Mahler D A, Weinberg D H, Wells C K, Feinstein A R
Chest. 1984 Jun;85(6):751-8. doi: 10.1378/chest.85.6.751.
To improve the clinical measurement of dyspnea, we developed a baseline dyspnea index that rated the severity of dyspnea at a single state and a transition dyspnea index that denoted changes from that baseline. The scores in both indexes depend on ratings for three different categories: functional impairment; magnitude of task, and magnitude of effort. At the baseline state, dyspnea was rated in five grades from 0 (severe) to 4 (unimpaired) for each category. The ratings for each of the three categories were added to form a baseline focal score (range, 0 to 12). At the transition period, changes in dyspnea were rated by seven grades, ranging from -3 (major deterioration), to +3 (major improvement). The ratings for each of the three categories were added to form a transition focal score (range, -9 to +9). In 38 patients tested with respiratory disease, interobserver agreement was highly satisfactory for both indexes. The baseline focal score had the highest correlation (r = 0.60; P less than 0.001) with the 12-minute walking distance (12 MW), while significant, but lower, correlations existed for lung function. For the transition focal score, there was a significant correlation only with the 12 MW (r = 0.33; p = 0.04). These results indicate that dyspnea can receive a direct clinical rating that provides important information not disclosed by customary physiologic tests.
为改善呼吸困难的临床测量方法，我们制定了一个基线呼吸困难指数，用于评定单一状态下呼吸困难的严重程度，还制定了一个过渡呼吸困难指数，用于表示相对于该基线的变化。两个指数的评分均取决于对三个不同类别的评级：功能损害；任务量；努力程度。在基线状态下，每个类别中的呼吸困难按从0（严重）到4（无损害）分为五个等级。将三个类别的评级相加，得出基线焦点评分（范围为0至12）。在过渡期间，呼吸困难的变化按七个等级评定，范围从-3（严重恶化）到+3（显著改善）。将三个类别的评级相加，得出过渡焦点评分（范围为-9至+9）。在38例患有呼吸系统疾病的受试患者中，两个指数的观察者间一致性都非常令人满意。基线焦点评分与12分钟步行距离（12MW）的相关性最高（r = 0.60；P < 0.001），与肺功能也存在显著但较低的相关性。对于过渡焦点评分，仅与12MW存在显著相关性（r = 0.33；p = 0.04）。这些结果表明，呼吸困难可以获得直接的临床评级，该评级提供了常规生理测试未揭示的重要信息。
