超声面积测量法与移动度测量法评估膈肌功能的比较

Comparison of ultrasonic area method with excursion method to assess diaphragmatic function

摘要:

目的： 比较超声面积测量法与移动度测量法评估膈肌收缩功能的准确性，得到测量膈肌收缩功能的新方法。方法： 选取2019年5月至2020年4月中国医科大学附属盛京医院的健康志愿者78例，收集并获取其一般信息。利用床旁超声分别测量平静呼吸及深呼吸时膈肌的移动度及平静呼吸及深呼吸过程中胸腔侧面积变化，以肺功能的深吸气量（inspiratory capacity，IC）为评价标准，采用Spearman相关性检验比较2种方法与IC的相关性。结果： 2种测量结果表明年龄、体质指数及性别均无统计学差异。平静呼吸过程中胸腔侧面积变化与IC的相关性（r=0.486，P=0.000）及平静呼吸过程中膈肌移动度与IC相关性（r=0.245，P=0.031），深呼吸过程中胸腔侧面积变化与IC的相关性（r=0.424，P=0.000）及深呼吸过程中膈肌移动度与IC的相关性（r=0.285，P=0.012）均具有统计学差异，深呼吸及平静呼吸时面积测量法与IC的相关系数均高于移动度测量法（平静呼吸面积差值>平静呼吸移动度，深呼吸面积差值>深呼吸移动度），且P值明显小于移动度测量法（平静呼吸面积差值<平静呼吸移动度，深呼吸面积差值<深呼吸移动度）。结论： 面积测量法比移动度测量法更能反映膈肌收缩功能，面积测量法与移动度测量法、膈肌增厚率相结合评估膈肌收缩力更加准确。

Abstract:

Objective: To explore a new method to measure the diaphragmatic contraction function by comparing the accuracy of the ultrasonic area method with excursion method. Methods: Seventy-eight healthy volunteers from Shengjing Hospital of China Medical University from May 2019 to April 2020 were selected in this study, and their general information was collected. Bedside ultrasound was used to measure the movement of the diaphragm and the change of the thoracic area during quiet breathing and deep breathing. Taking the deep inspiratory capacity (IC) of lung function as the evaluation standard, Spearman correlation test was used to compare the correlation between the two methods and IC. Results: There was no statistical difference in age, BMI and gender between the two measurement methods. There were significant differences in the correlation between the change of thoracic area and IC during quiet breathing (r=0.486, P=0.000) and the correlation between the change of diaphragmatic movement and IC during quiet breathing (r=0.245, P=0.031), and there were also statistical differences in the correlation between thoracic area and IC during quiet breathing (r=0.424, P=0.000) and between diaphragmatic movement and IC during deep breathing (r=0.285, P=0.012). The correlation between the change of thoracic area and IC measured by ultrasonic area method was stronger than that measured by excursion method (the quiet breathing area difference>the quiet breathing diaphragmatic movement, the deep breathing area difference>the deep breathing diaphragmatic movement), and the P value was significantly lower than that of the excursion method (the quiet breathing area difference<the quiet breathing diaphragmatic movement, and the deep breathing area difference<the deep breathing diaphragmatic movement). Conclusion: The area method is superior to the excursion method in the evaluation of diaphragmatic contraction function, and it’s more accurate to evaluate diaphragmatic contraction function combined with excursion method and diaphragmatic thickening rate.