摘要
目的评估病毒性肺炎住院患者出院时的心肺功能,并分析其与临床特征的相关性。方法选取2022年12月至2023年3月于南京中医药大学第二附属医院肺病科住院治疗且即将出院的63例病毒性肺炎患者作为研究对象。出院前1 d,采集患者静态肺功能、6分钟步行试验(6 minutes walk test,6MWT)数据,评估患者出院时的心肺功能,并比较非重型与重型患者肺功能指标[最大肺活量预计值百分比(percentage of predicted maximum vital capacity,VC max%pred)、用力肺活量预计值百分比(percentage of predicted forced vital capacity,FVC%pred)、第1秒用力呼气容积预计值百分比(percentage of predicted forced expiratory volume in one second,FEV_(1)%pred)、第1秒用力呼气容积与用力肺活量比值(forced expiratory volume in one second/forced vital capacity,FEV_(1)/FVC)、最大中段呼气流量预计值百分比(maximum mid-expiratory flow 75/25%predicted,MMEF75/25%pred)、呼气峰值流量预计值百分比(percentage of predicted peak expiratory flow,PEF%pred)、一氧化碳弥散量预计值百分比(percentage of predicted diffusion capacity of carbon monoxide in the lung-single breath,DLCO-SB%pred)、每升肺泡容积的一氧化碳弥散量预计值百分比(percentage of predicted diffusion capacity for carbon monoxide per liter of alveolar volume,DLCO/VA%pred)]、6MWT步行距离,分析肺功能指标、6MWT步行距离与临床特征的相关性。结果重型患者VC max%pred、FVC%pred、FEV_(1)%pred、FEV_(1)/FVC、PEF%pred、MMEF75/25%pred、DLCO-SB%pred、DLCO/VA%pred水平均低于非重型患者,6MWT步行距离短于非重型患者,差异有统计学意义(P<0.05)。相关性分析结果显示,VC max%pred、FVC%pred、FEV_(1)%pred、PEF%pred、MMEF75/25pred与年龄均呈负相关(r<0,P<0.05);VC max%pred、FVC%pred、FEV_(1)%pred、PEF%pred与D-二聚体水平均呈负相关(r<0,P<0.05);DLCO-SB%pred、DLCO/VA%pred与吸烟史均呈负相关(r<0,P<0.05);VC max%pred、FVC%pred、FEV_(1)%pred、MMEF75/25pred、DLCO-SB%pred、DLCO/VA%pred与纤维蛋白原水平均呈负相关(r<0,P<0.05)。6MWT步行距离与年龄、D-二聚体水平呈负相关(r<0,P<0.05),与静息SpO 2、血红蛋白水平均呈正相关(r>0,P<0.05)。结论病毒性肺炎患者出院时,心肺功能仍有不同程度受损,且受损程度与疾病严重程度有关,建议出院后继续行心肺康复治疗。年龄、吸烟史、血红蛋白水平、凝血功能可能是影响病毒性肺炎患者心肺功能恢复的潜在临床因素。
Objective To evaluate the level of cardiopulmonary function and analysis clinical related factors in discharged patients with viral pneumonia.Methods A total of 63 patients with viral pneumonia who were hospitalized and were about to be discharged in the department of Pulmonary Diseases of the Second Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from December 2022 to March 2023were selected as the research subjects.1 day before discharge,static lung function and 6-minute walking test(6MWT)data were collected to evaluate the cardiopulmonary function of patients at discharge,and lung function indicators(percentage of predicted maximum vital capacity[VC max%pred],percentage of predicted forced vital capacity[FVC%pred],percentage of predicted forced expiratory volume in one second[FEV_(1)%pred],forced expiratory volume in one second/forced vital capacity[FEV_(1)/FVC],maximum mid-expiratory flow 75/25%predicted[MMEF75/25%pred],percentage of predicted peak expiratory flow[PEF%pred],percentage of predicted diffusion capacity of carbon monoxide in the lung-single breath[DLCO-SB%pred],percentage of predicted diffusion capacity for carbon monoxide per liter of alveolar volume[DLCO/VA%pred])and 6MWT walking distance were compared between the non-heavy and the heavy patients,and the correlation between lung function index,6MWT walking distance and clinical indicators were analyzed.Results The VC max%pred,FVC%pred,FEV_(1)%pred,FEV_(1)/FVC,PEF%pred,MMEF75/25%pred,DLCO-SB%pred and DLCO/VA%pred in the heavy patients were all lower than those in the non-heavy patients,and the 6MWT walking distance was shorter than that in the non-heavy patients,and the 6MWT walking distance was shorter than that in the non-severe patients,the differences were statistically significant(P<0.05).The results of the correlation analysis showed that the VC max%pred,FVC%pred,FEV_(1)%pred,PEF%pred and MMEF75/25pred were negatively correlated with age(r<0,P<0.05);the VC max%pred,FVC%pred,FEV_(1)%pred and PEF%pred were negatively correlated with D-dimer levels(r<0,P<0.05);the DLCO-SB%pred and DLCO/VA%pred were negatively correlated with smoking history(r<0,P<0.05);the VC max%pred,FVC%pred,FEV_(1)%pred,MMEF75/25pred,DLCO-SB%pred and DLCO/VA%pred were negatively correlated with fibrinogen levels(r<0,P<0.05).The 6MWT walking distance was negatively correlated with age and D-dimer level(r<0,P<0.05),and positively correlated with resting SpO 2 and hemoglobin level(r>0,P<0.05).Conclusion When patients with viral pneumonia reach the discharge standard after treatment,their cardiopulmonary function is still damaged to varying degrees,which is related to the severity of the disease.It is recommended to continue cardiopulmonary rehabilitation after discharge.Age,smoking history,hemoglobin concentration,and coagulation function may be potential clinical factors affecting the recovery of cardiopulmonary function in patients with viral pneumonia.
作者
孙征
朱子龙
赵炜程
赵裕沛
倪志娟
林依人
陈鸿
张荣贤
朱益敏
张建斌
SUN Zheng;ZHU Zilong;ZHAO Weicheng;ZHAO Yupei;NI Zhijuan;LIN Yiren;CHEN Hong;ZHANG Rongxian;ZHU Yimin;ZHANG Jianbin(Department of Acupuncture Rehabilitation,the Second Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Nanjing,Jiangsu,210017,China;Department of Pulmonary Diseases,the Second Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Nanjing,Jiangsu,210017,China;Chinese Medicine Rehabilitation Centre,the Second Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Nanjing,Jiangsu,210017,China)
出处
《当代医学》
2025年第2期80-85,共6页
Contemporary Medicine
基金
江苏省中医药科技发展计划项目(ZT202208)。
关键词
病毒性肺炎
心肺功能
康复
Viral pneumonia
Cardiopulmonary function
Rehabilitation
