Tải bản đầy đủ - 0 (trang)
Complication of chronic cardio - pulmonary: edema, hepatomegaly, buccal vein, Hartzer positive. P – wave on electrocardiogram or pulmonary arterial hypertention on echocardiography.

Complication of chronic cardio - pulmonary: edema, hepatomegaly, buccal vein, Hartzer positive. P – wave on electrocardiogram or pulmonary arterial hypertention on echocardiography.

Tải bản đầy đủ - 0trang

9



Pulmonary

distention

Pulmonary

Mechanic

Diffusion

alveolar capillary



117

117

117

117

117

117

117

75

75



FEF 25-75% (liters)

MVV (liters)

RV (liters)

FRC (liters)

TLC (litres)

RV/ TLC

Raw (cmH2O/

liters/giây)

DLCO(mmolCO/

min/mmHg)

KCO(mmolCO/lit

ers/ min/mmHg)



0.57 ± 0.39

44.3 ± 23.1

4.08 ± 1.55

4.74 ± 1.50

6.45 ± 1,42

0.62 ± 0.13



22.3 ± 14.1

40.0 ± 19.8

207.2 ±76.7

145.6 ±42.0

130.5± 26.1



7.87 ± 4.2



570 ± 336



11,3 ± 4.8



77.8 ± 29.6



2.9 ± 0.9



77.6 ± 24.4



In patients with COPD, there was a decrease in the mean values

of parameters of pulmonary ventilation: VC, FEV 1, FEF25-75%, MVV

respectively 2.36 liters achieved 84.6% Pred; 1.19 liters achieved

51.8% Pred; 0.57 liters to 22.3% Pred; 44.3 liters achieved 40% Pred

and carbon monoxid diffusing parameters values were reduced to

11,3 mmolCO/ min/ mmHg and 77.8% Pred; KCO 2.9 mmolCO/

liter/ min/ mmHg achieved 77.6% Pred.



10

Figure 3.1. Distribution of patients for subgroups of stable COPD.

Patients in subgroup D were the most, 57.3%.

3.1.2. The change of the value of the respiratory functional

respiratory functional parameters in the subgroups of stable COPD.



Figure 3.2. % Pred value of pulmonary ventilatory parameters

in subgroups of stable COPD.

The %Pred value of the ventilation parameters (FVC, VC, FEV 1,

MVV) decreases in order from group A to B to C to D. Geansler

Index (FEV1/FVC) and parameters FEF25-75% decreased markedly in

group D.

expressional parameters in subgroups of stable COPD.



11



Figure 3.3. The % Pred value of the parameters shows pulmonary

hypertention according to subgroups in stable COPD.

The percentage of Pred of the pulmonary hypertentional

parameters was undifferentiated in 3 groups A, B, C, but increased

sharply in Group D.



12



Figure 3.4. The %Pred of Raw according to subgroups

in stable COPD.

The %Pred of the Raw parameter increased sharply from subgroup

A, B (376% SLT) and increased very strongly into group D.



Figure 3.5. The %Pred of diffusion parameters

according to subgroups in stable COPD.



13

The %Pred value of the diffusion parameters weren’t decreases

in order A, B, C, D, which decreases from A to C to B and finally D.

3.2. Evaluation of the relationship between lung functional parameters

and clinical, paraclinical characteristics in patients with COPD.

3.2.1. Characteristics of patients with COPD.

- Age:

Table 3.11. Characteristics of age in patients with COPD.

Characteristics of age

n

%

in patients with COPD

50 – 59

23

19.7

60 – 69

68

58.1

70 – 80

26

22.2

Total

117

100

Table 3.11 shows the results: patients with COPD are aged 50 years

and older. Subgroup of patient from 60 to 69 years old was 58.1%.

- Degree of obstruction.



-



Figure 3.9. Distribution of patients by degree of obstruction.

Patients in group GOLD 3 was highest rate, accounted 41.0%.

Phenotypic:



14



Figure 3.10. Phenotypes of patients with COPD (n = 117).

48.7% of patients with regularly exacerbations and predominant

emphysema phenotypes were superior than to the predominant

bronchitit; 73.5% compared to 26.5%.

- Complications:

Table 3.16. Characteristics of complications of patients with COPD

Chronic cardio –

Characteristics of

Total

pulmonary insufficiency

complications

Yes

No

n

%

7

10

17

14.5

Chronic respiratory Yes

No

24

76

100 85.5

distress

n

31

86

117 100

Total

%

26.5

73.5

100

26.5% of patients COPD with chronic cardiopulmonary complications

and 14.5% of patients with chronic respiratory distress were recorded.

