Capria María E, D' Negri Carlos, De Vito Eduardo L
Instituto de Investigaciones Médicas Alfredo Lanari, Facultad de Medicina, Universidad de Buenos Aires.
Medicina (B Aires). 2003;63(5):369-76.
The purpose of the present study was: 1) to relate the Hoover sign -SH (+)- with several functional (spirometry and lung volumes) and radiographic (AP x-ray) parameters, 2) to characterize the changes in diaphragmatic curvature radius and the efficiency and to establish some relationships with the functional and radiographic parameters. Fifteen patients with COPD (SH (+), n: 8) were studied. The radius was determined in the right hemidiaphragm after maximal inspired and expired x-ray. The SH (+) was found in more severely obstructed patients (FEV1%, p 0.005%) and with high degree of air trapping (RV/TLC %, p 0.01). The expiratory radius (Re) was higher (p 0.05), and their efficiency (1/Re), was minor (p 0.05). The FEV1% correlated with the degree of hyperinflation according to TLC % (r -0.58, p 0.022) and with air trapping according to RV % (r -0.77, p 0.0008). The patients with low FEV1% showed high Re (r -0.61, p 0.015) and decreased diaphragmatic efficiency during expiration (1/Re) according to 1/Re = 0.093 cm-1 + 0.0012 cm-1* FEV1% (r 0.688, p 0.0054). The FEV1 correlated with the diaphragmatic movement (r 0.71, p 0.003). The PaCO2 correlated with the TLC % (r 0.534, p 0.04), the RV% (r 0.62, p 0.014) and with the radiographic parameters of hyperinflation (r 0.546, p 0.035) and air trapping (r 0.528, p 0.043). The presence of Hoover sign suggest severe bronchial obstruction, diaphragmatic flattening, increase of curvature radius, decrease of mobility and efficiency.
1）将胡佛征-SH（+）-与几个功能参数（肺量计和肺容积）及影像学参数（前后位X线片）相关联；2）描述膈肌曲率半径的变化、效率，并与功能和影像学参数建立一些关系。对15例慢性阻塞性肺疾病患者（SH（+），n = 8）进行了研究。在最大吸气和呼气X线片后测定右半膈肌的半径。发现SH（+）在阻塞更严重的患者（第1秒用力呼气容积百分比，p = 0.005%）和肺内气体潴留程度高的患者（残气量/肺总量百分比，p = 0.01）中出现。呼气半径（Re）更高（p = 0.05），其效率（1/Re）更低（p = 0.05）。第1秒用力呼气容积百分比与基于肺总量百分比的肺过度充气程度相关（r = -0.58，p = 0.022），与基于残气量百分比的气体潴留相关（r = -0.77，p = 0.0008）。第1秒用力呼气容积百分比低的患者显示Re高（r = -0.61，p = 0.015），且根据1/Re = 0.093 cm⁻¹ + 0.0012 cm⁻¹×第1秒用力呼气容积百分比，呼气时膈肌效率降低（1/Re）（r = 0.688，p = 0.0054）。第1秒用力呼气容积与膈肌运动相关（r = 0.71，p = 0.003）。动脉血二氧化碳分压与肺总量百分比（r = 0.534，p = 0.04）、残气量百分比（r = 0.62，p = 0.014）以及肺过度充气的影像学参数（r = 0.546，p = 0.035）和气体潴留（r = 0.528，p = 0.043）相关。胡佛征的存在提示严重支气管阻塞、膈肌扁平、曲率半径增加、活动度和效率降低。
