Background: Neural respiratory drive (NRD) using diaphragm electromyography through an invasive transesophageal multi-electrode catheter can be used as a feasible clinical physiological parameter in patients with chronic obstructive pulmonary disease (COPD) to provide useful information on the treatment response. However, it remains unknown whether the surface diaphragm electromyogram (EMGdi) could be used to identify the deterioration of clinical symptoms and to predict the necessity of hospitalization in acute exacerbation of COPD (AECOPD) patients.
Methods: COPD patients visiting the outpatient department due to acute exacerbation were enrolled in this study. All patients who were subjected to EMGdi and classical parameters such as spirometry parameters, arterial blood gas analysis, COPD assessment test (CAT) score, and the modified early warning score (MEWS) in outpatient department, would be treated effectively in the outpatient or inpatient settings according to the Global Initiative for Chronic Obstructive Lung Disease guideline. When the acute exacerbation of the patients was managed, all the examination above would be repeated.
Results: We compared the relationships of admission-to-discharge changes (Δ) in the normalized value of the EMGdi, including the change of the percentage of maximal EMGdi (ΔEMGdi%max) and the change of the ratio of minute ventilation to the percentage of maximal EMGdi (ΔVE/EMGdi%max) with the changes of classical parameters. There was a significant positive association between ΔEMGdi%max and ΔCAT, ΔPaCO2, and ΔpH. The change (Δ) of EMGdi%max was negatively correlated with ΔPaO2/FiO2in the course of the treatment of AECOPD. Compared with the classical parameters including forced expiratory volume in 1 s, MEWS, PaO2/FiO2, the EMGdi%max (odds ratio 1.143, 95% confidence interval 1.004-1.300) has a higher sensitivity when detecting the early exacerbation and enables to predict the admission of hospital in the whole cohort.
Conclusions: The changes of surface EMGdi parameters had a direct correlation with classical measures in the whole cohort of AECOPD. The measurement of NRD by surface EMGdi represents a practical physiological biomarker, which may be helpful in detecting patients who should be hospitalized timely.
体表膈肌肌电反映的呼吸中枢驱动作为AECOPD患者住院治疗的预测指标的价值研究 摘要 背景：大量研究表明经食道膈肌肌电检测系统反映的呼吸中枢驱动在COPD患者的治愈率、28天再住院率以及支气管扩张剂的应用效果方面具有关键的评估作用。近年来随着技术进步，体表膈肌肌电技术在临床开始使用，它既保留了经食道膈肌肌电的灵敏性、特异性，也规避了侵入性操作的风险，具有较高的患者接受度。但是，表面膈肌肌电能否用于稳定期COPD患者临床症状恶化的识别以及预测AECOPD患者住院必要性尚未可知。 方法：收集因COPD急性加重至门诊就诊的COPD患者60例。在门诊按照GOLD指南对患者进行评估分级，其中22例患者评估为需要住院治疗组，另38例评估为门诊治疗组。两组患者均在入组当日行体表膈肌肌电、肺功能、动脉血气分析等检查，并予CAT、MEWS评分，之后仍依据GOLD指南给患者制定治疗方案，充分治疗并随访，在每位患者被评定为病情稳定后重复入院当日的各项检测。 结果：比较各参数在急性加重至稳定期之间差值的相关性，ΔEMGdi%max与ΔCAT、ΔPaCO2、ΔpH具有明显正相关，与ΔPaO2/FiO2负相关。在评估患者住院治疗的必要性方面，EMGdi%max较FEV1、MEWS、PaO2/FiO2具有更高的灵敏性。EMGdi%max(OR 1.143, 95% CI 1.004 to 1.300)对AECOPD患者住院治疗必要性具有较好的预测价值。 结论：在COPD急性加重至治疗稳定的过程中，体表膈肌肌电参数的变化与肺功能、动脉血气分析、CAT评分、MEWS评分等指标有较好的一致性。体表膈肌肌电可以作为AECOPD患者住院治疗的预测指标。.
Keywords: Acute Exacerbation of Chronic Obstructive Pulmonary Disease; Neural Respiratory Drive; Surface Diaphragm Electromyography.