中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2014年
10期
737-741
,共5页
蒋高立%王立波%陈超%万成宙%张晓波
蔣高立%王立波%陳超%萬成宙%張曉波
장고립%왕립파%진초%만성주%장효파
体积描记仪%肺功能%肺炎%婴儿,新生
體積描記儀%肺功能%肺炎%嬰兒,新生
체적묘기의%폐공능%폐염%영인,신생
Body plethysmography%Pulmonary function%Pneumonia%Neonate
目的 了解新生儿肺炎的肺功能改变,探讨婴幼儿体积描记仪(体描仪)在新生儿呼吸系统疾病诊疗中的价值.方法 采用体描仪检测117例急性期轻症新生儿肺炎(肺炎组,排除需氧疗、机械通气或有肺炎并发症者)和126例健康新生儿(健康对照组)的功能残气量(FRCP)、有效呼吸道阻力(Reff)和潮气呼吸参数.根据日龄,分为4～7d、8～14d、15 ～21 d、22～ 28 d等4个年龄段加以比较.结果 117例肺炎患儿中79例(67.5％)肺功能异常,肺炎组与健康对照组的达峰时间比(TPTEF/TE)分别为(26.5±10.0)％、(36.8±9.9)％,达峰容积比(VPTEF/VE)分别为(27.9±7.3)％、(35.6±8.4)％,肺内剩余25％潮气量时的潮气呼气流速(TEF25)分别为(36.3±11.7) mL/s、(40.1±12.4)mL/s,前者均显著低于后者,差异均有统计学意义(P均＜0.05);而潮气呼吸峰流速(PTEF)分别为(59.4±16.6)mL/s、(52.9±16.6)mL/s,肺内剩余75％潮气量时的潮气呼气流速(TEF75)分别为(57.4±16.7) mL/s、(49.5±16.7) mL/s,特殊有效呼吸道阻力(sReff)中位数分别为0.48 kPa ·s、0.27 kPa ·s,Reff分别为6.96 kPa·s/L、4.82 kPa·s/L,公斤体质量有效呼吸道阻力(Reff/kg)分别为1.99 kPa·s/(L·kg)、1.44 kPa·s/(L·kg),肺炎组均明显高于健康对照组,差异均有统计学意义(P均＜ 0.001);肺炎组的呼吸频率、FRCp、FRCP/kg略高于健康对照组,但差异无统计学意义.进一步按日龄分组比较发现,15～ 28 d忠儿与≤14 d忠儿相比,前者主要肺功能指标与健康对照组间的差异较明显,肺功能损害程度较重.结论 新生儿肺炎的肺功能异常率较高,为67.5％,病变主要累及小呼吸道,以阻塞性病变为主,肺功能损害以15 ～ 28 d日龄的大龄新生儿更为明显.体描仪评估新生儿肺功能确切有效,可敏感反映肺功能的异常.
目的 瞭解新生兒肺炎的肺功能改變,探討嬰幼兒體積描記儀(體描儀)在新生兒呼吸繫統疾病診療中的價值.方法 採用體描儀檢測117例急性期輕癥新生兒肺炎(肺炎組,排除需氧療、機械通氣或有肺炎併髮癥者)和126例健康新生兒(健康對照組)的功能殘氣量(FRCP)、有效呼吸道阻力(Reff)和潮氣呼吸參數.根據日齡,分為4～7d、8～14d、15 ～21 d、22～ 28 d等4箇年齡段加以比較.結果 117例肺炎患兒中79例(67.5％)肺功能異常,肺炎組與健康對照組的達峰時間比(TPTEF/TE)分彆為(26.5±10.0)％、(36.8±9.9)％,達峰容積比(VPTEF/VE)分彆為(27.9±7.3)％、(35.6±8.4)％,肺內剩餘25％潮氣量時的潮氣呼氣流速(TEF25)分彆為(36.3±11.7) mL/s、(40.1±12.4)mL/s,前者均顯著低于後者,差異均有統計學意義(P均＜0.05);而潮氣呼吸峰流速(PTEF)分彆為(59.4±16.6)mL/s、(52.9±16.6)mL/s,肺內剩餘75％潮氣量時的潮氣呼氣流速(TEF75)分彆為(57.4±16.7) mL/s、(49.5±16.7) mL/s,特殊有效呼吸道阻力(sReff)中位數分彆為0.48 kPa ·s、0.27 kPa ·s,Reff分彆為6.96 kPa·s/L、4.82 kPa·s/L,公斤體質量有效呼吸道阻力(Reff/kg)分彆為1.99 kPa·s/(L·kg)、1.44 kPa·s/(L·kg),肺炎組均明顯高于健康對照組,差異均有統計學意義(P均＜ 0.001);肺炎組的呼吸頻率、FRCp、FRCP/kg略高于健康對照組,但差異無統計學意義.進一步按日齡分組比較髮現,15～ 28 d忠兒與≤14 d忠兒相比,前者主要肺功能指標與健康對照組間的差異較明顯,肺功能損害程度較重.結論 新生兒肺炎的肺功能異常率較高,為67.5％,病變主要纍及小呼吸道,以阻塞性病變為主,肺功能損害以15 ～ 28 d日齡的大齡新生兒更為明顯.體描儀評估新生兒肺功能確切有效,可敏感反映肺功能的異常.
