肺功能在中心气道阻塞诊断中的作用

发布时间：2018-07-29 11:24

【摘要】：目的中心气道阻塞是指气管、隆突、左右主支气管及中间段支气管的阻塞,病因多样,很多均可通过支气管镜介入治疗得到改善。为了观察流速-容量曲线、IOS及体描对中心气道阻塞患者诊断的意义,我们进行了此项回顾性研究。方法本研究共纳入54名经支气管镜确诊中心气道阻塞患者,对其肺功能检查结果进行统计分析,并予支气管镜检查结果进行对比分析,三种检查技术诊断准确性进行分析。结果 54名支气管镜确诊中心气道阻塞的患者,其中手术、外伤及气管插管后造成的气管狭窄有18例,气道肿物(良恶性均有)有14例,54例患者均进行了肺通气检查,流速-容量曲线显示:83.33%患者FEV1/FVC70%,87.04%患者FEV1占预计值的百分比80%,96.30%患者PEF占预计值的百分比80%,;18例患者FEF50/FIF501,提示存在胸腔外气道阻塞的可能,支气管镜结果其中14名均为声门下及气管上段狭窄,可符合胸腔外气道阻塞,3例患者为胸腔内气道阻塞,1例患者同时存在胸腔内外气道阻塞;4例患者0.2,提示可变性胸腔内气道阻塞,支气管镜结果均提示胸腔内气道阻塞;流速-容量曲线均符合阻塞图形,提示可疑狭窄与支气管镜明确狭窄部位具有一定相关性。50例患者可获得MVV数据,90%患者80%。34例患者脉冲振荡肺结果 70.59%患者R5增加,提示气道总阻力增加,R5:0.73±0.41kpa/(L/s),但仅有29.41%患者R20增加,提示中心气道阻力增加,R20:0.36±0.13kpa/(L/s);X曲线:16例患者呈弓背向上图形,有可疑平台或凹陷。37例患者进行了体描测定:78.38%患者Raw增加,Raw:0.67±0.56(kpa*s)/L,sRaw环:3例患者呈陡峭线性环,提示大致正常,5例患者呈类似勺型改变;17例患者呈顺时针环形,斜率较正常下降,提示吸气及呼气的阻力均增加,大气道阻力增高,12例患者呈S型改变,提示中心气道阻力增加。结论用力流速=容量曲线、IOS及体描诊断中心气道狭窄均有一定意义,但后两者均不够敏感,三者联合可以增加诊断的敏感性及特异性。
[Abstract]:Objective Central airway obstruction refers to the obstruction of trachea, protuberance, left and right main bronchus and middle bronchus, with various etiology, many of which can be improved by bronchoscopic interventional therapy. In order to observe the diagnostic significance of flow volume curve iOS and body-drawing in patients with central airway obstruction, we conducted a retrospective study. Methods 54 patients with central airway obstruction diagnosed by bronchoscopy were included in this study. The results of pulmonary function examination were statistically analyzed and compared with the results of bronchoscopy. The diagnostic accuracy of the three methods was analyzed. Results among 54 patients with central airway obstruction diagnosed by bronchoscopy, 18 cases had tracheal stenosis caused by operation, trauma and tracheal intubation, and 14 cases of airway masses (both benign and malignant) were examined by pulmonary ventilation. The flow-volume curve showed that FEV1 / FVC70% of the patients with FEV1 / FVC70 and 87.04% of the patients had FEV1 as a percentage of the predicted value. 80% of the patients with PEF accounted for 80% of the predicted value, and 80% of the 18 patients had FEF50 / FIF501, indicating the possibility of obstruction of the extrathoracic airway. The results of bronchoscopy showed that 14 of them were subglottic and superior tracheal stenosis. The results showed that there were 3 cases of intrathoracic airway obstruction and 1 case of intrathoracic airway obstruction. 4 cases had intrathoracic airway obstruction, suggesting degenerative intrathoracic airway obstruction, and bronchoscopy results showed thoracic airway obstruction. The flow-volume curves were in accordance with the occlusion pattern, suggesting that there was a certain correlation between suspected stenosis and the definite stenotic site under bronchoscopy. MVV data were obtained in 90% of 80. 34 patients with pulmonary pulse oscillation and 70.59% of patients with increased R5. It was suggested that the total airway resistance was increased by R5: 0.73 卤0.41kpa/ (L / s), but only 29.41% of the patients had increased R20, suggesting that the central airway resistance increased R20: 0.36 卤0.13kpa/ (L / s) X curve: 16 patients showed an upward pattern of the back of the bow. A total of 37 patients with suspicious platform or depression were measured by body drawing. Raw increased by 0.67 卤0.56 (kpa*s) / LnsRaw in 3 patients with steep linear loop, suggesting that 5 patients had similar spoon-shaped changes, 17 patients had clockwise loop, and the slope was lower than normal. The results indicated that the resistance of inspiratory and expiratory was increased, and the resistance of atmospheric tract was increased in 12 patients with S-type change, suggesting the increase of central airway resistance. Conclusion the forced flow velocity = volume curve iOS and body drawing have some significance in the diagnosis of central airway stenosis, but the latter two are not sensitive enough, the combination of the three can increase the sensitivity and specificity of the diagnosis.
【作者单位】：北京大学第一医院呼吸内科;
【分类号】：R56

【相似文献】