[经验会影响对呼吸困难的感知吗？]

Martínez-Moragón E, Perpiñá M, Belloch A

Servicio de Neumología, Hospital Universitario La Fe de Valencia, Valencia, Spain.

Arch Bronconeumol. 2006 Apr;42(4):171-4. doi: 10.1016/s1579-2129(06)60438-2.

OBJECTIVE

The perception of somatic sensations like dyspnea can be influenced by such factors as an individual s personality, experiences, or ability to adapt to stimuli. Our aim was to determine whether the perception of acute bronchoconstriction is different for patients with asthma and patients who have never experienced an episode of airway obstruction.

PATIENTS AND METHOD

We studied 2 groups of patients. The first consisted of 24 subjects with intermittent rhinitis and asthma (10 females and 14 males) with a mean (SD) age of 25 (7) years. All reported not feeling dyspnea at rest on a Borg scale. The second group consisted of 24 subjects who only had rhinitis but no lung disease (no episode of asthma) or dyspnea at rest (12 females and 12 males) with a mean age of 27 (6) years. There were no significant differences between the groups with regard to sex, smoking, economic or educational level, anxiety (determined by the trait portion of the State-Trait Anxiety Inventory), depression (Beck Depression Inventory), or spirometric parameters. All took a histamine bronchial provocation test in which the patient assessed dyspnea on a modified Borg scale after each histamine dose. The provocation dose needed to produce a 20% decrease (PD20) in forced expiratory volume in the first second (FEV1) was calculated. We also recorded dyspnea perception score when FEV1 fell 5%, 10%, 15%, and 20%.

RESULTS

No dyspnea was perceived at PS20 by 12.5% of the asthmatics and by 45% of nonasthmatics (P< .0001). The mean PS20 was 2.4 (2.1) (range, 0-7) in the first group and 0.37 (0.48) (range, 0-3) in the second (P< .0001). More asthma patients than nonasthmatics perceived dyspnea at all degrees of bronchial obstruction. PD20 was different in the 2 groups (1.6 [2] vs 6.03 [5] for the first and second groups, respectively; P< .003), but there was no significant relation between PD20 and PS20 (Spearman s correlation coefficient, 0.19; P= .221).

CONCLUSION

Our findings support the hypothesis that appropriate perception of dyspnea is grounded in prior experience and learning.

目的

诸如呼吸困难等躯体感觉的感知会受到个体性格、经历或适应刺激能力等因素的影响。我们的目的是确定哮喘患者与从未经历过气道阻塞发作的患者对急性支气管收缩的感知是否存在差异。

患者与方法

我们研究了两组患者。第一组由24名患有间歇性鼻炎和哮喘的受试者组成（10名女性和14名男性），平均（标准差）年龄为25（7）岁。所有患者在Borg量表上均表示静息时无呼吸困难。第二组由24名仅患有鼻炎但无肺部疾病（无哮喘发作）或静息时无呼吸困难的受试者组成（12名女性和12名男性），平均年龄为27（6）岁。两组在性别、吸烟、经济或教育水平、焦虑（由状态-特质焦虑量表的特质部分确定）、抑郁（贝克抑郁量表）或肺功能参数方面无显著差异。所有患者均进行组胺支气管激发试验，在每次给予组胺剂量后，患者用改良的Borg量表评估呼吸困难程度。计算使第一秒用力呼气量（FEV1）下降20%所需的激发剂量（PD20）。我们还记录了FEV1下降5%、10%、15%和20%时的呼吸困难感知评分。

结果

12.5%的哮喘患者和45%的非哮喘患者在PD20时未感觉到呼吸困难（P<0.0001）。第一组的平均PD20为2.4（2.1）（范围0 - 7），第二组为0.37（0.48）（范围0 - 3）（P<0.0001）。在所有支气管阻塞程度下，感觉到呼吸困难的哮喘患者比非哮喘患者更多。两组的PD20不同（第一组和第二组分别为1.6[2]和6.03[5]；P<0.003），但PD20与PS20之间无显著相关性（斯皮尔曼相关系数为0.19；P = 0.221）。