목적 료해신생인폐염적폐공능개변,탐토영유인체적묘기의(체묘의)재신생인호흡계통질병진료중적개치.방법 채용체묘의검측117례급성기경증신생인폐염(폐염조,배제수양료、궤계통기혹유폐염병발증자)화126례건강신생인(건강대조조)적공능잔기량(FRCP)、유효호흡도조력(Reff)화조기호흡삼수.근거일령,분위4～7d、8～14d、15 ～21 d、22～ 28 d등4개년령단가이비교.결과 117례폐염환인중79례(67.5％)폐공능이상,폐염조여건강대조조적체봉시간비(TPTEF/TE)분별위(26.5±10.0)％、(36.8±9.9)％,체봉용적비(VPTEF/VE)분별위(27.9±7.3)％、(35.6±8.4)％,폐내잉여25％조기량시적조기호기류속(TEF25)분별위(36.3±11.7) mL/s、(40.1±12.4)mL/s,전자균현저저우후자,차이균유통계학의의(P균＜0.05);이조기호흡봉류속(PTEF)분별위(59.4±16.6)mL/s、(52.9±16.6)mL/s,폐내잉여75％조기량시적조기호기류속(TEF75)분별위(57.4±16.7) mL/s、(49.5±16.7) mL/s,특수유효호흡도조력(sReff)중위수분별위0.48 kPa ·s、0.27 kPa ·s,Reff분별위6.96 kPa·s/L、4.82 kPa·s/L,공근체질량유효호흡도조력(Reff/kg)분별위1.99 kPa·s/(L·kg)、1.44 kPa·s/(L·kg),폐염조균명현고우건강대조조,차이균유통계학의의(P균＜ 0.001);폐염조적호흡빈솔、FRCp、FRCP/kg략고우건강대조조,단차이무통계학의의.진일보안일령분조비교발현,15～ 28 d충인여≤14 d충인상비,전자주요폐공능지표여건강대조조간적차이교명현,폐공능손해정도교중.결론 신생인폐염적폐공능이상솔교고,위67.5％,병변주요루급소호흡도,이조새성병변위주,폐공능손해이15 ～ 28 d일령적대령신생인경위명현.체묘의평고신생인폐공능학절유효,가민감반영폐공능적이상.
Objective To access the changes of lung function of newborns with pneumonia and to investigate the feasibility of measuring lung function in the body plcthysmograph for diagnosing and treating respiratory diseases.Methods There were 117 infants,1 day after being diagnosed with mild or moderate pneumonia,aged 4-28 days,involved in the study,those who needed oxygen cure,mechanical ventilation,or had complications from pneumonia were ruled out.Pulmonary function tests (PFTs) were performed in the baby body plethysmography to access tidal breathing,plethysmographic functional residual capacity (FRCp),and effective airway resistance (Reff).The other 126 contemporaneous healthy children took the same test for comparison.According to their ages,infants were grouped into 4-7 d,8-14 d,15-21 d and 22-28 d.Results Of the 117 infants with pneumonia,79 (67.5 ％ equivalently) had abnormal lung function.Compared with the controls,infants with pneumonia had significantly higher values of peak tidal expiratory flow [(59.4 ± 16.6) mL/s vs (52.9 ± 16.6) mL/s],expiratory flow at 75％ tidal volume [(57.4 ± 16.7) mL/s vs (49.5 ± 16.7) mL/s],special effective airway resistance (0.48 kPa · s vs O.27 kPa · s),Reff [6.96 kPa · s/L vs 4.82 kPa · s/L] and Reff per kilogram [1.99 kPa · s/(L · kg) vs 1.44 kPa · s/(L · kg)],but lower values of time to peak tidal expiratory flow as a percentage of total expiratory time [(26.5 ± 10.0) ％ vs (36.8 ± 9.9) ％],volume to peak tidal expiratory flow as a percentage of total expiratory volune [(27.9 ± 7.3) ％ vs (35.6 ± 8.4) ％]and expiratory flow at 25％ tidal volume [(36.3 ± 11.7) mL/s vs (40.1 ± 12.4) mL/s].There were no sig± nificant differences in the values of respiratory rate,FRCp and FRCp/kg between the pneumonia children and the healthy control chidren.Compared with the infants aged ≤ 14 days,there were more significant differences in relative parameters of lung funetion between the pneumonia group and the healthy control group for infants aged 15-28 days.Conclusions Newborns with pneumonia had a high ratio of abnormal lung function,which went up to 67.5％,and had apparent obstruction of small airways.Neonates with pneumonia aged 15-28 days had more apparent lesion of lang function.Measuring lang function by means of plethysmography among newborns is feasible and it can detect abnormal lung function sensitively.
