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9РЕСПИРАТОРНЫЕ ИСХОДЫ У ПАЦИЕНТОВ, ПЕРЕНЕСШИХ COVID-19
Гончаров Иван Михайлович Привалова Ирина Леонидовна
Курский Государственный Медицинский Университет Абдурахимов Абдухалим Холиддин угли Хегай Любовь Николаевна
Ташкентская медицинская академия
В данной статье рассматривается взаимосвязь между перенесенной коронавирусной инфекцией и легочными функциями больных. Изучены пациентов, у которых был COVID-19 за последние две недели. Мы пришли к выводу, что снижение функции внешнего дыхания можно проследить независимо от возраста, пола и сопутствующих внелегочных заболеваний. Таким образом, среднее отклонение от VC у мужчин и женщин составило 22,3% и 25,3% соответственно.
Ключевые слова: коронавирусная инфекция, реабилитация, пульмонология, спирометрия.
RESPIRATORY OUTCOMES IN PATIENTS FOLLOWING COVID-19
This article discusses the relationship between the transferred coronovirus infection and the pulmonary functions ofpatients. We studied patients who had COVID-19 in the last two weeks. We came to the conclusion that a decrease in the function of external respiration can be traced regardless of age, gender and concomitant extrapulmonary diseases. Thus, the average deviation from VC in men and women was 22.3% and 25.3%.
Key words: coronavirus infection, rehabilitation, pulmonology, spirometry.
Introduction. In the 21st century in China, the causative agent of a new coronavirus infection was first identified - a virus that spread throughout the world in a matter of months and caused a pandemic that continues to this day. Over the past three years, according to various estimates, approximately 6.8 million people have died [4,10]. The most common clinical form of coronavirus infection is bilateral pneumonia, which tends to transform into acute respiratory distress syndrome [6,8].
It is known that an inadequate immune response, accompanied by excessive production of anti-inflammatory cytokines initiated by the SARS-CoV-2 virus, plays a leading role in lung tissue damage [8]. In this process, alteration of the lung tissue occurs in the form of a diffuse alveolar lesion. Based on the results of the studies, it can be assumed that the virus is sensitive to the ciliated epithelium of the respiratory tract throughout, as well as to respiratory (type I) and secretory (type II) alveolocytes. The affected organ in a cytokine storm is the lungs, which is associated with the aforementioned tropism of the virus to the respiratory epithelium. All immune responses are limited to lung tissue and nearby lymphoid tissue [8]. These factors contribute to the development of hypoxia and respiratory failure.
When diagnosing the disease, the "gold" standard is computed tomography of the chest organs [3,8], which allows differentiation and assessment of the severity of the lesion. On the CT image, characteristic areas of compaction are determined according to the "ground glass" type [8]. Along with CT, laboratory diagnostics is used - the detection of the genetic material of the virus during PCR (polymerase chain reaction).
During the period of post-COVID rehabilitation, it is necessary to monitor the patient's condition with the help of spirometry, which can provide information about the return of body functions to normal [9]. Many patients who have had a coronovirus infection complain of exercise
intolerance, which manifests itself in shortness of breath, which is a consequence of impaired lung function [2]. Thus, impaired respiratory function in patients who have had a coronavirus infection can be observed for several months to several years and mainly consists in a violation of the diffuse ability of the lungs [1]. In this regard, it is recommended to start the rehabilitation of patients with coronavirus pneumonia in a hospital and continue at the outpatient stage [8]. All these measures are aimed at minimizing the disruption of the quality of life. In this regard, in order to assess the degree of rehabilitation and return to normal working capacity, it is necessary to assess the function of external respiration in patients who have had a coronavirus infection, which is the purpose of this study.
Materials and methods. During the observational study, we studied patients (n = 40) who had a coronavirus infection; whose average age was 31 and 32 years, respectively. At the time of the study, the number of people who did not smoke during their lifetime (85%) and who smoked earlier (15%) was calculated. Current smokers were not studied. All the subjects had been infected with coronavirus no more than a month ago and were treated in medical institutions in Kursk.