3.2.2. Relationship between respiratory functional parameters and

clinical and subclinical characteristics in patients with COPD.

3.2.2.1. Relative to the age of the patients.

Table 3.16. Relationship between parameters and age of patients

%Pred of parameters

VC (lit)

FEV1 (lit)

MVV (lit)



n

117

117

117



r (with age)

0.089

0.163

0.085



p

> 0.05

> 0.05

> 0.05



15

TLC (lit)

117

-0.103

> 0.05

FRC (lit)

117

-0.110

> 0.05

RV (lit)

117

-0.251

< 0.05

RV/TLC

117

0.001

> 0.05

Raw (cmH2O/lít/giây)

117

-0.013

> 0.05

DLCO (mmolCO/min/mmHg)

75

0.071

> 0.05

KCO (mmolCO/min/mmHg/l)

75

0.033

> 0.05

Most of the lung functional parameters were no more correlated

with age in patient with COPD.

3.2.2.2. Correlation with dyspnea and quality of life.

Table 3.19. Correlation between respiratory functional parameters

with mMRC and CAT scales.

Correlation between parameters

mMRC

CAT

with clinical scales

Parameters Units

n

r

p

r

p

VC

%Pred 117 - 0.401 < 0,05 - 0.407 < 0,05

FEV1

%Pred 117 - 0.611 < 0,05 - 0.585 < 0,05

MVV

%Pred 117 - 0.645 < 0,05 - 0.621 < 0,05

RV

%Pred 117 0.524 < 0,05 0.542 < 0,05

FRC

%Pred 117 0.487 < 0,05 0.510 < 0,05

TLC

%Pred 117 0.379 < 0,05 0.399 < 0,05

RV/TLC

%

117 0.611 < 0,05 0.600 < 0,05

Raw

%Pred 117 0.397 < 0,05 0.338 < 0,05

DLCO

%Pred 75 - 0.338 < 0,05 - 0.570 < 0,05

KCO

%Pred 75 - 0.470 < 0,05 - 0.456 < 0,05

Table 3.19 shows that in COPD, respiratory functional

parameters has both moderate correlation with dyspnea by mMRC

and quality of life by CAT.

3.2.2.3. Value of respiratory functional parameters with the degree

of obstruction.



16



Figure 3.11; 3.12; 3.13; 3.14. Correlation between

%Pred of respiratory functional parameters with %Pred of FEV 1.

The parameters of the pulmonary ventilation and diffusion were lowers,

the obstruction was more gravity (more decrease in FEV1%). The



17

correlation was highly positive with the parameters of pulmonary ventilation

(r = 0.813 - 0.887), was moderate positive with diffusion (r = 0.459 - 0.675).

The parameters of the pulmonary distention and airway resistance

were higher, the obstruction was more gravity (more decrease in

FEV1%), resulting in a negative correlation (r = - 0.237 to - 0.792). In

which, RV/ TLC index gives the best correlation r = - 0.792.

3.3.5. Relationships with phenotypes of COPD.

Table 3.21. Relationship between respiratory functional parameters

with phenotype emphsema/ chronic bronchitis dominant.

Emphysema

chronic

Mean of

bronchitis

parameter

Units

dominant

p

s

dominant (n =31)

(n = 86)

VC

%Pred

84.4 ± 25.4

84.9 ± 23.5

> 0.05

FEV1

%Pred

49 ± 24.1

60.0 ± 21.6

< 0.05

FEF25 -75%

%Pred

20.5 ± 12.9

27.4 ± 15.9

< 0.05

MVV

%Pred

37.7 ± 20.5

46.5 ± 16.3

< 0.05

TLC

%Pred

136.7 ± 20.6

113.3 ± 31.8

< 0.05

FRC

%Pred

154.4 ± 32,0

121.1 ± 55.4

< 0.05

RV

%Pred

222.6 ± 61.7

164.4 ± 97.1

< 0.05

RV/TLC

%

64.6 ± 11.8

54.5 ± 14.2

< 0.05

Raw

%Pred 610.1 ± 347.2

458.7 ± 278.7

< 0.05

DLCO***

%Pred

76.9 ± 30.8 *

81.0 ± 25.8 **

> 0.05

KCO***

%Pred

74.7 ± 23.4 *

87.4 ± 26.1 **

> 0.05

* : n = 58, ** : n = 17 , *** : n = 75

The group of emphsema dominant had a greater reduction in %

Pred of FEV1, MVV, KCO parameters and more increases in

parameters of pulmonary distention than group of chronic bronchitis

dominant, statistically significant p < 0.05. There was no difference

between the two groups of emphsema dominant and chronic

bronchitis dominant for diffusion parameters.

