The Role of Spirometry and Dyspnea Index in the Management of Subglottic Stenosis
The Role of Spirometry and Dyspnea Index in the Management of Subglottic Stenosis
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DOI：
10.1002/lary.28337
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发表时间：
2019-10-11
期刊：
影响因子：
2.6
通讯作者：
Shah, Rupali N.
中科院分区：
文献类型：
--
作者：
Tie, Kevin;Buckmire, Robert A.;Shah, Rupali N.
目的：我们旨在评估肺功能测定和呼吸困难指数（DI）在声门下狭窄（SGS）治疗中的作用以及预测手术需求的能力。我们还评估了肺功能测定、DI和身体SGS参数之间的相关性。方法前瞻性纳入37例成年女性SGS患者。在连续临床访视时获得肺功能测定数据和DI;术中获得物理SGS参数。比较了接受手术干预的患者术前与术后的PIFR、PEFR、EDI、FEV 1/FVC和DI。分析肺活量测定数据、DI和物理SGS参数的相关性，并为肺活量测定测量和DI创建受试者工作特征（ROC）曲线，以确定推荐手术的最佳截止值。结果从术前到术后，所有肺功能测定指标的平均值变化显著（P <0.05）。平均DI在术前（27.5，n = 13，SD = 8.6）和术后访视（8.6，n = 13，SD = 5.5，P < 5 x 10（-5））之间变化显著。所有Pearson相关性均为可忽略不计至中度。峰吸气流速（PIFR）的曲线下面积（AUC）为0.903（95% CI，0.832-0.974），临界值为2.10 L/s; DI的AUC为0.874（95% CI，0.791-0.956），临界值在22-25之间;呼气峰流速（PEFR）的AUC为0.806（95% CI，0.702-0.910），临界值为2.5 L/s;所有其他ROC曲线均低于良好。结论SGS治疗后PIFR、PEFR、EDI、FEV 1/FVC、DI均明显改善。肺功能测定、DI和物理SGS参数之间不存在强相关性。PIFR是我们队列中预测手术干预时机最敏感和特异的指标。证据等级1b喉镜，2019
Objectives We aimed to assess the role of spirometry measures and Dyspnea Index (DI) in response to treatment of subglottic stenosis (SGS) and ability to predict need for surgery. We also assessed correlations between spirometry measures, DI, and physical SGS parameters. Methods Thirty-seven adult female SGS patients were prospectively enrolled. Spirometry data and DI were obtained at serial clinic visits; physical SGS parameters were obtained intraoperatively. PIFR, PEFR, EDI, FEV1/FVC, and DI were compared preoperatively to postoperatively for patients who underwent operative intervention. Spirometry data, DI, and physical SGS parameters were analyzed for correlations, and receiver operating characteristic (ROC) curves were created for spirometry measures and DI to determine optimal cutoffs for recommending surgery. Results Means of all measured spirometry measures changed significantly from preoperative to postoperative visits (P < .05). Mean DIs changed significantly between preoperative (27.5, n = 13, SD = 8.6) and postoperative visits (8.6, n = 13, SD = 5.5, P < 5 x 10(-5)). All Pearson correlations were negligible to moderate. The area under the curve (AUC) for peak inspiratory flow rate (PIFR) was 0.903 (95% CI, 0.832-0.974) with cutoff at 2.10 L/s; the AUC for DI was 0.874 (95% CI, 0.791-0.956) with cutoff between 22-25; the AUC for peak expiratory flow rate (PEFR) was 0.806 (95% CI, 0.702-0.910) with cutoff at 2.5 L/s; all other ROC curves were less than good. Conclusion PIFR, PEFR, EDI, FEV1/FVC, and DIs significantly improve after treatment for SGS. No strong correlations exist between spirometry measures, DI, and physical SGS parameters. PIFR was the most sensitive and specific for predicting timing of operative intervention in our cohort. Level of Evidence 1b Laryngoscope, 2019