All the subjects did not suffer from concomitant bronchopulmonary pathologies (COPD, BA, etc.). The number of patients with concomitant extrapulmonary diseases was 5 people (12.5%). Of these: 60% arterial hypertension, 20% type I diabetes, 20% varicose veins.
All patients had bilateral ground-glass lung disease associated with the SARS-CoV-2 virus. The disease was established according to the results of CT in 15 patients (37.5%). Of these, the number of those with the first degree of lung damage was 76.4%, the second degree of lung damage - 26.4%. The maximum degree of lung damage according to the results of computed tomography was 50%, the minimum degree of damage was 7%.
In 25 patients, the diagnosis based on the results of the polymerase chain reaction with the detection of the ribonucleic acid of the virus in the biological material was 62.5%.
All patients signed an informed voluntary consent for the study of respiratory function using spirometry. All studies were carried out on a computerized spirograph "Valenta" (Russia), taking into account modern guidelines for the use of the spirometry method during the period of coronavirus infection [5].
During the study, we studied the vital capacity of the lungs using spirometry. To assess the VC test, 3 separate exhalations were performed after a deep calm breath [7]. Proper vital capacity (JVC) was determined according to the ECCS (European Community for Coal and Steel) scale taking into account the anthropometric data of the patient: JVC (men, age from 18 to 70) 7.9942 - 12.509 x H + 6.05 x H2; (women, ages 18 to 70) 4.66 x H - 0.026 x A - 3.28. The results were expressed as a percentage of the expected value: actual value / due value x 100%.
Normal indicators of VC are considered to be 80-95% of VC. VC less than 79% is considered a low value (Table 1) [5].
Table 1.
The severity of the decrease in lung capacity
Severity Of Decreased Lung Capacity Decrease Percentage
Mild form 60-80%
Moderate form 50-60%
Severe <50%
An analysis was made of the Tiffno index, which is determined by the ratio of forced expiratory volume in the first second to the vital capacity of the lungs (FEV1/VC). This indicator is the most informative when performing spirometry in patients with suspected diseases of the respiratory system, as it makes it possible to assess the degree of obstruction.
Statistica 13.3 software was used for statistical data analysis.
Results. Studying the data of CT, the patients were found to have characteristic structural changes in the lung tissue of varying severity (from 7% to 50%). An additional measurement of the level of arterial blood oxygenation (saturation) did not reveal significant deviations, the average number was 95%.
When analyzing the indicators of the function of external respiration, it can be concluded that in all patients there was a decrease in the actual VC to varying degrees compared with the proper
value (Fig. 1.)
Figure 1. Change in the vital capacity of the lungs in men compared to the proper value after
a coronavirus infection. It is advisable to give a separate chart of average comparative indicators for women, since the vital capacity of the lungs is very different compared to men (Fig. 2).
Figure 2. Change in lung capacity in women compared with the proper value after a
coronavirus infection.
Thus, the average deviation from JEL in men and women was 22.3% and 25.3%, respectively. A decrease in VC of more than 20% can be considered a moderate deviation from the norm, which is associated with a mild to moderate coronavirus infection.
Discussions. The greatest deviations in VC were observed in patients who had a degree of lung damage according to CT equal to two (25-50%). In these patients, a clear decrease in lung capacity is noticeable (34.25%).
There were no obvious deviations of VC in patients suffering from extrapulmonary pathologies compared with patients without extrapulmonary pathologies. The average deviation of VC in patients with extrapulmonary pathologies was 23.75%.
A deviation in the Tiffno index was observed in 18 people, which affects the ventilation capacity of the lungs. Thus, the minimum indicator of the Tiffno index was 64%, the average number was 73.9%, which is at the lower limit of the norm.
It was noted that some of the subjects complained of a decrease in working capacity and the level of quality of life associated with moderate shortness of breath.
We found a moderate inverse relationship between VC and the degree of lung tissue damage according to CT data, which is associated with possible pulmonary fibrosis [6, 8].
Conclusions. Thus, we can conclude that a decrease in VC in patients who have had a coronavirus infection can be traced regardless of gender and the presence of concomitant diseases.
Based on this, it is worth noting that the assessment of the function of external respiration is one of the key functional studies in the post-COVID assessment of the condition of patients.
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