻合。1～2岁和-3岁MP肺炎亚组咳痰分别为22例（51．2％）和9例（26．5％）,肺部闻及湿啰音分别为19例（44．2％）和8例（23．5％）,胸部X线检查见斑片状影分别为36例（83．7％）和14例（41．2％）,差异均有统计学意义（P均〈0．05）;1～2岁和～3岁MP肺炎亚组发热、喘息或呼吸困难发生率差异均无统计学意义。结论肺功能检测是监测幼儿MP肺炎急性期肺功能改变的较理想方法。1～2岁MP肺炎患儿急性期肺功能改变较大,呈现大、小气道阻力增高,FRC／kg和Crs／kg下降,RR增加;而-3岁MP肺炎患儿急性期肺功能改变相对较小,仅呈现小气道阻力增高改变。     

佐剂性关节炎大鼠肺功能变化与Foxp3、TGF-β1/Smads信号传导通路的相关性研究

目的:观察佐剂性关节炎(Adjuvant arthritis,AA)大鼠肺系数、肺功能变化、调节性T细胞及Foxp3、TGF-β1、Smad3、Smad7蛋白表达,探讨Foxp3与TGF-β/Smads信号传导通路在佐剂性关节炎大鼠肺功能降低中的可能作用机制。方法:将24只Wistar大鼠随机分为正常对照组和模型组,每组12只,向模型组大鼠右后足跖皮内注射弗氏完全佐剂0.1 ml致炎,复制成佐剂性关节炎模型。致炎48天后,观察两组大鼠足跖肿胀度及关节炎指数(AI),计算两组大鼠肺系数,检测大鼠肺功能,测定调节性T细胞百分率,HE染色观察肺病理学改变,免疫组化染色观察Foxp3、TGF-β1、Smad3、Smad7蛋白表达情况。结果:①与正常对照组相比,AA模型组大鼠足跖肿胀度、AI、肺系数、1秒内平均呼气流量(FEV1/FVC)、肺泡炎积分、TGF-β1及Smad3蛋白表达明显升高(P0.01);用力肺活量(FVC)、25%肺活量的最大呼气流量(FEF25)、50%肺活量的最大呼气流量(FEF50)、75%肺活量的最大呼气流量(FEF75)、最大呼气中期流量(MMF)、用力最大呼气流量(PEF)、肺动态顺应性(Cldyn)、CD4+T细胞、CD25+T细胞、CD4+CD25+T细胞百分率、Foxp3蛋白及Smad7蛋白表达显著降低(P0.01)。②Spearman相关分析可知,AA大鼠肺功能参数中FEF50、MMF与足跖肿胀度呈负相关,MMF与肺系数呈负相关,Cldyn与TGF-β1蛋白积分光密度值呈负相关;FEF50、MMF与关节炎指数呈正相关,FEF75与肺系数呈正相关,FEV1/FVC与Foxp3蛋白表达染色指数、Foxp3蛋白积分光密度值呈正相关(P0.05或P0.01)。结论:AA大鼠在足跖肿胀度、关节炎指数升高的同时出现肺功能的下降,提示可能是致炎后炎症的持续、发展而出现慢性炎症反应导致肺的损伤(肺间质纤维化),而肺功能的下降与Foxp3、Smad3、Smad7、TGF-β1蛋白表达呈相关性,说明转录因子Foxp3和TGF-β1/Smads信号传导通路共同参与其作用机制。     

The changes in airway structure associated with reduced FEV1

The purpose of this study is to clarify the changes in the small airways associated with reduced forced expiratory volume in one second (FEV1). We compared the structure of the membranous and respiratory bronchioles of resected lungs from 111 patients with a normal predicted FEV1 to the structure of these airways from 45 patients with an FEV1 reduced below the 95% confidence limits for height and age. Membranous and respiratory bronchioles of less than 2 mm in internal diameter were counted and their diameter and wall thickness were measured. The data show that there were more membranous bronchioles of internal diameter less than 0.4 mm in patients with reduced FEV1. The walls of membranous bronchioles were not increased in thickness but there was an increase in the ratio of wall thickness to lumen diameter. The wall thickness of respiratory bronchioles was increased in the obstructed group and there was also an increase in the ratio of wall thickness to lumen diameter in these airways. We conclude that the patients with obstructive lung disease have a greater increase in wall thickness than can be explained by a reduction in airway support due to emphysema and suggest that the airways obstruction in these patients is due to thickening of the wall and narrowing of the lumen by a chronic inflammatory process.     

Chest wall volumes during inspiratory loaded breathing in COPD patients

Chest wall volumes and breathing patterns of 13 male COPD patients were evaluated at rest and during inspiratory loaded breathing (ILB). The sternocleidomastoid (SMM) and abdominal muscle activity was also evaluated. The main compartment responsible for the tidal volume at rest and during ILB was the abdomen. During ILB patients exhibited, in addition to increases in the ratio of inspiratory time to total time of the respiratory cycle and minute ventilation, increases (p < 0.05) in the chest wall tidal volume by an increase in abdomen tidal volume as a result of improvement of end chest wall inspiratory volume without changing on end chest wall expiratory volume. The SMM and abdominal muscle activity increased 63.84% and 1.94% during ILB. Overall, to overcome the load imposed by ILB, COPD patients improve the tidal volume by changing the inspiratory chest wall volume without modifying the predominant mobility of the abdomen at rest and without affecting the end chest wall expiratory volume.     