3.3.7. Relationships with the complications of COPD.

Table 3.23. Relationship between the lung functional parameters and

chronic cardiopulmonary complications in patients with COPD.

Mean of

Units

COPD+ chronic

COPD

p



18



%Pred

%Pred

%Pred

%Pred

%Pred

%Pred

%

%Pred



cardiopulmonary

complications

(n = 31)

78.7 ± 22.5

43.6 ± 17.9

31.7 ± 13.0

131.0 ± 24.3

151.2 ± 40.1

216.9 ± 73.8

65.1 ± 13.2

665 ± 347.9



86.7 ± 25.3

54.7 ± 25.2

43.1 ± 20.9

130.3 ± 26.8

143.6 ± 42.7

203.7 ± 77.8

60.8 ± 13.3

535.7 ± 327



> 0.05

< 0.05

< 0.05

> 0.05

> 0.05

> 005

> 0.05

> 0.05



%Pred



60.2 ± 24.4*



84.3 ±28.9**



< 0.05



paramet

ers

VC

FEV1

MVV

TLC

FRC

RV

RV/TLC

Raw

DLCO**

*

KCO***



%Pred



(n = 86)



67.4 ± 23.0*

81.4± 24.0** < 0.05

* : n = 20, **: n= 55, *** : n=75

Table 3.23. showed that: value of FEV 1, MVV and diffusive

parameters in group of patients COPD with cardiopulmonary

complication was significantly lower than in group patients without

complication, p < 0.05. Values of parameters of RV, FRC, and TLC

were not significantly different between the two groups with or

without chronic cardiopulmonary complications.

CHAPTER 4: DISCUSSION

4.1. Evaluating the change of some respiratory functional

parameters by subgroups in stable COPD by plethysmography.

4.1.1. Characteristics of the respiratory functional parameters of

patients with COPD by plethysmography.

4.1.1.1. Determination of the value of respiratory functional

parameters in patients with COPD by plethysmography.

In respiratory functional exploration, plethysmography that is

considered to be a the most modern and trust methods, has been used in

this study. Table 3.1. showed a total decrease of pulmonary ventilation

parameters such as FEV1, FEF25-75%, in which FEF 25-75% decreased the

most, only 22.3 ± 14.1% compared to prediction. Mean values of static



19

volume, capacity (TLC, FRC, FV, RV/ TLC) in patients with COPD

were higher than prediction. Value of airway resistance was increased

7.87 ± 4.2 (cmH2O/ liter/ second) to 570.0% ± 336.0% Pred. The mean

of diffusional parameters in 75 patients with COPD were 11.3 ± 4.8

mmolCO/ min / mmHg, only 77.8% ± 29.6% Pred. This finding was

convenient with result of the Ceveri I. study: The values of the

parameters of pulmonary distention were increased in order from RV,

FRC, TLC and DLCO, KCO parameters were decreased by 65% ± 19%

Pred, 67% ± 17% Pred in patients with COPD.

4.1.1.2. Distribution of patients with COPD for subgroups of stable

COPD.

Distribute patients into subgroups of stable COPD arcording to

GOLD 2016, results showed patients with subtype D (group of

many symptoms, high risk) was at most 57.3%. Group B (less risky

for multiple symptoms) and group C (multiple risk, less symptoms)

had the same quantily (14.5%). Group A (low symptoms, low risk)

had the lowest rate of 13.7%. The results was agreed with many

national and international studies, Its also show that the proportion of

patients in group D is the highest. Thus, patients with COPD were

often hospitalized at late stage, posing problem that respiratory

functional sysmetitc exploration (pulmonary ventilation, pulmonary

distension, diffusion, resistance) was an important contributor to the

diagnosis and prognosis of treatment.

4.1.2. Change in the value of the parameters by the subgroups.

To evaluate the value of a lung functional parameter that is usually

not based on this parameter is high or low, but based on percentage of

this parameters is compared to predictions (calculated on the same

person gender, age and height, weight). Therefore, determining the

%Pred of the lung functional parameters under subgroups A, B, C, D

and evaluating this change is the objective of this study.

Fifure 3.2. shows that %Pred of some parameters of pulmonary

ventilation (FEV1, VC, FVC, MVV) all gradually decreased linearly

from A to B to C to D. The Geansler and FEF 25-75% weren’t decreased



Tài liệu bạn tìm kiếm đã sẵn sàng tải về

Complication of chronic cardio - pulmonary: edema, hepatomegaly, buccal vein, Hartzer positive. P – wave on electrocardiogram or pulmonary arterial hypertention on echocardiography.

Tải bản đầy đủ ngay(0 tr)

×