Ультразвуковая оценка состояния диафрагмы у пациентов хронической обструктивной болезнью легких, перенесших COVID-19

Меньшикова Ираида Георгиевна; Магаляс Елена Владимировна; Скляр Ирина Васильевна

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Журнал

Амурский медицинский журнал

2024

Область наук

Клиническая медицина

Ключевые слова

хроническая обструктивная болезнь легких / COVID-19 / дисфункция диафрагмы / chronic obstructive pulmonary disease / COVID-19 / diaphragm dysfunction

Аннотация научной статьи по клинической медицине, автор научной работы — Меньшикова Ираида Георгиевна, Магаляс Елена Владимировна, Скляр Ирина Васильевна

С целью ультразвуковой оценки функционального состояния диафрагмы у пациентов ХОБЛ, перенесших COVID-19, обследовано 39 пациентов ХОБЛ, осложненной компенсированным ХЛС. В 1 группу вошли 19 пациентов ХОБЛ, перенесших COVID-19, во 2 группу – 20 пациентов ХОБЛ. Исследование проведено через 3 месяца после перенесенного COVID-19. Результаты исследования показали наибольшее снижение высоты стояния купола диафрагмы в 1-ой группе (р=0,001). Экскурсия диафрагмы при спокойном дыхании была увеличена в обеих группах, во 2-ой группе показатель был на 12% больше, чем в 1 группе. Скорость экскурсии диафрагмы на вдохе и выдохе при спокойном и форсированном дыхании в обеих группах была достоверно увеличена по сравнению с контрольной группой. При этом в 1-ой группе скорость экскурсии диафрагмы на выдохе была выше на 49%. В обеих группах, по сравнению с контрольной группой, толщина мышечной части диафрагмы на вдохе и выдохе при спокойном дыхании была достоверно выше, но различий между группами не наблюдалось. Расчет фракции утолщения мышечной части диафрагмы позволяет точнее оценить сократительную способность диафрагмальной мышцы. При спокойном дыхании этот показатель был снижен в среднем на 23,9% (р=0,01) в обеих группах, при форсированном дыхании на 35,8% (р=0,001) по сравнению с контрольной группой, что свидетельствует о начальном развитии слабости дыхательных мышц диафрагмы у пациентов, перенесших COVID-19. Таким образом, изучение функциональной активности диафрагмы дает возможность раннего выявления усталости и слабости мышц диафрагмы, что позволит открыть новые возможности профилактики и диагностики развития дыхательной недостаточности, своевременной коррекции установленных нарушений.

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Ultrasonic assessment of the condition of the diaphragm in patients with chronic obstructive pulmonary disease who have experienced COVID-19

For the purpose of ultrasound assessment of the functional state of the diaphragm in patients with COPD who had suffered from COVID-19, 39 patients with COPD complicated by compensated CHL were examined. Group 1 included 19 patients with COPD who had suffered from COVID-19, group 2 included 20 patients with COPD. The study was conducted 3 months after contracting COVID-19. The results of the study showed the greatest decrease in the height of the diaphragm dome in group 1 (p = 0.001). The excursion of the diaphragm during quiet breathing was increased in both groups; in group 2 the indicator was 12% higher than in group 1. The rate of excursion of the diaphragm during inhalation and exhalation during quiet and forced breathing in both groups was significantly increased compared to the control group. Moreover, in group 1, the rate of exhalation of the diaphragm during exhalation was 49% higher. In both groups, compared with the control group, the thickness of the muscular part of the diaphragm during inhalation and exhalation during quiet breathing was significantly higher, but no differences were observed between the groups. Calculation of the fraction of thickening of the muscular part of the diaphragm allows a more accurate assessment of the contractility of the diaphragm muscle. With quiet breathing, this indicator was reduced by an average of 23.9% (p = 0.01) in both groups, with forced breathing by 35.8% (p = 0.001) compared to the control group, which indicates the initial development weakness of the respiratory muscles of the diaphragm in patients who have had COVID-19. Thus, studying the functional activity of the diaphragm makes it possible to early detect fatigue and weakness of the diaphragm muscles, which will open up new opportunities for the prevention and diagnosis of the development of respiratory failure, and timely correction of established disorders.

Текст научной работы на тему «Ультразвуковая оценка состояния диафрагмы у пациентов хронической обструктивной болезнью легких, перенесших COVID-19»

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Original article

ULTRASONIC ASSESSMENT OF THE CONDITION OF THE DIAPHRAGM IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE WHO HAVE EXPERIENCED COVID-19

Iraida G. Menshikova, Elena V. Magalyas, Irina V. Sklyar

1 Amur State Medical Academy of the Ministry of Health of the Russian Federation,

Blagoveshchensk, Russia [email protected]; [email protected]; [email protected]

Abstract. For the purpose of ultrasound assessment of the functional state of the diaphragm in patients with COPD who had suffered from COVID-19, 39 patients with COPD complicated by compensated CHL were examined. Group 1 included 19 patients with COPD who had suffered from COVID-19, group 2 included 20 patients with COPD. The study was conducted 3 months after contracting COVID-19. The results of the study showed the greatest decrease in the height of the diaphragm dome in group 1 (p = 0.001). The excursion of the diaphragm during quiet breathing was increased in both groups; in group 2 the indicator was 12% higher than in group 1. The rate of excursion of the diaphragm during inhalation and exhalation during quiet and forced breathing in both groups was significantly increased compared to the control

