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目的 评价吸入支气管扩张剂治疗对慢性阻塞性肺疾病 (COPD)患者呼气流速受限 (EFL)的影响。方法 2 8例稳定期中、重度COPD患者在吸入沙丁胺醇干粉剂前后行常规肺功能测定和呼气负压 (NEP)测试。结果 NEP测试显示所有患者均存在EFL。吸入沙丁胺醇后FEV1 ,FVC和FEF50 iso vol均有显著增高 ,流速受限 (FL)指数则明显下降〔(79.1± 1 2 .0 ) %与 (63 .2± 1 2 .9) % ,P <0 .0 1〕。 1 1例COPD患者的FEV1 ≥ 1 5 % (阳性组 ) ,其余1 7例FEV1 <1 5 % (阴性组 ) ,两组患者的FEF50 iso vol和FL指数则无明显差异 (FEF50 iso vol为 (43 .3± 2 0 .2 ) %与 (39.6± 2 1 .7) % ,FL指数为〔(2 1 .5± 8.4) %与 (1 9.6± 1 1 .7) % ,均P >0 .0 5〕。FL指数与ΔFEF50 % iso vol呈显著相关(r =0 .50 8,P <0 .0 1 ) ,而与FEV1 的相关性不明显 (r=0 .1 0 6 ,P >0 .0 5)。结论 COPD患者在吸入支气管扩张剂后其EFL可得到显著改善 ,FVC和FEV1 均显著增加 ,EFL的改善程度相当于FEF50 %的改变程度
Objective To evaluate the effect of inhaled bronchodilator therapy on expiratory flow limitation (EFL) in patients with chronic obstructive pulmonary disease (COPD). Methods Twenty-eight patients with moderate and severe COPD underwent routine pulmonary function test and negative exhalation (NEP) tests before and after inhaling albuterol dry powder. Results The NEP test showed that all patients had EFL. The inhalation of albuterol FEV1, FVC and FEF50 iso vol were significantly increased, flow limited (FL) index decreased significantly (79.1 ± 122.0)% and (63.2 ± 122.9)%, P < 0 .0 1]. Eleven COPD patients had an FEV1 ≥ 15% (positive group) and the remaining 17 patients had a FEV1 <15% (negative group). There was no significant difference in FEF50 iso vol and FL indices between the two groups (FEF50 iso vol was ( 43.3 ± 20.2% and 39.6 ± 21.7%, respectively. The FL index was (21.5 ± 8.4)% and (9.6 ± 10.17)%, both P> 0 .0 5〕 .The FL index was significantly correlated with ΔFEF50% iso vol (r = 0.508, P <0.01), but not with FEV1 (r = 0.106, P> 0 .0 5) .Conclusion EFD can be significantly improved in patients with COPD after bronchodilator inhalation, FVC and FEV1 were significantly increased, EFL improvement is equivalent to the degree of FEF50% change