Mishima M, Oku Y, Muro S, Hirai T, Chin K, Ohi M, Nakagawa M, Fujita M, Sato K, Shimada K, Yamaoka S, Oda Y, Asai N, Sagawa Y, Kuno K
Department of Clinical Physiology, Chest Disease Research Institute, Kyoto University.
Intern Med. 1996 Jun;35(6):453-8. doi: 10.2169/internalmedicine.35.453.
We examined the relationships among dyspnea ratings in daily life, the physiologic state, and anxiety and depression of fifty-two patients with chronic obstructive disease (COPD) during long-term domiciliary oxygen therapy (LTOT). Clinical ratings of dyspnea were assessed by the visual-analog scale (VAS) during eight types of basic behavior in indoor daily life. Analysis of the physiologic state included forced expiratory volume in 1 second (FEV1.0), and arterial blood gas (PaO2, PaCO2) at rest while breathing room air. The hospital anxiety and depression (HAD) scale, which consists of 14 questions, was used to assess the degree of anxiety (HAD-A) and depression (HAD-D). The mean age of the patients was 69.5 +/- 10.8 year (SD), and the duration of LTOT was 944 +/- 739 days. The mean values were 0.77 +/- 0.45 L for FEV1.0, 57.7 +/- 7.4 Torr for PaO2, and 47.4 +/- 8.1 Torr for PaCO2. FEV1.0 was correlated with PaCO2(r = -0.548, p < 0.0001), but it was not correlated with PaO2. High correlation was noted between HAD-A and HAD-D (r = 0.693, P < 0.0001), whereas correlation was not noted between HAD and the physiologic state. VAS was significantly correlated with FEV1.0 (r = 0.320, p < 0.05), as well as with HAD-A (r = 0.358, p < 0.01) and HAD-D (r = 0.444, p < 0.01). Dyspnea ratings were found to be influenced by anxiety and the depression state, and also by the degree of flow limitation in patients with COPD during LTOT. In contrast, the physiologic state scarcely influenced the anxiety and depression state. Thus, psychotherapy may play an important role in the reduction of dyspnea sensation, which is an important determinant of quality of life.
我们研究了52例慢性阻塞性肺疾病（COPD）患者在长期家庭氧疗（LTOT）期间，日常生活中的呼吸困难评分、生理状态以及焦虑和抑郁之间的关系。通过视觉模拟量表（VAS）对室内日常生活中8种基本行为时的呼吸困难进行临床评分。生理状态分析包括静息状态下呼吸室内空气时的1秒用力呼气量（FEV1.0）和动脉血气（PaO2、PaCO2）。采用包含14个问题的医院焦虑抑郁量表（HAD）评估焦虑程度（HAD-A）和抑郁程度（HAD-D）。患者的平均年龄为69.5±10.8岁（标准差），LTOT持续时间为944±739天。FEV1.0的平均值为0.77±0.45L，PaO2为57.7±7.4Torr，PaCO2为47.4±8.1Torr。FEV1.0与PaCO2相关（r = -0.548，p < 0.0001），但与PaO2不相关。HAD-A与HAD-D之间存在高度相关性（r = 0.693，P < 0.0001），而HAD与生理状态之间无相关性。VAS与FEV1.0显著相关（r = 0.320，p < 0.05），也与HAD-A（r = 0.358，p < 0.01）和HAD-D（r = 0.444，p < 0.01）相关。结果发现，在LTOT期间，COPD患者的呼吸困难评分受焦虑和抑郁状态影响，也受气流受限程度影响。相比之下，生理状态对焦虑和抑郁状态几乎没有影响。因此，心理治疗可能在减轻呼吸困难感觉方面发挥重要作用，而呼吸困难感觉是生活质量的一个重要决定因素。
