Stoller J K, Ferranti R, Feinstein A R
Am Rev Respir Dis. 1986 Dec;134(6):1129-34. doi: 10.1164/arrd.1986.134.5.1129.
When breathlessness is described in conventional clinical indexes-such as the Pneumoconiosis Research Unit score or the Medical Research Council index-the ratings depend only on the magnitude of the most taxing task that the patient can perform. No attention is given to the patient's effort in performing tasks or to the functional impairment produced by dyspnea in everyday activities. To improve the effectiveness and scope of the assessment, the patient's magnitude of effort and task, as well as functional impairment, were combined in a recently developed new index of dyspnea. In the current research, this new index has been further improved and tested. The ratings have been cited with more precise criteria, and the results of the Modified Dyspnea Index created by the new criteria have been compared with results of the conventional Pneumoconiosis Research Unit score, and with physiologic measurements of pulmonary function. For 32 patients with stable chronic obstructive pulmonary disease (COPD), the Modified Dyspnea Index had a moderate correlation with the Pneumoconiosis Research Unit score (Spearman rho = -0.62) and with the FEV1 (Pearson r = 0.71) and FVC (Pearson r = 0.69). Among patients with the same Pneumoconiosis Research Unit score, however, the Modified Dyspnea Index scores showed a substantial gradient. Ratings with both the previous and the modified new dyspnea indexes correlated most strongly with respiratory muscle strength, supporting the idea that dyspnea is mediated by alteration of respiratory muscle function.(ABSTRACT TRUNCATED AT 250 WORDS)
当用传统临床指标（如尘肺病研究单位评分或医学研究委员会指数）来描述呼吸困难时，评分仅取决于患者能够完成的最费力任务的强度。对于患者完成任务时付出的努力或日常活动中呼吸困难所产生的功能损害则未予以关注。为了提高评估的有效性和范围，在最近制定的一项新的呼吸困难指数中，综合考虑了患者的努力程度、任务强度以及功能损害。在当前研究中，这一新指数得到了进一步改进和测试。评分采用了更精确的标准，并将新标准创建的改良呼吸困难指数结果与传统尘肺病研究单位评分结果以及肺功能的生理测量结果进行了比较。对于32例稳定期慢性阻塞性肺疾病（COPD）患者，改良呼吸困难指数与尘肺病研究单位评分（Spearman等级相关系数=-0.62）、第一秒用力呼气容积（FEV1，Pearson相关系数=0.71）和用力肺活量（FVC，Pearson相关系数=0.69）具有中度相关性。然而，在尘肺病研究单位评分相同的患者中，改良呼吸困难指数评分呈现出显著的梯度差异。使用先前和改良后的新呼吸困难指数进行的评分与呼吸肌力量的相关性最强，这支持了呼吸困难是由呼吸肌功能改变介导的观点。（摘要截选至250词）
