老年慢性阻塞性肺疾病急性加重期病人膈肌形态改变及相关因素分析

doi:10.3969/j.issn.1003-9198.2022.11.006

Abstract

Abstract: Objective To analyze the morphological changes of diaphragm and the related factors in the elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 58 elderly AECOPD inpatients admitted to Shaanxi Provincial People's Hospital were collected as the AECOPD group, and 49 healthy subjects were collected as the control group. The diaphragm thickness at function residual capacity(Tdi_FRC), diaphragm thickness at forced vital capacity(Tdi_FVC), diaphragm thickness at residual volume(Tdi_RV), diaphragmatic displacement during tidal breathing (DD) and diaphragmatic displacement during forced breathing (DDmax) were measured by using Ultrasonography, then the thickening fraction (TF) was calculated. All the indicators between the two groups were compared and multiple linear regression was used to analyze the influencing factors of TF and DD. Results The AECOPD patients were divided into two groups according to GOLD classification: mild-moderate group and severe-very severe group. Compared with the control group and the mild-moderate group, the severe-very severe group showed significantly difference in Tdi_FRC, Tdi_RV, DD, DDmax and TF values (all P＜0.05);And mild-moderate group showed lower level in Tdi_FVC,DDmax and TF than those in the control group ( all P＜0.05). TF was positively correlated with forced expiratory volume in 1 second percentage predicted (FEV1%pred) (β=0.547, P＜0.05), and negtively correlated with the duration of COPD (β=-0.959, P＜0.05) and the number of acute exacerbations in the past 1 year (β=-5.978, P＜0.05), while DD was lowly negatively correlated with the duration of COPD (β=-0.027, P＜0.05) and the number of acute exacerbations within 1 year (β=-0.150, P<0.05). Conclusions Both TF and DDmax in the elderly patients with AECOPD decrease significantly, which are mainly affected by the disease itself, and it is necessary to actively control the progression of COPD and reduce the frequency of exacerbation.

Key words: acute exacerbation of chronic obstructive pulmonary disease, ultrasonography, diaphragm

CLC Number:

R563

LI Yan, WANG Xiao-xiao, SUN Li, NAN Shu-liang, HUO Shu-fen, REN Xiao-ping, WANG Shui-li, WEN Hong-xia. Morphological changes of diaphragm and related factors in elderly patients with AECOPD[J]. Practical Geriatrics, 2022, 36(11): 1101-1105.

References

[1] WANG C, XU J, YANG L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study[J]. Lancet, 2018, 391(10131):1706-1717.
[2] McCOOL F D, TZELEPISG E. Dysfunction of the diaphragm[J]. N Eng J Med, 2012, 366(10):932-942.
[3] ALQAHTANI J S, OYELADE T, SREEDHARAN J, et al. Diagnostic and clinical values of non-cardiac ultrasound in COPD: a systematic review[J]. BMJ Open Respir Res, 2020, 7(1) : e000717.
[4] 韩铭欣, 潘萌萌, 宋维,等. 床旁超声评估脓毒症患者膈肌的形态与功能研究[J]. 中华结核和呼吸杂志,2020, 43(1):35-39.
[5] XU Y, YAMASHIRO T, MORIYA H, et al. Hyperinflated lungs compress the heart during expiration in COPD patients: a new finding on dynamic-ventilation computed tomography[J]. Int J Chron Obstruct Pulmon Dis, 2017, 12:3123-3131.
[6] SAFAVI S, ARTHOFER C, COOPER A, et al. Assessing the impact of posture on diaphragm morphology and function using an open upright MRI system - a pilot study[J]. Eur J Radiol, 2020, 130:109196.
[7] CORBELLINI C, BOUSSUGES A, VILLAFANE J H, et al. Diaphragmatic mobility loss in subjects with moderate to very severe COPD may improve after in-patient pulmonary rehabilitation[J]. Respir Care, 2018, 63(10):1271-1280.
[8] LIM S Y, LIM G, LEE Y J, et al. Ultrasound assessment of diaphragmatic function during acute exacerbation of chronic obstructive pulmonary disease: a pilot study[J]. Int J Chron Obstruct Pulmon Dis, 2019, 14:2479-2484.
[9] KHARAT A, PLOJOUX J. Diaphragmatic assessment by ultrasonography[J]. Rev Med Suisse, 2021, 17(759):1962-1966.
[10] GOLIGHER E C, LAGHI F, DETSKY M E, et al. Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity[J]. Intensive Care Med, 2015, 41(4):642-649.
[11] OKURA K, IWAKURA M, SHIBATA K, et al. Diaphragm thickening assessed by ultrasonography is lower than healthy adults in patients with chronic obstructive pulmonary disease[J]. Clin Respir J, 2020, 14(6):521-526.
[12] YALÇıN B, SEKMENLI N, BAKTIK B, et al. Evaluation of diaphragm thickness and function with ultrasound technique and comparison with spirometry in stable chronic obstructive pulmonary disease[J]. Tuberk Toraks, 2022, 70(1):76-84.
[13] BOUSSUGES A, GOLE Y, BLANC P. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values[J]. Chest, 2009, 135(2):391-400.
[14] GEA J, PASCUAL S, CASADEVALL C, et al. Muscle dysfunction in chronic obstructive pulmonary disease: update on causes and biological findings[J]. J Thorac Dis, 2015,7(10):E418-E438.
[15] DOS SANTOS YAMAGUTI W P, PAULIN E, SHIBAO S, et al. Air trapping: the major factor limiting diaphragm mobility in chronic obstructive pulmonary disease patients[J]. Respirology, 2008,13(1):138-144.
[16] 于刚刚, 王维, 陈疆红,等. 动态胸部数字化X线摄影对慢性阻塞性肺疾病患者膈肌运动功能的评估[J]. 国际呼吸杂志,2021,41(19):1500-1505.
[17] SCOTT A, WANG X, ROAD J D, et al. Increased injury and intramuscular collagen of the diaphragm in COPD: autopsy observations[J]. Eur Respir J,2006,27(1):51-59.

Morphological changes of diaphragm and related factors in elderly patients with AECOPD

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 2

Metrics

Recommended 10

[1]	BAO Ying-ying, ZHUANG Yong-mei, CHE Pei, JI Ying-ying, CHEN Lan,XIAO Yue, LU Jun, ZHAO Ruo-xin, XU Guang-xu. Clinical study on the effects of modified Wuqinxi in improving respiratory function in elderly patients with stroke [J]. Practical Geriatrics, 2023, 37(5): 444-448.
[2]	HUANG Fei. Comparison of NIV-PSV and NIV-NAVA on weaning rate and lung function in ICU patients with AECOPD complicated with respiratory failure [J]. Practical Geriatrics, 2021, 35(8): 820-824.