Značilnosti ultrazvočne preiskave trebušne prepone in spirometrije pri bolnikih s spinalno mišično atrofijo : magistrsko delo

Okršlar, Kaja (avtor), Leonardis, Lea (mentor), Rugelj, Darja (recenzent)

Uvod: Spremljanje in ocenjevanje dihalne funkcije je pri bolnikih s spinalno mišično atrofijo (SMA) ključnega pomena zaradi pravočasnega prepoznavanja in preprečevanja respiratornih zapletov. Običajne metode (spirometrija, merjenje inspiratornega pritiska pri vdihu skozi nos - SNIP test) lahko pozno zaznajo oslabelost inspiratornih mišic, zato se kot dodatna metoda kaže ultrazvok (UZ) za oceno trebušne prepone (TP) in njenega delovanja, saj je neinvazivna in nezahtevna za preiskovalca in bolnika. Namen: Namen magistrske naloge je bil z raziskavo ugotoviti, ali je UZ TP klinično uporabna metoda za ugotavljanje oslabelosti TP pri bolnikih s SMA, ali vrednosti UZ meritev korelirajo z vrednostmi standardnih testov za oceno dihalne funkcije, in kakšne so razlike z meritvami UZ pri zdravi populaciji. Metode dela: V raziskavo smo vključili 22 bolnikov s SMA in 21 zdravih prostovoljcev. Izvedli smo meritve spirometrije in SNIP test ter UZ meritev za oceno debeline, amplitude in hitrosti gibanja TP. Rezultati: Rezultati UZ meritev TP korelirajo z rezultati nekaterih spremenljivk spirometrije (VC, PEF) in SNIP testom pri vseh vključenih preiskovancih. Meritve debeline TP pri izdihu (DEBi) in hitrost premika TP pri hitrem vdihu skozi nos (Hsnip) so višjih vrednosti pri bolnikih s SMA kot pri zdravih posameznikih. Pri bolnikih s SMA UZ spremenljivka DEBi korelira z vsemi parametri spirometrije in SNIP testom. V skupini SMA bolnikov so višje vrednosti DEBi in amplitude gibanja TP pri globokem vdihu (AMPgv) dosegli bolniki z normalno dihalno funkcijo kot tisti z oslabljeno. Vsi parametri spirometrije in SNIP testa zmerno do močno korelirajo tudi s Hammersmithsko lestvico (p<0,05). Razprava in zaključek: UZ ocena TP se je izkazala kot ustrezna diagnostična metoda za ugotavljanje dihalne nezadostnosti. Kot najprimernejši parametri UZ za oceno dihalne funkcije so se izkazali debelina TP pri normalnem in globokem dihanju, amplituda gibanja TP pri globokem vdihu in razlika amplitude TP med normalnim in globokim dihanjem. Ugotovili smo, da imajo bolniki s SMA ohranjeno (in močnejšo) funkcijo TP kot zdravi preiskovanci. Znotraj posameznikov s SMA je funkcija TP boljša pri tistih z neokvarjeno dihalno funkcijo. Ker pa je bil vzorec preiskovancev majhen, je to tudi odlična podlaga za nadaljnje raziskovanje na tem področju.

• Jezik: Slovenski jezik
• Ključne besede: magistrska dela, fizioterapija, trebušna prepona, ultrazvok, spinalna mišična atrofija, dihalna funkcija, ocena
• Vrsta gradiva: Magistrsko delo/naloga
• Tipologija: 2.09 - Magistrsko delo
• Organizacija: ZF - Zdravstvena fakulteta
• Kraj izida: Ljubljana
• Založnik: [K. Okršlar]
• Leto izida: 2022
• Št. strani: 35 str., [16] str. pril.
• PID: 20.500.12556/RUL-137676
• UDK: 615.8
• COBISS.SI-ID: 113684483
• Datum objave v RUL: 25.06.2022

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Diaphragm ultrasound and spirometry in patients with spinal muscular atrophy : master thesis

Izvleček

Introduction: Careful assessment and monitoring of respiratory function is crucial for timely identification and prevention of respiratory complications in patients with spinal muscular atrophy (SMA). Conventional methods (spirometry, sniff nasal inspiratory pressure – SNIP test) can detect inspiratory weakness but this discovery is often late. Therefore, it seems that diaphragm ultrasound (US) for assessment of the diaphrahm thickness and its function is appropriate additional method, as it is non-invasive and easy to perform for the patient and investigator. Purpose: The purpose od this study was to establish whether diaphragm US could be clinically useful method to detect diaphragm weakness in SMA patients. We also wanted to establish possible correlations between US values and standard respiratory tests, and possible differences with US values in healthy population. Methods: The study included 22 SMA patients and 21 healthy volunteers. All subjects participated in spirometry tests and sniff nasal inspiratory pressure test (SNIP). Diaphragm US was used to assess thickness and movement of the muscle. Results: Correlation was found between some of the US and spyrometry values (VC, PEF) and SNIP in all participants. SMA patients showed higher diaphragm thickness (DEBi) and speed at snip maneuver (Hsnip) than healthy volunteers. DEBi also correlates with all parameters of spirometry and SNIP in SMA patients. SMA individuals with normal respiratory function had better outcomes in DEBi and movement of diaphragm during deep breathing (AMPgv) compared to SMA individuals with decreased respiratory function. There was also moderate to high correlation between all spirometry parameters and SNIP and Hammersmith functional motor scale expanded (p<0,05). Discussion and conclusion: US assessment of the diaphragm seems to be appropriate method for respiratory insufficiency and disfunction. Diaphragm thickness during normal and deep breathing, movement during deep breathing and the difference between movement during quiet and deep breathing (DEBi, DEBv, AMPgv, ΔAMP) proved to be the most suitable parameters fort he assessment of respiratory status. It was found that SMA patients have preserved (and stronger) diaphragmal function than healthy participants. Within SMA group, diaphragm function is better and more intact in individuals with normal respiratory function. Due to small number of participants this research seems to have potential to be continued on bigger number of healthy and SMA subjects.

• Ključne besede: master's theses, physiotherapy, diaphragm, ultrasound, spinal muscular atrophy, respiratory function, assessment