| Purpose By measuring the changes of diaphragm function and pulmonary function in patients with COPD before and after treatment,the value of ultrasound in the assessment of diaphragm function in patients with COPD and the correlation between diaphragm ultrasound indicators and pulmonary function were explored.Method A total of 210 inpatients and healthy people from the Department of Respiratory and Critical Care Medicine,Affiliated Central Hospital of Shenyang Medical College were selected,including 166 patients with acute exacerbation of COPD（88 males and 78 females）and 44 controls（males）.30 cases,14 females).According to the 2021 edition of the Global Initiative for Chronic Obstructive Pulmonary Disease（GOLD）guidelines,patients were grouped by the nature and severity of symptoms and the risk of acute exacerbation,including 31 patients in group A（19 males and 12 females）and 45 patients in group B（28 males and 17 females）,36 patients in group C（16 males and 20 females）,and 54 patients in group D（25 males and 29 females）.The general data of the enrolled patients on admission were collected,and the ultrasound parameters of the diaphragm thickness（DT）,diaphragm thickening fraction（DTF）,the degree of diaphragm（DD）during quiet breathing,diaphragmatic mobility during deep breathing,and pulmonary function)were collected.Indicators（maximum mid-expiratory flow（MMEF25）,forced expiratory volume in 1 second（FEV1）,forced expiratory volume in 1 second to vital capacity ratio（FEV1/FVC））,assessment and calculation of patient COPD assessment test scores（CAT score）and Modified Dyspnea Rating Scale（m MRC score）.Review and record the diaphragmatic ultrasound indexes,pulmonary function indexes,and CAT scores of the patients after treatment.Compare the general data of COPD subgroups and the control group,Differences between diaphragmatic ultrasound indexes and CAT scores,the influencing indexes of diaphragm muscle function in COPD group,and the correlation between diaphragmatic muscle ultrasound indexes and pulmonary function.All data were analyzed using SPSS23.0,and the difference was statistically significant when P<0.05 study meaning.Result 1.Comparison of the thickness of the diaphragm before treatment between the COPD groups and the control group There were significant statistical differences in the thickness of the diaphragm between the five groups（P<0.05）;compared with the control group,the thickness of the diaphragm in group A was similar with no significant difference（P>0.05）.The thickness of the diaphragm muscle decreased significantly,and the difference was statistically significant（P<0.05）.The thickness of the diaphragm and the thickening score of the left diaphragm in group D were significantly decreased,with a statistically significant difference（P<0.05）.The right diaphragm was thickened.The scores did not decrease significantly,and there was no significant statistical difference（P>0.05）.2.Comparison of degree of diaphragm between each COPD group and the control group During calm breathing,compared with the control group,the mobility of the left and right degree of diaphragm in each COPD group was significantly increased,with a statistically significant difference（P<0.05）.During deep breathing,compared with the control group,the movement of the left and right degree of diaphragm in each COPD group was significantly decreased,with a statistically significant difference（P<0.05）.During calm breathing,the range of the left and right degree of diaphragm in the COPD group was the same,and there was no significant difference（P>0.05）.During deep breathing,the left degree of diaphragm in the three groups A,B,and C was greater than that of the right,with significant statistical difference（P<0.05）.（P>0.05）.3.Changes of diaphragm function in each subgroup of COPD before and after treatment The diaphragm thickness of group A patients did not change significantly before and after treatment,and there was no statistically significant difference（P>0.05）.The thickness of diaphragm increased after treatment in group B and group D,with a statistically significant difference（P<0.05）.The thickness of the left diaphragm in group C had little difference before and after treatment,but the right side changed significantly,with significant statistical significance（P<0.05）.There was no significant difference in the fraction of diaphragm thickening in group A after treatment compared with before treatment（P<0.05）.The diaphragm thickening scores in groups B and C were significantly increased after treatment,with significant statistical significance（P<0.05）.There was no significant change in the fraction of diaphragm muscle thickening in group D after treatment（P>0.05）.During calm breathing,there was no significant change in the movement of the diaphragm in groups A and C after treatment（P>0.05）,while the movement of the diaphragm in groups B and D decreased significantly after treatment,and the difference was significant（P<0.05）.During deep breathing,the movement of the diaphragm in each COPD group was significantly increased after treatment,and the difference was significant（P<0.05）.4.Linear regression analysis of the correlation factors between diaphragm thickening fraction and degree of diaphragm Multiple linear regression analysis showed that FEV1/FVC was an influencing factor of diaphragmatic activity during deep breathing in patients with COPD.Among them,the left side DD[β=0.026,P=0.008,95%CI（0.011,0.042）];the right side[β=0.029,P=0.001,95%CI（0.011,0.047）].5.Correlation between ultrasonographic indexes of diaphragm and pulmonary function indexes in patients with chronic obstructive pulmonary disease There was a significant correlation between the right diaphragm thickening fraction and lung function in each subgroup of COPD patients（P<0.05）.In COPD group,DD was not correlated with pulmonary function indexes during calm breathing,but was significantly positively correlated with DD during deep breathing.6.Correlation between CAT score and diaphragmatic ultrasound index in COPD group Spearman correlation analysis showed that CAT score was significantly negatively correlated with diaphragm thickness,diaphragm thickening score and diaphragm movement during deep breathing（P<0.05）.Conclusion 1.Dynamic assessment of diaphragm thickness,diaphragm thickening fraction,and degree of diaphragm is clinically feasible and can assist in the diagnosis and treatment of COPD;2.Ultrasound,as a non-invasive and non-invasive detection method,can dynamically and real-time observe the movement of diaphragm,for the objective and direct evaluation of respiratory movement,with potential clinical value. |
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