To Discuss The Clinical Significance Of Pulmonary Ventilation Function Change Of Patient With Upper Airway Obstruction

Objective:To analyze the clinical features and pulmonary ventilation function of upper airway obstruction(UAO)and improve the levels of diagnosisMethods:Clinical data of 60 patients with UAO diagnosed by pulmonary ventilation function test,spiral CT of neck and chest and bronchoscopy in our hospital from February 2012 to October 2014 were retrospectively analyzed.The patients were divided into two groups basing on severity of airway narrowing;mild and moderate UAO group(the group with 50%or less than 50%stenosis,group A,n=26)and severe and extreme UAO group(the group with more than 50%stenosis,group B,n=34),the clinical data of those two groups were analysedResults:1.There were 26 females and 34 males,with a mean(SD)age of(57.33± 13.04)years(range,33-81years).There was no significant difference in gender,age and BMI between group A and group B.Main clinical manifestations of the patients with UAO were dyspnea(n=39,65%),cough(n=30,50%),productive cough(n=27,43%),three depression signs of inspiration(n=18,30%),inspiratory wheeze(n=20,33.3%)Etiology:tracheal tumor(n=28,46.7%),tracheotomy or tracheal intubation(n=11,18.3%),trachea or laryngeal tuberculosis(n=7,11.8%),thyroid disease(n=6,10%),relapsing polychondritis(n=4,6.6%),tracheal amyloidosis(n=4,6.6%)2.According to the flow-volume curves(F-V curves)of the 60 patients with UAO,there were 41 patients with characteristic platform change of UAO,there were 9 cases in group A(34.6%)and 32 cases in group B(94.1%),with statistic significant difference between each group(?2=24.11,P<0.01)3.The pulmonary ventilation function parameters of the group A were as follows,ie.FVC%of(87.6±10.8)%,FEV1%of(84.5±17.1)%,FEV]/FVC%of(77.1±13.2)%,MVV%of(68,1 ± 14.4)%.The pulmonary ventilation function parameters of the group B were as follows,ie.FVC%of(80.1±20.1)%,FEV1%of(59.1±26.9)%,FEV1/FVC%of(60.5±24.2)%,MVV%of(35.2±11.2)%.Indicators such as FVC%,FEV1%,FEV1/FVC%and MVV%were all significantly decreased in group B lower than those in group A(P<0.01).MVV%decreased in two group,In group A,MVV%decreased while FVC%,FEV1%and FEV1/FVC%kept on a normal level.In group B,MVV%,FEV1%and FEV1/FVC%all decreased,and the decrease of MVV%was more obvious than that of FEV1%.Conclusions:1.UAO is uncommon and often occurs in middle-aged and ekiery man.The main clinical symptoms of UAO are dyspnea and cough,lack of specificity,the etiology is complicated.2.The F-V curve showed that the change of characteristic platform has certain diagnostic value for UAO,but the sensitivity is low.This change of characteristic platform often occurred in patients with severe and extreme UAO,but it less occurred in patients with most of mild and moderate UAO.3.MVV%decreased may be a sensitive index for diagnosis of airway obstruction,which needed to be further study.Objective:To explore the diagnostic value of maximal ventilator volume(MVV)in upper airway obstruction(UAO)and improve the early diagnostic level.Methods:Clinical data of 70 patients with UAO diagnosed by pulmonary ventilation function test,spiral CT of neck and chest and bronchoscopy in our hospital from November 2014 to March 2017 were prospectively analyzed.According to the results of pulmonary ventilation function in 70 patients with UAO,the patients were divided into group A(n=30)which have no obstructive ventilation dysfunction and group C(n=40)which have obstructive ventilation dysfunction.We randomly selected patients whose pulmonary ventilation function were normal as control group(B,n=30)for group A,the clinical data of the two groups were compared.We randomly selected patients whose pulmonary ventilation function showed obstructive ventilation dysfunction as control group(D,n=40)for group B,the clinical data of the two groups were comparedResults:1.MVV%and MVV/FEV1 were significantly lower in group A than those in group B(P<0.01).MVV%and MVV/FEV1 were significantly lower in group C than those in group D(P<0.01)2.The diameter of tracheal stenosis was positively correlated with FEV1%,FEV1/FVC%,MW%and MVV/FEV1(P<0.01)3.In group A and group B,FVC%,FEV1%and FEV1/FVC%were normal,but MVV%decreased in group A,and MVV%was norma]in group B.There were 4 cases of normal MVV%and 26 cases of abnormal MVV%in group A.There were 22 cases of normal MVV%and 8 cases of abnormal MVV%in group B.Regarded group B patients as controls,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of MVV%<80%in the diagnosis of group A patients were 86.7%,73.3%,80%,76.5%,84.6%.4.In group C and group D,MVV%,FEV1%and FEV1/FVC%all decreased,but the decrease of MVV%was more obvious than that of FEV1%in group C,MVV%and FEV1%decreased in the same degree in group D.Receiver operating characteristic curv(ROC)analysed:regarded group D patients as controls,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of MVV/FEV1<31.1 in the diagnosis of group C patients were 90%,62.5%,76.3%,70.5%,86.2%,with an area under the curve(AUC)=0.878,p=0.000,95%CI[0.805-0.951].Conclusions:1.The pulmonary ventilation function of UAO showed that the decrease of MVV%was more obvious than that of FEV1%,and MVV might be the more sensitive index for diagnosis of UAO.2.When pulmonary ventilation function showed MVV%decreased while FVC%,FEV1%and FEV1/FVC%were normal,UAO with slight pulmonary ventilation dysfunction should be considered.3.The pulmonary ventilation function showed that MVV%,FEVi%and FEV1/FVC%were decreased,accompanied by MVV/FEV1<31.1,which might be helpful for the diagnosis of UAO.