The Spatial Variable Of The Changes In Diaphragm Of COPD Patients By Ultrasonographic Technology

Objective The aim of the study was to investigate the spatial variable of the patients’ s diaphragm with chronic obstructive pulmonary disease(COPD)on ultrasound, and preliminary to assess the severity of the COPD patients.Methods(1)According to the 2011 version of “COPD global initiative to guid”,80 cases of COPD patients were grouped into high-risk group,mild group, moderate group, severe group with the classification of pulmonary ventilation function, which each group was 20 patients, and 30 healthy people were selected as the control group.(2) During the patients quiet breathing, two doctors separately repeated twice to measure the diaphragm movement of the control group by using three methods,including M-mode ultrasoud direct measurement method, B-mode ultrasound direct measurement method and B-mode ultrasound indirect method with measuring the longitudinal displacement of portal sagittal,and the consistency and reproducibility of these three methods were compared through analysis of Bland-Altman map and the intraclass correlation coefficient(ICC).(3)The spatial variables of the diaphragm for each group,including the diaphragm thickness, mobility, the angle difference between at the end of calm expiratory and exertion expiratory which were formed by the diaphragm at the right costophrenic angle and chest wall(ΔA), the difference of the histograma gray-scale between at the end of calm expiratory and exertion expiratory(ΔG), were measured by ultrasonic and anlyzed with the statistics.Results(1) The study on the repeatability and consistency of diaphragm movement measurement during quiet breathing showed that the inter-operator and Intra-operator ICC of M-mode method、B-mode direct method and B-mode indirect method were 0.9437, 0.9279, 0.9338 and 0.9310, 0.9185, 0.9200, and 95% of the boundary in consistency were(-2.16 ~ 1.76),(-2.0 ~ 2.3),(-1.9 ~ 2.3) and(-2.5 ~ 2.2),(-2.2 ~ 2.6),(-2.4 ~ 2.6),respectively. It demonstated that among these three methods using in the inter-operator and intra-operator, the repeatability and consistency of M-mode methodwas the best.(2) The relevant parameters including diaphragmatic movement during quiet breathing(Δm), diaphragm thickness at the end of calm inpiratory and expiratory, diaphragm thickness at the end of exertion inpiratory and expiratory, which were tended to increase as the overall COPD level rised, and the moderate group and severe group were obvious(P <0.01). Especially at the end of exertin expiratory phase, the average thickness of diaphragm in the severe group was 3.16±0.64 mm, and its thickening of about 59.6% on average compared with the control group, the percentage increase was the highest in the measurement parameters.(3) The relevant parameters including diaphragmatic movement on exertion breathing(ΔM), ΔM-Δm, the diaphragm thickness change with calm respiratory termina phase(Δd), the diaphragm thickness change with exertion respiratory terminal phase(ΔD), the difference value of contact angle fromed diaphragm and chest wall between exertion expiratory and calm expiratory(ΔA), the number of histogram gray levels value between exertion expiratory and calm expiratory(ΔG), which were tended to decrease as the overall COPD level rised,and the moderate group and severe group were obvious(P <0.01). Especially the parameters of Δd,the average Δd in the severe group was 0.77±0.34 mm, and the average thickness than the control group decreased by about 30%, which the percentage reducing was the highest in the measurement parameters.(3) The all parameters in this study, the high-risk group compared with the control group with no significant difference(P> 0.05).Conclusion(1)M-mode ultrasonic measurement method in the measurement of diaphragm movement has clinical feasibility.(2)Ultrasound is non-invasive, real-time and dynamic to observe the spatial variables of the diaphragm, and preliminary predicted the degree of COPD from moderate to severe, so it has potential clinical value.