Ultrazvočna ocena trebušne prepone pri bolnikih z amiotrofično lateralno sklerozo : magistrsko delo

Matelič, Jana (author), Leonardis, Lea (mentor), Puh, Urška (reviewer)

Uvod: Natančna ocena in spremljanje dihalne funkcije nam pomagata, da se pri bolniku z amiotrofično lateralno sklerozo (ALS) pravočasno odločimo o nadaljnjem poteku zdravljenja in podpore. Ustaljene metode za oceno dihalne funkcije niso brez pomanjkljivosti. Ultrazvok (UZ) trebušne prepone se ponuja kot primerna metoda za oceno njenega delovanja in posledično dihalne funkcije pri bolnikih z ALS, saj je neinvazivna in zahteva manj sodelovanja bolnika. Namen: Namen magistrske naloge je bil s pomočjo raziskave ugotoviti, ali je UZ trebušne prepone klinično uporabna metoda za ugotavljanje oslabelosti trebušne prepone pri bolnikih z ALS; zanimalo nas je tudi, ali rezultati meritev UZ trebušne prepone statistično značilno korelirajo z rezultati drugih meritev za oceno dihalne funkcije, ki se že uporabljajo v klinični praksi. Metode dela: V raziskavo smo vključili 24 bolnikov z ALS in 36 zdravih preiskovancev. Izvedli smo UZ meritev, ki je vključevala oceno debeline trebušne prepone in meritve amplitude ter hitrosti gibanja trebušne prepone. Izvedli smo tudi meritve spirometrije in test maksimalnega vdiha skozi nos. Rezultati: Rezultati meritev UZ trebušne prepone so nižjih vrednosti pri bolnikih, katerih vrednosti vitalne kapacitete in testa maksimalnega vdiha skozi nos kažejo na oslabelo dihalno funkcijo, kot pri preiskovancih z normalnimi vrednostmi dihalne funkcije. Določeni parametri za oceno debeline trebušne prepone z UZ korelirajo z rezultati meritev spirometrije z nizko korelacijo (r=0,291–0,465), parametri za oceno gibanja trebušne prepone pa nizko do zmerno korelirajo z rezultati meritev tako spirometrije (r=0,259 – 0,618) kot tudi z rezultati testa maksimalnega vdiha skozi nos (r=0,325– 0,445). Določeni parametri UZ zmerno do visoko korelirajo z rezultati ALSFRS-R lestvice in tudi z rezultati samo respiratorne podkategorije testa (r=0,516–0,626). Razprava in zaključek: UZ trebušne prepone omogoča ugotavljanje dihalne nezadostnosti pri bolnikih z ALS in nam da primerljive rezultate kot drugi testi za oceno dihalne funkcije. Indeks debeline trebušne prepone, amplituda gibanja trebušne prepone ob globokem vdihu in hitrost gibanja trebušne prepone se kažejo kot najbolj primerni parametri UZ trebušne prepone za oceno dihalne funkcije in za nadaljnje raziskovanje na tem področju.

• Language: Slovenian
• Keywords: magistrska dela, fizioterapija, ultrazvok, trebušna prepona, amiotrofična lateralna skleroza, dihalna funkcija, respiratorna ocena
• Work type: Master's thesis/paper
• Typology: 2.09 - Master's Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [J. Matelič]
• Year: 2021
• Number of pages: 41 str., [7] str. pril.
• PID: 20.500.12556/RUL-129579
• UDC: 615.8
• COBISS.SI-ID: 75474179
• Publication date in RUL: 05.09.2021

Secondary language

• Language: English
• Title: Diaphragm ultrasound in patients with amyotrophic lateral sclerosis : master's thesis

Abstract

Introduction: With careful assessment and monitoring of respiratory function, we can make timely decisions about further treatment and support in patients with amyotrophic lateral sclerosis (ALS). Established methods for assessing respiratory function have their limitations. Diaphragm ultrasound (US) seems to be a suitable method for assessment of the diaphragm and consequently respiratory function in patients with ALS because it is non-invasive and requires less patient participation. Purpose: The purpose of this study was to determine whether diaphragm US is a useful method for determining respiratory dysfunction in patients with ALS; we were also interested in whether the results of diaphragm US measurements correlate with the results of other respiratory function tests, usually used in clinical practice. Methods: The study included 24 patients with ALS and 36 healthy volunteers. We performed diaphragm US, which included measurements to determine diaphragm thickness and measurements to determine diaphragm movement. We also performed spirometry measurements and measured sniff nasal inspiratory pressure. Results: Subjects with vital capacity and sniff nasal inspiratory pressure values lower than normal had also lower values of diaphragm US measurements. Certain diaphragm US measurements for estimating diaphragm thickness correlate with spirometry measurements (r=0,291–0,465). Measurements for estimating diaphragm movement significantly correlate with spirometry (r=0,259 – 0,618) and sniff nasal inspiratory pressure (r=0,325– 0,445) measurements. Certain diaphragm US measurements significantly correlate with ALSFRS-R scale results and with the results of its respiratory subcategory as well (r=0,516–0,626). Discussion and conclusion: Diaphragm US allows the determination of respiratory dysfunction in patients with ALS and can show comparable results as other assessment tolls. The diaphragm thickness index, the amplitude of the diaphragm movement during deep breathing, and the diaphragm velocity seem to be the most appropriate diaphragm US parameters for assessing respiratory function and for further research.

• Keywords: master's theses, physiotherapy, ultrasound, diaphragm, amyotrophic lateral sclerosis, respiratory function, respiratory assessment