Kurpatov I G, Geltser B I, Kinyaikin M F
Far Eastern Federal University.
Vladivostok State Medical University.
Ter Arkh. 2020 Apr 27;92(3):7-12. doi: 10.26442/00403660.2020.03.000239.
The respiratory muscles (RM) strength is the main indicator of their functional state. However, RM strength is not used as criteria for chronic obstructive pulmonary disease (COPD) stratification.
To evaluate the RM power of COPD patients with various variants of comorbidity and to determine the role of comorbidity in the development of respiratory muscle dysfunction.
RM strength of 64 men with exacerbation of COPD was studied. The severity of comorbidity was assessed by the Charlson index. Depending on the prevalence of comorbidity, patients were divided into 3 groups: cardiovascular, cerebrovascular and metabolic. Maximum inspiratory (MIP) and expiratory (MEP) pressures in the oral cavity, maximum rate of pressure development (MRPD), sniff nasal inspiratory pressure (SNIP), MEP/MIP and SNIP/MIP indexes were determined with MicroRPM device (UK). Measured values of MIP, MEP and SNIP were compared with the proper ones. The most noticeable decrease of RM strength was defined in the group of patients with severe comorbidity.
In case of a mild comorbidity MEP and SNIP values were 68 and 78% of the predicted values and MIP value corresponded to the personified standard. RM strength of patients with COPD depended on the clinical variant of comorbidity. Thus, in the group of patients with cardiovascular variant of comorbidity auxiliary inspiratory muscles strength decreased. In the group of patients with cerebrovascular variant of comorbidity the expiratory muscles dysfunction predominated. In the group of patients with metabolic variant of comorbidity diaphragm dysfunction predominated.
The pathogenetic significance of various factors of COPD comorbidity in the development of RM dysfunction was confirmed by the results of the correlation analysis.
呼吸肌（RM）力量是其功能状态的主要指标。然而，RM力量未被用作慢性阻塞性肺疾病（COPD）分层的标准。
评估合并症不同类型的COPD患者的RM功率，并确定合并症在呼吸肌功能障碍发展中的作用。
研究了64例COPD加重期男性患者的RM力量。采用Charlson指数评估合并症的严重程度。根据合并症的患病率，患者分为3组：心血管组、脑血管组和代谢组。使用MicroRPM设备（英国）测定口腔内的最大吸气（MIP）和呼气（MEP）压力、最大压力发展速率（MRPD）、嗅鼻吸气压力（SNIP）、MEP/MIP和SNIP/MIP指数。将MIP、MEP和SNIP的测量值与相应的正常值进行比较。在合并症严重的患者组中，RM力量下降最为明显。
在轻度合并症的情况下，MEP和SNIP值分别为预测值的68%和78%，MIP值符合个体化标准。COPD患者的RM力量取决于合并症的临床类型。因此，在合并心血管疾病的患者组中，辅助吸气肌力量下降。在合并脑血管疾病的患者组中，呼气肌功能障碍占主导。在合并代谢疾病的患者组中，膈肌功能障碍占主导。
相关性分析结果证实了COPD合并症的各种因素在RM功能障碍发展中的致病意义。
