摘要
目的研究慢性阻塞性肺疾病(COPD)伴心力衰竭患者膈肌移动度与心肺功能的关联性。方法选取2022年1月至2024年1月确诊为COPD伴心力衰竭的患者100例纳入观察组。另选取同期接受体检的健康志愿者100例纳入对照组。两组受检者均接受心肺功能和膈肌移动度检查。评估两组受检者呼吸困难指数、肺通气情况。以对照组为参考,评价观察组膈肌移动度,分析膈肌移动度与肺功能的关联性;对不同分级心力衰竭患者膈肌移动度差异进行评估,分析膈肌移动度与心力衰竭分级之间的关联性。结果观察组改良版英国医学研究委员会呼吸困难问卷评分高于对照组(P<0.05)。相较于对照组,观察组各肺通气指标及膈肌移动度更差(P<0.05)。重度COPD平静呼吸时、用力呼吸时膈肌移动度较轻度、中度COPD膈肌移动度变化幅度更大,膈肌移动度差值更小(P<0.05)。Ⅲ级心力衰竭组平静呼吸时、用力呼吸时膈肌移动度以及膈肌移动度差值较Ⅰ级、Ⅱ级心力衰竭组变化幅度更大(P<0.05),Ⅳ级心力衰竭组上述指标变化幅度进一步加大,较Ⅲ级心力衰竭组差异更加显著(P<0.05)。COPD严重程度、心力衰竭分级、呼吸困难严重程度、残气量与肺总容量比值与平静呼吸时膈肌移动度均呈正相关,与用力呼吸时膈肌移动度均呈负相关(P<0.01)。结论膈肌功能异常不仅是COPD和心力衰竭的共同病理表现,还可能通过影响通气和心脏前负荷等机制,进一步加剧心肺功能的恶化。因此,通过超声技术评估膈肌移动度,有助于更全面地评估COPD伴心力衰竭患者的病情严重程度和预后,并为个体化治疗提供依据。
Objective To study the correlation between diaphragmatic mobility and cardiopulmonary function in patients with chronic obstructive pulmonary disease(COPD)complicated by heart failure.Method One hundred patients diagnosed with COPD complicated by heart failure from January 2022 to January 2024 were selected and included in the observation group.Another 100 healthy volunteers who underwent physical examinations during the same period were selected and included in the control group.Both groups of subjects underwent tests for cardiopulmonary function and diaphragmatic mobility.The dyspnea index and pulmonary ventilation conditions of the two groups were evaluated.Taking the control group as a reference,the diaphragmatic mobility of the observation group was evaluated,and the correlation between diaphragmatic mobility and lung function was analyzed.The differences in diaphragm mobility among patients with different grades of heart failure were evaluated,and the correlation between diaphragm mobility and the grade of heart failure was analyzed and confirmed.Result The score of the modified British Medical Research Council dyspnea Questionnaire(mMRC)in the observation group was higher than that in the control group(P<0.05).Compared with the control group,the ventilation indicators of each lung and the diaphragm mobility in the observation group were worse(P<0.05).In severe COPD,the diaphragmatic mobility changes more significantly during calm breathing and forced breathing than in mild and moderate COPD,and the difference in diaphragmatic mobility is smaller(P<0.05).The diaphragmatic mobility and the difference in diaphragmatic mobility during calm breathing and forced breathing in the grade III heart failure group changed more significantly than those in the grade I and grade II heart failure groups(P<0.05).The changes in the above indicators in the grade IV heart failure group further increased,and the difference was more significant than that in the grade III heart failure group(P<0.05).The severity of COPD,the classification of heart failure,the severity of dyspnea,and the ratio of residual volume to total lung capacity were all positively correlated with the diaphragm mobility during calm breathing,and negatively correlated with the diaphragm mobility during forced breathing(P<0.01).Conclusion Abnormal diaphragm function is not only a common pathological manifestation of COPD and heart failure,but may also further exacerbate the deterioration of cardiopulmonary function by affecting mechanisms such as ventilation and cardiac preload.Therefore,evaluating diaphragmatic mobility through ultrasound technology helps to more comprehensively assess the severity and prognosis of COPD patients with heart failure,and provides a basis for individualized treatment.
作者
刘惠敏
何钢
魏杰
刘皎然
周梦
张荣心
林玉
LIU Huimin;HE Gang;WEI Jie;LIU Jiaoran;ZHOU Meng;ZHANG Rongxin;LIN Yu(Department of Respiratory and Critical Care,the 980th Hospital of Joint Logistic Support Force of the PLA,Shijiazhuang,Hebei 050082,China;Department of Emergency,the 980th Hospital of Joint Logistic Support Force of the PLA,Shijiazhuang,Hebei 050082,China;Department of Ultrasound Diagnosis,the 980th Hospital of Joint Logistic Support Force of the PLA,Shijiazhuang,Hebei 050082,China)
出处
《临床误诊误治》
2025年第19期56-62,共7页
Clinical Misdiagnosis & Mistherapy
基金
河北省医学科学研究课题计划资助(Medical Science Research Project of Hebei,20231327)。
关键词
慢性阻塞性肺疾病
心力衰竭
超声检查
膈肌移动度
心功能
相关性
chronic obstructive pulmonary disease
heart failure
ultrasonography
diaphragmatic mobility
heart function
correlation
作者简介
刘惠敏,本科,主治医师。主要从事呼吸与危重症方向研究;通信作者:何钢,Email:hegyouxiang@163.com。
