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目的应用超声评估慢性阻塞性肺疾病(COPD)患者的膈肌移动度与对合角度变化及其意义。方法用M超法、B超直接法与B超间接法分析平静呼吸时不同操作者及同一操作者测量膈肌移动度用的一致性与重复性;并对各组膈肌移动度、平静及用力呼气末右侧肋膈角处膈与胸壁所形成的对合角度差值(ΔA)进行分析。结果 (1)平静呼吸时,同一操作者与不同操作者中,M超法测量膈肌移动度的一致性与重复性最好。(2)在平静呼吸时膈肌移动度(Δm),其测值均随着COPD病情加重而呈增加趋势,而在用力呼吸时膈肌的移动度(ΔM)、ΔM-Δm、ΔA测值随着COPD的病情加重而呈减少趋势,并且各项指标均以中度组及重度以上组明显(P均<0.01)。结论COPD膈肌移动度及对合角度的超声变化,可作为判定COPD的严重程度的一个指标。
OBJECTIVE: To evaluate the changes of diaphragmatic muscle movement and the angle of confluence in patients with chronic obstructive pulmonary disease (COPD) by ultrasound and its significance. Methods The consistency and repeatability of diaphragmatic muscle mobility measured by different operators and the same operator during calm breathing were analyzed by M-ultrasonography, B-ultrasonography and B-ultrasound method. The changes of diaphragmatic muscle mobility, calmness and force The difference of airway angle (ΔA) formed by the diaphragmatic wall and the chest wall on the right side of the mediastinum was analyzed. Results (1) In the calm breathing, the consistency and repeatability of the M-diaphragmatic muscle mobility were the best among the same operator and different operators. (2) The diaphragmatic muscle mobility (Δm) during calm breathing increased with the severity of COPD, while diaphragmatic muscle mobility (ΔM), ΔM-Δm and ΔA measured with forced respiration COPD was aggravated and showed a decreasing trend, and the indicators were moderate and severe over the group was significantly (P all <0.01). Conclusions The diastolic and diagonal changes of diaphragmatic muscle in COPD can be used as an index to judge the severity of COPD.