膈肌功能测定及其在慢性阻塞性肺疾病中的应用

目的　比较最大跨膈压 (Pdimax)、最大口腔吸气压 (MIP)、最大吸鼻跨膈压 (Pdisniff)和颤搐性跨膈压(Pdi(t)ele)在评价膈肌功能中的差异及其在慢性阻塞性肺疾病 (COPD)中的应用。方法　对 13例正常者和 7例轻度与 7例重度COPD病人分别测定Pdimax、MIP、Pdisniff和Pdi(t)ele。结果　 (1)正常对照组的Pdimax、MIP、Pdisniff与轻度COPD组比较差异无显著性 ,与重度COPD组比较差异有显著性 (P 分别为 :<0 0 1、0 0 5和 0 0 5 ) ;而正常对照组Pdi(t)ele均比轻度和重度COPD组的高 (P均 <0 0 1)差异显著。 (2 )Pdi(t)ele的个体内变异性在正常对照组中均比Pdimax、MIP、Pdisniff小 (P分别为 :<0 0 1、0 0 1和 0 0 5 ) ;在COPD组中 ,明显比Pdimax小 (P <0 0 1) ,而与MIP和Pdisniff比较差异没有显著性。 (3)Pdi(t)ele与FEV1具有显著相关性 (P <0 0 5 )。结论　Pdi(t)ele能更客观、更敏感地反映膈肌功能。

Comparison of different methods in assessing diaphragmatic muscle function and their application in patients with COPD

Objective To compare the sensitivity and variability of Pdi max,MIP,Pdi sniff and Pdi (t)ele in the assessment of diaphragmatic strength and investigate theirs application in patients with COPD.Methods Pdi max,MIP, Pdi sniff and Pdi (t)ele were measured in 13 normal subjects ,7 mild COPD and 7 severe COPD patients.Results (1)The Pdi max?MIP ?Pdi sniff in the normal group were significantly higher than that in the severe COPD (P<0 01?<0 05 and <0 05,respectively),but there was no difference between the normal group and the mild COPD group.However,the Pdi (t)ele in normal subjects were significantly higher than the mild and the severe COPD group(both P<0 01).(2)The within-subject variability of Pdi (t)ele was less than that of Pdi max?MIP ?Pdi sniff in the normal group (P<0 01,<0 01 and <0 05,respectively) and that of Pdi max(P < 0 01) in the COPD group,but there was no difference between Pdi (t)ele and MIP or Pdi sniff in the COPD group.(3)There was a significant relationship between the Pdi (t)ele and FEV 1(P<0 05) in the COPD group.Conclusion Pdi (t)ele is more reliable and sensitive in assessing diaphragmatic function.