Interpretation of changes in spirographic and flow-volume variables after operative treatment in bilateral vocal cord paralysis

In 13 patients, who underwent a superolateralization of a vocal cord after bilateral vocal cord paralysis, we studied pre- and postoperatively spirometric dynamic and static lung volumes and variables from maximal expiratory and maximal inspiratory flow-volume (MEFV and MIFV) curves. The effects of surgical treatment on these variables have been established by comparing the statistical significance of the changes post- versus preoperative. A significant increase was found in the vital capacity and a significant decrease in the indices associated with the dynamic variability of the obstruction. The most significant changes were found in peak inspiratory flow and peak expiratory flow, and in the inspiratory defined dynamic estimates, as forced inspiratory volume in 1 second and maximal voluntary ventilation at a frequency of 30 c X min-1. Significant correlations, however, were found to exist only for the changes within the group of flow-volume indices and for those within the group of spirographic variables. This led us to the conclusion that for the diagnosis of this type of upper airway obstruction these measurements are additive, reflecting different aspects of airway mechanics.     

同步悬空俯卧位对稳定期慢性阻塞性肺疾病患者肺通气功能的影响

探讨同步悬空俯卧位对稳定期慢性阻塞性肺疾病(COPD)患者肺通气功能情况的影响。方法 2009年6月至10月本院门诊就诊的12例稳定期COPD患者,在人工呼吸床上随机采用仰卧位、悬空俯卧位、托平俯卧位、同步悬空俯卧位4种不同体位,每个体位观察10 min,通过NICO无创心肺功能监测系统连续测定患者在不同体位时的心率、动脉血氧饱和度、呼气末二氧化碳分压等一般生命体征和呼吸频率、潮气量、肺泡潮气量、生理无效腔(Vd/Vt)、吸气峰流速(PIF)、呼气峰流速(PEF)等呼吸动力学指标。根据患者的肺功能按美国胸科协会(ATS)和欧洲呼吸学会(ERS)制定的肺功能共同指南标准划分不同阻塞程度,并分析存在通气功能障碍患者的潮气量和呼吸频率等肺功能变化情况。结果 4种体位对心率、动脉血氧饱和度、呼气末二氧化碳分压无明显的影响。呼吸频率在4种体位中由慢至快呈现同步悬空俯卧位＜仰卧位＜托平俯卧位＜悬空俯卧位的趋势[(14.8±3.2)次/min＜(17.6±4.5)次/min ＜(18.4±3.4)次/min＜(19.5±3.4)次/min,均P＜0.05],潮气量和肺泡潮气量由高至低呈现同步悬空俯卧位＞仰卧位＞托平俯卧位＞悬空俯卧位的趋势。生理无效腔、PIF、PEF各组差异无统计学意义。3例重度和5例极重度阻塞通气功能障碍的患者潮气量在各体位间差异均无统计学意义,呼吸频率则在同步悬空俯卧位时最低,分别为(15.3±1.8)次/min、(16.6±1.8)次/min,且与悬空俯卧位时的呼吸频率差异有统计学意义[(19.4±3.4)次/min、(21.4±3.6)次/min,均P＜0.05]。结论 同步悬空俯卧位与其他两种俯卧呼吸体位一样,经短时间观察是安全稳定的,同步悬空俯卧位显著降低患者的呼吸频率、增加潮气量。在阻塞性通气功能障碍的情况下,对潮气量的影响不明显,但仍能降低患者的呼吸频率。     

Pulmonary rehabilitation in patients with neuromuscular disease

In neuromuscular disease (NMD) patients with progressive muscle weakness, respiratory muscles are also affected and hypercapnia can increase gradually as the disease progresses. The fundamental respiratory problems NMD patients experience are decreased alveolar ventilation and coughing ability. For these reasons, it is necessary to precisely evaluate pulmonary function to provide the proper inspiratory and expiratory muscle aids in order to maintain adequate respiratory function. As inspiratory muscle weakening progresses, NMD patients experience hypoventilation. At this point, respiratory support by mechanical ventilator should be initiated to relieve respiratory distress symptoms. Patients with adequate bulbar muscle strength and cognitive function who use a non-invasive ventilation aid, via a mouthpiece or a nasal mask, may have their hypercapnia and associated symptoms resolved. For a proper cough assist, it is necessary to provide additional insufflation to patients with inspiratory muscle weakness before using abdominal thrust. Another effective method for managing airway secretions is a device that performs mechanical insufflation-exsufflation. In conclusion, application of non-invasive respiratory aids, taking into consideration characterization of respiratory pathophysiology, have made it possible to maintain a better quality of life in addition to prolonging the life span of patients with NMD.