肺气肿患者支气管镜肺减容术后动态过度充气的变化。
Change in Dynamic Hyperinflation After Bronchoscopic Lung Volume Reduction in Patients with Emphysema.
机构信息
Department of Pulmonary Diseases, University Medical Center Groningen, Research Institute for Asthma and COPD Groningen, University of Groningen, Groningen, The Netherlands.
Department of Pulmonary Diseases, AA11, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands.
出版信息
Lung. 2020 Oct;198(5):795-801. doi: 10.1007/s00408-020-00382-x. Epub 2020 Jul 24.
BACKGROUND AND PURPOSE
In patients with severe emphysema, dynamic hyperinflation is superimposed on top of already existing static hyperinflation. Static hyperinflation reduces significantly after bronchoscopic lung volume reduction (BLVR). In this study, we investigated the effect of BLVR compared to standard of care (SoC) on dynamic hyperinflation.
METHODS
Dynamic hyperinflation was induced by a manually paced tachypnea test (MPT) and was defined by change in inspiratory capacity (IC) measured before and after MPT. Static and dynamic hyperinflation measurements were performed both at baseline and 6 months after BLVR with endobronchial valves or coils (treatment group) or SoC (control group).
RESULTS
Eighteen patients underwent BLVR (78% female, 57 (43-67) years, FEV 25(18-37) %predicted, residual volume 231 (182-376) %predicted). Thirteen patients received SoC (100% female, 59 (44-74) years, FEV 25 (19-37) %predicted, residual volume 225 (152-279) %predicted. The 6 months median change in dynamic hyperinflation in the treatment group was: + 225 ml (range - 113 to + 803) (p < 0.01) vs 0 ml (- 1067 to + 500) in the control group (p = 0.422). An increase in dynamic hyperinflation was significantly associated with a decrease in residual volume (r = - 0.439, p < 0.01).
CONCLUSION
Bronchoscopic lung volume reduction increases the ability for dynamic hyperinflation in patients with severe emphysema. We propose this is a consequence of improved static hyperinflation.
背景与目的
在严重肺气肿患者中，动态过度充气叠加于已存在的静态过度充气之上。支气管镜肺减容术（BLVR）后显著降低静态过度充气。在本研究中，我们研究了 BLVR 与标准治疗（SoC）对动态过度充气的影响。
方法
通过手动 paced 呼吸急促试验（MPT）诱导动态过度充气，并通过 MPT 前后吸气量（IC）的变化来定义。在 BLVR 后使用支气管镜内瓣膜或线圈（治疗组）或 SoC（对照组）进行静态和动态过度充气测量，分别在基线和 6 个月时进行。
结果
18 名患者接受了 BLVR（78%女性，57（43-67）岁，FEV 25（18-37）%预计值，残气量 231（182-376）%预计值）。13 名患者接受了 SoC（100%女性，59（44-74）岁，FEV 25（19-37）%预计值，残气量 225（152-279）%预计值）。治疗组 6 个月时动态过度充气的中位数变化为：+225 ml（范围-113 至+803）（p<0.01），对照组为 0 ml（-1067 至+500）（p=0.422）。动态过度充气增加与残气量减少显著相关（r=-0.439，p<0.01）。
结论
支气管镜肺减容术增加了严重肺气肿患者的动态过度充气能力。我们提出这是静态过度充气改善的结果。
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