容积二氧化碳图死腔参数在慢性阻塞性肺疾病和支气管哮喘中的异同特点分析

目的探讨死腔参数在慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）与支气管哮喘（简称哮喘）中变化趋势的异同。方法对49例COPD患者、35例哮喘患者和35名健康志愿者的肺通气指标及Threshhold死腔（VDT）、Langley死腔（VDL）、Fowler死腔（VDF）、Wolff死腔（VDW）和Bohr死腔（VDB）进行测定分析。结果与健康对照组比较,COPD组VDT显著减小,而VDW、VDB则显著增大,差异均有统计学意义（P〈0.05）,COPD组中VDL、VDF与健康对照组比较差异无统计学意义;在哮喘组中,VDT、VDL、VDF、VDW均较健康对照组显著减小,而VDB与健康对照组比较差异无统计学意义。阻塞程度相同的COPD与哮喘患者比较,VDF、VDW和VDB在COPD组显著高于哮喘组,而VDT、VDL在两组间差异则无统计学意义。相关分析显示,在COPD组中,VDT、VDF、VDW及VDB均与FEV1/FVC呈负相关（P〈0.05）。VDF、VDW及VDB还与FEV1呈负相关（P〈0.05）。而在哮喘组中,除VDB与FEV1呈负相关外（P〈0.05）,其余死腔参数与FEV1/FVC、FEV1均无明显相关性（P〉0.05）。结论由于COPD和哮喘患者在呼吸生理方面变化的异同,其各容积二氧化碳图死腔参数的变化也有所区别。通过分析两者死腔参数的变化趋势,可为临床工作者在COPD和哮喘的诊断及鉴别诊断中提供参考。

The Similar and Different Changes of Volumetric Capnography Dead Spaces in Chronic Obstructive Pulmonary Disease and Asthma

Objective To evaluate the similar and different changes of volumetric capnography dead spaces between chronic obstructive pulmonary disease(COPD) and asthma.Methods Forty-nine COPD patients, thirty-five asthma patients and thirty-five healthy volunteers were enrolled in this study. We measured their spirometry indices and volumetric capnography dead spaces such as VDT, VDL, VDF, VDW and VDB.Results Compared with the healthy controls, VDT in COPD patients decreased significantly, while VDW and VDB significantly increased on the other hand. There were no difference about VDL and VDF between COPD patients and healthy controls. Except for VDB, all of the dead spaces such as VDT、VDL、VDF and VDW in asthma patients were significantly decreased when compared with the health. In the same airway obstructive degree, VDF, VDW and VDB had higher values in COPD patients than in asthma patients, but VDT and VDL had no significant difference between the two groups. Correlation analysis showed that VDT, VDF, VDW and VDB correlated with FEV1/FVC negatively, and VDF, VDW and VDB negatively correlated with FEV1 in COPD group. In the asthma group, only VDB was correlated with FEV1 negatively.Conclusions Volumetric capnography dead space measurements may help us to differentiate asthma and COPD patients.