目的 評價吸入支氣管舒張劑對中重度慢性阻塞性肺疾?。–OPD）患者平靜呼吸狀態(tài)呼吸力學(xué)的影響。方法 20例中重度COPD患者分別在基礎(chǔ)狀態(tài)和吸入安慰劑30 min后測定基礎(chǔ)肺功能、主觀呼吸困難評分（Borg score）、呼吸方式和呼吸力學(xué)指標(biāo)后，病例分成三組：Ⅰ組吸入沙丁胺醇400 μg 15 min后；Ⅱ組順序吸入異丙托溴胺80 μg 30 min后和吸入沙丁胺醇400 μg 15 min后；Ⅲ組順序吸入沙丁胺醇400 μg 15 min后和吸入異丙托溴胺80 μg 30 min后，分別重復(fù)上述指標(biāo)測定。結(jié)果 與安慰劑對照，吸入支氣管舒張劑后，三組肺功能指標(biāo)（FEV1、FVC、IC）增加（P lt;0.05），跨膈壓（Pdi）、食道壓（Peso）、跨膈壓壓力時間乘積（PTPdi）、食道壓壓力時間乘積PTPeso）和氣道阻力（Raw）均明顯減少（P均 lt;0.05）；PTPeso的減少與Peso和Raw的減少呈顯著正相關(guān)（r分別為0.713和0.602，P均 lt;0.01）；三組主觀呼吸困難評分降低（P lt;0.05），呼吸困難（Borg score）減輕與吸氣做功（ΔPTPeso%）和Raw的減少（ΔRaw）呈正相關(guān)（r分別為0.339和0.358，P均 lt;0.05），與肺功能的變化無顯著相關(guān)性。結(jié)論 吸入支氣管舒張劑可以降低COPD患者吸氣做功和氣道阻力，吸氣做功的減少與氣道阻力減少有關(guān)。支氣管舒張劑能通過減少氣道阻力和吸氣做功減輕COPD患者呼吸困難癥狀。
引用本文： 李寅環(huán),陳榮昌,侯宇虹,陳新,鄭則廣. 吸入支氣管舒張劑對慢性阻塞性肺疾病患者呼吸力學(xué)的影響. 中國呼吸與危重監(jiān)護(hù)雜志, 2007, 6(3): 171-176. doi: 復(fù)制
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| 15. | O’Donnell DE，Lam M，Webb KA.Spirometric correlates of improvement in exercise performance after anticholinergic therapy in chronic obstructive pulmonary disease.Am J Respir Crit Care Med，1999，160：542-549. |
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- 1. Taube C，Lehnigk B，Paasch K，et al.Factor analysis of changes in dyspnea and lung function parameters after bronchodilation in chronic obstructive pulmonary disease.Am J Respir Crit Care Med，2000，162：216-220.
- 2. Di Marco F，Milic-Emili J，Boveri B，et al.Effect of inhaled bronchodilators on inspiratory capacity and dyspnoea at rest in COPD.Eur Respir J，2003，21：86-94.
- 3. Ayers ML，Mejia R，Ward J，et al.Effectiveness of salmeterol versus ipratropium bromide on exertional dyspnoea in COPD.Eur Respir J，2001，17：1132-1137.
- 4. De Troyer A.Effect of hyperinflation on the diaphragm.Eur Respir J，1997，10：708-713.
- 5. Hatipoglu U，Laghi F，Tobin MJ.Does inhaled albuterol improve diaphragmatic contractility in patients with chronic obstructive pulmonary disease?.Am J Respir Crit Care Med，1999，160：1916-1921.
- 6. Maesen BL，Westermann CJ，Duurkens VA，et al.Effects of formoterol in apparently poorly reversible chronic obstructive pulmonary disease.Eur Respir J，1999，13：1103-1108.
- 7. 中華醫(yī)學(xué)會呼吸病學(xué)分會慢性阻塞性肺疾病學(xué)組.慢性阻塞性肺疾病診治指南.中華結(jié)核和呼吸雜志，2002，25：453-460.
- 8. ATS/ERS Statement on respiratory muscle testing.Am J Respir Crit Care Med，2002，166：518-624.
- 9. 鄭則廣，陳榮昌，張秀燕，等.膈肌功能測定及其在慢性阻塞性肺疾病中的應(yīng)用.中國實用內(nèi)科雜志，2003：530-532.
- 10. Dyspnea.Mechanisms，assessment，and management：a consensus statement.American Thoracic Society.Am J Respir Crit Care Med，1999，159：321-340.
- 11. Orozco-Levi M.Structure and function of the respiratory muscles in patients with COPD：impairment or adaptation?.Eur Respir J Suppl，2003，46：41s-51s.
- 12. Gibson GJ.Pulmonary hyperinflation a clinical overview.Eur Respir J，1996，9：2640-2649.
- 13. van der Heijden HF，Dekhuijzen PN，F(xiàn)olgering H，et al.Inotropic effects of salbutamol on rat diaphragm contractility are potentiated by foreshortening.Am J Respir Crit Care Med，1997，155：1072-1079.
- 14. Ram FS，Sestini P.Regular inhaled short acting beta2 agonists for the management of stable chronic obstructive pulmonary disease：Cochrane systematic review and meta-analysis.Thorax，2003，58：580-584.
- 15. O’Donnell DE，Lam M，Webb KA.Spirometric correlates of improvement in exercise performance after anticholinergic therapy in chronic obstructive pulmonary disease.Am J Respir Crit Care Med，1999，160：542-549.
- 16. O’Donnell DE，F(xiàn)orkert L，Webb KA.Evaluation of bronchodilator responses in patients with "irreversible" emphysema.Eur Respir J，2001，18：914-920.
- 17. Duranti R，Misuri G，Gorini M，et al.Mechanical loading and control of breathing in patients with severe chronic obstructive pulmonary disease.Thorax，1995，50：127-133.