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目的探讨不同严重程度慢性持续性哮喘患者肺容量和弥散功能的特点及临床意义。方法收集2014年1月至2015年4月就诊于四川大学华西医院呼吸与危重症医学科门诊的慢性持续期哮喘患者,记录其临床资料以及肺通气功能指标[第1秒用力呼气容积(FEV_1)],采用体积描记法和气体稀释法测定肺容量指标[肺总量(TLC)、残气容积(RV)及RV/TLC],采用单次呼吸法测定肺一氧化碳弥散量(D_LCO)。根据患者的临床症状和FEV_1占预计值百分比(FEV_1%pred)将这些患者分为轻度、中度和重度,对组间资料进行比较,并对肺通气功能指标与肺容量和D_LCO%pred的关系进行相关分析。结果共纳入93例哮喘患者。随哮喘患者严重程度的加重,肺容量指标(TLC、RV和RV/TLC)逐渐增加,而且体积描记法和气体稀释法两种方法之间的差值△TLC%pred、△RV%pred和△RV/TLC逐渐增加。随FEV_1%pred的降低,D_LCO%pred则稍有下降。相关分析显示,FEV_1%pred与△TLC%pred、ARV%pred和△RV/TLC呈显著负相关,与D_LCO%pred呈显著正相关。结论与气体稀释法相比,体积描记法能更准确地对哮喘患者的肺容量进行测定。随气流受限程度加重,哮喘患者弥散功能逐渐下降,但仍在正常范围。
Objective To investigate the characteristics and clinical significance of lung volume and diffuse function in patients with chronic persistent asthma of different severity. Methods Patients with chronic persistent asthma who were referred to Respiratory and Critical Care Medicine Clinic at West China Hospital of Sichuan University from January 2014 to April 2015 were enrolled in this study. The clinical data and pulmonary function indexes (FEV_1 )]. Pulmonary volume index (pulmonary volume (TLC), residual volume (RV) and RV / TLC] were measured by plethysmography and gas dilution method. The diffusing capacity of carbon monoxide (D_LCO) was determined by single breath method. These patients were categorized as mild, moderate, and severe according to their clinical symptoms and FEV 1% predictor (FEV 1% pred). Data were compared between groups and the lung function and lung volume and D_LCO% pred Relationship analysis. Results A total of 93 asthma patients were enrolled. With the severity of asthma exacerbations, the lung volume index (TLC, RV and RV / TLC) increased gradually, and the differences between the two methods of plethysmography and gas dilution were TLC% pred, △ RV% pred and △ RV / TLC gradually increased. As FEV_1% pred decreases, D_LCO% pred decreases slightly. Correlation analysis showed that FEV_1% pred had a significant negative correlation with △ TLC% pred, ARV% pred and △ RV / TLC, and had a significant positive correlation with D_LCO% pred. Conclusions Compared with the gas dilution method, the plethysmography can determine the lung capacity of asthmatic patients more accurately. With the degree of airflow limitation increased, diffuse function gradually decreased in patients with asthma, but still in the normal range.