国际呼吸杂志
國際呼吸雜誌
국제호흡잡지
INTERNATIONAL JOURNAL OF RESPIRATION
2008年
19期
1171-1174
,共4页
呼出气CO2容积曲线%肺泡死腔%通气/血流灌注%气体分布%肺疾病
呼齣氣CO2容積麯線%肺泡死腔%通氣/血流灌註%氣體分佈%肺疾病
호출기CO2용적곡선%폐포사강%통기/혈류관주%기체분포%폐질병
Volumetric capnoraphy%Alveolar dead space%Ventilation-perfusion tatio%Gasdistribution%Pulmonary disease
目的 评价无创肺换气功能诊断技术即呼出气CO2容积曲线(VCap)对肺部疾病慢性阻塞性肺疾病(chronic obstructive pulmonary disease.COPD)、支气管哮喘(简称哮喘)和间质性肺疾病(ILD)患者换气功能障碍的诊断价值及临床意义.方法 对照组(医院对照)94人,平均年龄(61.59±8.73)岁.COPD组287例.平均年龄(64.31±11.71)岁.根据COPD肺功能分级标准分4级:COPD Ⅰ级(9例)、COPD Ⅱ级(141例)、COPD Ⅲ级(75例)、COPDⅣ级(62例).哮喘组251例,平均年龄(57.86±13.54)岁.根据气道阻塞程度分4级(分级标准同COPD):轻度阻塞(6例)、中度阻塞(113例)、重度阻塞(100例)、极重度阻塞(32例).ILD组45例,平均年龄(56.42±13.97)岁.主要分析变量:最大呼出气二氧化碳浓度、Ⅲ相斜率(dC/dV3)、呼出气最高CO2浓度的25%～50%时的容积与潮气容积的比值(Vm25-50/VT)、呼出气最高CO2浓度的50%～75%时的容积与潮气容积的比值(Vm50-75/VT).结果 ①ILD、哮喘和COPD分别与对照组比较:Vm25-50/VT、Vm50-75/VT、FeCO2max、dC/dV3,差异有统计学意义(P<0.01);②轻度哮喘和轻度COPD组比较:Vm50-75/VT,dC/dV3差异无统计学意义;中、重度组比较:Vms50-75/VT,dC/dV3差异有统计学意义(P<0.01);哮喘合并肺气肿和COPD(肺气肿)组比较差异无统计学意义;③Vm50-75/VT和dC/dV3用于COPD(肺气肿)的评价敏感度分别为98.3%和96.5%.特异度分别为91.4%和86.1%.结论 ①COPD、哮喘和ILD患者VCap形态异常.dC/dV3增高并且与疾病的严重程度有关,示肺内气体分布不均,系气道阻力增高和(或)肺顺应性改变导致吸入气体分布不均和呼出气体非同步排空所致,ILD相对于COPD和哮喘则气体分布不均更为突出;②变量Vm50-75/VT间接反映肺泡死腔量,相对受生理因素及通气量的影响小,与常规肺功能指标均有较好的相关性,可作为评价肺部疾病换气功能障碍即肺泡死腔增大,通气血流/灌注失调间接指标.③Vm50-75/VT%≥10%和dC/dV3≥1.3%/L用于评价肺气肿有较高敏感度和特异度.
目的 評價無創肺換氣功能診斷技術即呼齣氣CO2容積麯線(VCap)對肺部疾病慢性阻塞性肺疾病(chronic obstructive pulmonary disease.COPD)、支氣管哮喘(簡稱哮喘)和間質性肺疾病(ILD)患者換氣功能障礙的診斷價值及臨床意義.方法 對照組(醫院對照)94人,平均年齡(61.59±8.73)歲.COPD組287例.平均年齡(64.31±11.71)歲.根據COPD肺功能分級標準分4級:COPD Ⅰ級(9例)、COPD Ⅱ級(141例)、COPD Ⅲ級(75例)、COPDⅣ級(62例).哮喘組251例,平均年齡(57.86±13.54)歲.根據氣道阻塞程度分4級(分級標準同COPD):輕度阻塞(6例)、中度阻塞(113例)、重度阻塞(100例)、極重度阻塞(32例).ILD組45例,平均年齡(56.42±13.97)歲.主要分析變量:最大呼齣氣二氧化碳濃度、Ⅲ相斜率(dC/dV3)、呼齣氣最高CO2濃度的25%～50%時的容積與潮氣容積的比值(Vm25-50/VT)、呼齣氣最高CO2濃度的50%～75%時的容積與潮氣容積的比值(Vm50-75/VT).結果 ①ILD、哮喘和COPD分彆與對照組比較:Vm25-50/VT、Vm50-75/VT、FeCO2max、dC/dV3,差異有統計學意義(P<0.01);②輕度哮喘和輕度COPD組比較:Vm50-75/VT,dC/dV3差異無統計學意義;中、重度組比較:Vms50-75/VT,dC/dV3差異有統計學意義(P<0.01);哮喘閤併肺氣腫和COPD(肺氣腫)組比較差異無統計學意義;③Vm50-75/VT和dC/dV3用于COPD(肺氣腫)的評價敏感度分彆為98.3%和96.5%.特異度分彆為91.4%和86.1%.結論 ①COPD、哮喘和ILD患者VCap形態異常.dC/dV3增高併且與疾病的嚴重程度有關,示肺內氣體分佈不均,繫氣道阻力增高和(或)肺順應性改變導緻吸入氣體分佈不均和呼齣氣體非同步排空所緻,ILD相對于COPD和哮喘則氣體分佈不均更為突齣;②變量Vm50-75/VT間接反映肺泡死腔量,相對受生理因素及通氣量的影響小,與常規肺功能指標均有較好的相關性,可作為評價肺部疾病換氣功能障礙即肺泡死腔增大,通氣血流/灌註失調間接指標.③Vm50-75/VT%≥10%和dC/dV3≥1.3%/L用于評價肺氣腫有較高敏感度和特異度.
