单呼吸计数法在脊髓损伤肺功能评价中的应用

doi:10.3969/j.issn.1006-9771.2020.10.005

摘要/Abstract

摘要：

目的观察单呼吸计数(SBC)与脊髓损伤患者肺功能测试指标之间的相关性,评价其对脊髓损伤肺功能水平的预测价值。
方法选取2018年10月至2019年2月门诊及住院的脊髓损伤患者42例,分为颈段(n = 24)和胸段(n = 18),分别完成SBC评估和标准肺功能测试。将SBC结果分别与用力肺活量(FVC)、第1秒用力呼气量(FEV1)、第1秒呼气容积比用力肺活量(FEV1/FVC)、慢呼气肺活量(EVC)及各指标占正常预计值的百分比(%pred)进行相关性分析。根据FEV1%pred分级标准构建接受者工作特征(ROC)曲线。
结果 SBC结果与总体(r= 0.723~0.760, P< 0.01)、颈段(r= 0.549~0.657, P < 0.01)和胸段( r= 0.623~0.847, P < 0.01)的FVC、EVC及预计值百分比均呈正相关,还与总体和颈段的FEV1及预计值百分比呈正相关( r = 0.622~0.760, P< 0.01)。不同界值下ROC曲线下面积为0.864~0.941。
结论在脊髓损伤患者中,SBC测试与标准肺功能测试多个指标之间相关性较好,可用于辅助评估脊髓损伤患者肺功能水平。

关键词: 脊髓损伤, 肺功能, 评定, 单呼吸计数

Abstract:

Objective To investigate the correlation between single-breath counting (SBC) and standard measures of pulmonary function in patients with spinal cord injury, to evaluate the value for predicting pulmonary function.
Methods Forty-two patients (24 with cervical injury and 18 with thoracic injury) were selected from October, 2018 to February, 2019 in outpatients and inpatients. SBC and standard laboratory spirometer tests were performed separately. The correlation of the outcome of SBC and lung function indicators including forced vital capacity (FVC), forced respiratory capacity in the first second (FEV1), FEV1/FVC, slow expiratory vital capacity (EVC) and all the predicted values on the percentage (%pred) were analyzed. A receiver operating characteristic (ROC) curve was constructed according to the lung function classification criteria.
Results The outcome of SBS was correlated with FVC, EVC as well as the percentage of predicted values (r= 0.723 to 0.760, P< 0.01 for the whole patients;r= 0.549 to 0.657, P < 0.01 for cervical ones; r= 0.623 to 0.847, P < 0.01 for thoracic ones), and was also correlated with FEV1 as well as the percentage of predicted values ( r = 0.622 to 0.760, P< 0.01 for whole patients and cervical ones). The area under the ROC curve was 0.864 to 0.941.
Conclusion There is a good correlation between SBC and standard lung function for patients with spinal cord injury, suggesting an assistive diagnostic value for patients with reduced lung function.

Key words: spinal cord injury, pulmonary function, assessment, single-breath counting

中图分类号:

R651.2

龚迪,齐燕,何雅琳,王惠芳. 单呼吸计数法在脊髓损伤肺功能评价中的应用[J]. 《中国康复理论与实践》, 2020, 26(10): 1147-1151.

GONG Di,QI Yan,HE Ya-lin,WANG Hui-fang. Application of Single-breath Counting in Assessment of Pulmonary Function after Spinal Cord Injury[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(10): 1147-1151.

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项目	颈段(n = 28)	胸段(n = 14)	χ²/t值	P值
性别(男/女,n)	24/4	10/4	0.483	0.487
年龄(岁)	46.770±15.179	43.000±8.727	1.011	0.319
体质量(kg)	67.000±14.532	69.69±12.925	0.568	0.573
身高(cm)	169.81±7.185	167.23±7.049	1.072	0.291
病程(月)	10.229±9.188	11.25±6.369	0.345	0.733
ASIA残损分级(n)			2.390	0.495
A级	13	10
B级	3	1
C级	4	1
D级	8	2

项目	总体(n= 42)	颈段(n= 28)	胸段 (n= 14)	t/Z值	P值
FVC( L)	2.69±1.01	2.36±0.84	3.35±1.03	3.367	0.002
FVC%pred (%)	65.07±22.93	56.50±18.52	82.21±21.72	3.794	0.001
FEV1( L)	2.13±0.70	1.92±0.65	2.55±0.62	3.014	0.004
FEV1% pred (%)	63.76±20.45	57.07±18.51	77.14±17.83	3.016	0.002^a
FEV1/FVC(%)	81.92±6.89	83.34±6.80	79.09±6.38	1.948	0.058
FEV1/FVC% pred (%)	103.48±9.47	105.61±9.52	99.21±8.08	2.153	0.037
EVC( L)	2.54±1.00	2.23±0.84	3.15±1.05	3.103	0.004
EVC% pred (%)	60.29±23.31	52.00±18.54	76.86±23.59	3.738	0.001
SBC	36.93±18.67	31.04±14.43	48.71±21.01	3.205	0.003

肺功能指标	总体	颈段	胸段
FVC	0.757^a	0.656^a	0.752^a
FVC% pred	0.729^a	0.572^a	0.847^a
FEV1	0.760^a	0.709^a	0.464
FEV1% pred	0.744^a	0.622^a	0.797^a
FEV1/FVC	-0.175	0.101	-0.516
FEV1/FVC% pred	-0.186	0.079	-0.475
EVC	0.723^a	0.549^a	0.827^a
EVC% pred	0.760^a	0.657^a	0.623^a

肺通气界值(FEV₁% pred)	AUC	下限	上限	敏感性	特异性	P值	最佳界值
70%	0.927	0.858	1.000	0.842	0.87	< 0.001	39.0
60%	0.871	0.761	0.980	0.696	0.947	< 0.001	40.5
50%	0.864	0.754	0.974	0.724	0.923	< 0.001	33.0
35%	0.941	0.739	1	0.816	1	0.004	21.5