� �� . �., �� . �., �� . �., 2024 group. Moreover, in group 1, the rate of exhalation of the diaphragm during exhalation was 49% higher. In both groups, compared with the control group, the thickness of the muscular part of the diaphragm during inhalation and exhalation during quiet breathing was significantly higher, but no differences were observed between the groups. Calculation of the fraction of thickening of the muscular part of the diaphragm allows a more accurate assessment of the contractility of the diaphragm muscle. With quiet breathing, this indicator was reduced by an average of 23.9% (p = 0.01) in both groups, with forced breathing -by 35.8% (p = 0.001) compared to the control group, which indicates the initial development weakness of the respiratory muscles of the diaphragm in patients who have had COVID-19. Thus, studying the functional activity of the diaphragm makes it possible to early detect fatigue and weakness of the diaphragm muscles, which will open up new opportunities for the prevention and diagnosis of the development of respiratory failure, and timely correction of established disorders

Keywords: chronic obstructive pulmonary disease, COVID-19, diaphragm dysfunction.

For citation: Menshikova IG, Magalyas EV, Sklyar IV. Ultrasonic assessment of the condition of the diaphragm in patients with chronic obstructive pulmonary disease who have experienced COVID-19. Amurskii meditsinskii zhurnal. � Amur Medical Journal. 2024;12;1(36):22�29. (In Russ.). https://doi.org/10.24412/2311�5068-2024-12-1-22.

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7.

Eisner M.D., Anthonisen N., Coultas D. et al. An official American Thoracic Society public policy statement: novel risk factors and the global burden of chronic obstructive pulmonary disease // Am J Respir Crit Care Med. - 2010. � Vol. 182. � P. 693�718.

8.

Farr E, Wolfe AR, Deshmukh S, Rydberg L, Soriano R, Walter JM, Boon AJ, Wolfe LF, Franz CK. Diaphragm dysfunction in severe COVID-19 as determined by neuromuscular ultrasound // Annals of Clinical and Translational Neurology. � 2021. Vol. 8(8). - P. 1745-9.

9.

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10.Funke-Chambour M., Bridevaux P.O., Clarenbach C.F. et al.; Swiss COVID Lung Study Group and the Swiss Society of Pulmonology.Swiss Recommendation for the follow-up and treatment of pulmonary Long COVID // Respiration. � 2021. Vol. 100 (8). � P. 826�41. https://dx.doi. org/10.1159/000517255.

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12.Lamprecht B., McBurnie M.A., Vollmer W.M., et al., BOLD Collaborative Research Group: COPD in never smokers: results form the population-based burden of obstructive lung disease study // Chest. -2011. � Vol. 139. � P. 752�763.

13.Torres-Castro R., Vasconcello-Castillo L., Alsina-Restoy X. et al. Respiratory function in patients post�infection by COVID-19: a systematic review and meta-analysis // Pulmonology. � 2021.Vol. 27(4). �P. 328�37. https://dx.doi.org/10.1016/j.pulmoe.2020.10.013.

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Available at: https://www.who.int/ru/news-room/fact-sheets/detail/

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Farr E, Wolfe AR, Deshmukh S, Rydberg L, Soriano R, Walter JM, Boon AJ, Wolfe LF, Franz CK. Diaphragm dysfunction in severe COVID-19 as determined by neuromuscular ultrasound // Annals of Clinical and Translational Neurology. � 2021. Vol. 8(8). - P. 1745-9.

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13.Torres-Castro R., Vasconcello-Castillo L., Alsina-Restoy X. et al. Respiratory function in patients post�infection by COVID-19: a systematic review and meta-analysis // Pulmonology. � 2021.Vol. 27(4). �P. 328�37. https://dx.doi.org/10.1016/j.pulmoe.2020.10.013.

14.World Health Organization. The top 10 causes of death. Fact sheets.

Available at: https://www.who.int/ru/news-room/fact-sheets/detail/

the-top-10-causes-of-death [Accessed: January 31, 2020].

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�� 08.02.2024; �� 20.03.2024; �� 28.03.2023. The article was submitted 08.02.2024; approved after reviewing 20.03.2024; accepted for publication 28.03.2023.

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Аннотация научной статьи по клинической медицине, автор научной работы — Меньшикова Ираида Георгиевна, Магаляс Елена Владимировна, Скляр Ирина Васильевна

Похожие темы научных работ по клинической медицине , автор научной работы — Меньшикова Ираида Георгиевна, Магаляс Елена Владимировна, Скляр Ирина Васильевна

Ultrasonic assessment of the condition of the diaphragm in patients with chronic obstructive pulmonary disease who have experienced COVID-19

Текст научной работы на тему «Ультразвуковая оценка состояния диафрагмы у пациентов хронической обструктивной болезнью легких, перенесших COVID-19»