목적 평개무창폐환기공능진단기술즉호출기CO2용적곡선(VCap)대폐부질병만성조새성폐질병(chronic obstructive pulmonary disease.COPD)、지기관효천(간칭효천)화간질성폐질병(ILD)환자환기공능장애적진단개치급림상의의.방법 대조조(의원대조)94인,평균년령(61.59±8.73)세.COPD조287례.평균년령(64.31±11.71)세.근거COPD폐공능분급표준분4급:COPD Ⅰ급(9례)、COPD Ⅱ급(141례)、COPD Ⅲ급(75례)、COPDⅣ급(62례).효천조251례,평균년령(57.86±13.54)세.근거기도조새정도분4급(분급표준동COPD):경도조새(6례)、중도조새(113례)、중도조새(100례)、겁중도조새(32례).ILD조45례,평균년령(56.42±13.97)세.주요분석변량:최대호출기이양화탄농도、Ⅲ상사솔(dC/dV3)、호출기최고CO2농도적25%～50%시적용적여조기용적적비치(Vm25-50/VT)、호출기최고CO2농도적50%～75%시적용적여조기용적적비치(Vm50-75/VT).결과 ①ILD、효천화COPD분별여대조조비교:Vm25-50/VT、Vm50-75/VT、FeCO2max、dC/dV3,차이유통계학의의(P<0.01);②경도효천화경도COPD조비교:Vm50-75/VT,dC/dV3차이무통계학의의;중、중도조비교:Vms50-75/VT,dC/dV3차이유통계학의의(P<0.01);효천합병폐기종화COPD(폐기종)조비교차이무통계학의의;③Vm50-75/VT화dC/dV3용우COPD(폐기종)적평개민감도분별위98.3%화96.5%.특이도분별위91.4%화86.1%.결론 ①COPD、효천화ILD환자VCap형태이상.dC/dV3증고병차여질병적엄중정도유관,시폐내기체분포불균,계기도조력증고화(혹)폐순응성개변도치흡입기체분포불균화호출기체비동보배공소치,ILD상대우COPD화효천칙기체분포불균경위돌출;②변량Vm50-75/VT간접반영폐포사강량,상대수생리인소급통기량적영향소,여상규폐공능지표균유교호적상관성,가작위평개폐부질병환기공능장애즉폐포사강증대,통기혈류/관주실조간접지표.③Vm50-75/VT%≥10%화dC/dV3≥1.3%/L용우평개폐기종유교고민감도화특이도.
Objective To evaluate the diagnostic and clinical value of volumetric capnography(VCap)for pulmonary gas exchange dysfunction in patients with pulmonary disease. Methods VCap was performedon all patients with pulmonary disease, including 287 chronic obstructive pulmonary disease (COPD)patients,251 asthma patients, 45 interstitial lung diseases(ILD) patients and 94 control subjects. Mainvariables: maximum CO2 concentration(CO2 max), the slope of phase3 (dC/dV3), volume between 25% and50 % of CO2 max (Vm25-50), volume between 50% and 75% of CO2 max (Vm50-75), Vm25-50/VT, Vm50-75/VT.Results (1)Four variables of Vcap exhibited statistical differences (P<0.01) between three disease groups(ILD,asthma,COPD) and control group; (2) Vm50-75/VT and dC/dV2 had no statistical differences betweenlight asthma and light COPD, but showed statistical differences (P<0.01) between moderate, severeasthma and COPD, and had no statistical differences between COPD(emphysema) and asthma combiningwith emphysema; (3) Vm50-75/VT and dC/dV3 had high sensitivity (98.3%, 96.50%) and specificity (91.4 %,86.1%) in estimating COPD(emphysema). Conclusions (1)The values and pattern of VCap are obviouslyabnormal,which can be used for diagnosing pulmonary gas exchange dysfunction of patients with COPD.dC/dV3 (≥1.3%) has a prominent rise in COPD patients and relates to the severity of COPD, showing anunequal pulmonary gas distributing;(2)Vm50-75/VT and Vm25-50/VT are less affected by physiological factorsand expired volume, Vm25-50/VT (≥7%), Vm50-75/VT≥10%) indirectly reflects alveolar dead spaceincreasing and unequal ventilation-perfusion ratio commendably; (3)VCap is simple, rapid, non-invasive, andsecure and can be repeated well.
