Air trapping: The major factor limiting diaphragm mobility in chronic obstructive pulmonary disease patients
Air trapping: The major factor limiting diaphragm mobility in chronic obstructive pulmonary disease patients
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DOI：
10.1111/j.1440-1843.2007.01194.x
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发表时间：
2008-01-01
期刊：
影响因子：
6.9
通讯作者：
Fernandes Carvalho, Celso Ricardo
中科院分区：
文献类型：
--
作者：
Dos Santos Yamaguti, Wellington Pereira;Paulin, Elaine;Fernandes Carvalho, Celso Ricardo
背景和目的：慢性阻塞性肺病患者可有膈肌力学受损。一种新的方法来评估隔膜的流动性，使用超声波，最近已被验证。本研究评估COPD患者肺功能与膈肌活动度的关系，以及呼吸肌力量与膈肌活动度的关系。方法：对合并肺恶性膨胀的慢性阻塞性肺病患者54例和健康者20例进行研究。采用超声测量门静脉左支颅足位移，检测患者肺功能、最大呼吸压力和膈肌活动度。结果：COPD患者膈肌活动度低于健康人（36.5 +/- 10.9 mm vs 46.3 +/- 9.5 mm, P = 0.001）。在慢性阻塞性肺病患者中，膈肌活动度与肺功能参数的相关性强（RV: r = -0.60, P < 0.001; RV/TLC: r = -0.76, P < 0.001），中度伴气道阻塞（FEV1: r = 0.55, P < 0.001；气道阻力：r = -0.32, P = 0.02），轻度伴肺过度充气（TLC: r = -0.28, P = 0.04）。膈肌活动度与呼吸肌力量无相关性（最大吸气压力：r = -0.11, P = 0.43；最大呼气压力：r = 0.03, P = 0.80）。结论：本研究结果提示COPD患者膈肌活动度的降低主要是由于空气困住，而不受呼吸肌力量或肺恶性膨胀的影响。
Background and objective: Patients with COPD can have impaired diaphragm mechanics. A new method of assessing the mobility of the diaphragm, using ultrasound, has recently been validated. This study evaluated the relationship between pulmonary function and diaphragm mobility, as well as that between respiratory muscle strength and diaphragm mobility, in COPD patients.Methods: COPD patients with pulmonary hyperinflation (n = 54) and healthy subjects (n = 20) were studied. Patients were tested for pulmonary function, maximal respiratory pressures and diaphragm mobility using ultrasound to measure the craniocaudal displacement of the left branch of the portal vein.Results: COPD patients had less diaphragm mobility than did healthy individuals (36.5 +/- 10.9 mm vs 46.3 +/- 9.5 mm, P = 0.001). In COPD patients, diaphragm mobility correlated strongly with pulmonary function parameters that quantify air trapping (RV: r = -0.60, P < 0.001; RV/TLC: r = -0.76, P < 0.001), moderately with airway obstruction (FEV1: r = 0.55, P < 0.001; airway resistance: r = -0.32, P = 0.02) and weakly with pulmonary hyperinflation (TLC: r = -0.28, P = 0.04). No relationship was observed between diaphragm mobility and respiratory muscle strength (maximal inspiratory pressure: r = -0.11, P = 0.43; maximal expiratory pressure: r = 0.03, P = 0.80).Conclusion: The results of this study suggest that the reduction in diaphragm mobility in COPD patients is mainly due to air trapping and is not influenced by respiratory muscle strength or pulmonary hyperinflation.