中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2014年
7期
525-530
,共6页
张晓波%蒋高立%王立波%刘丽娟%施鹏%万成宙%钱莉玲
張曉波%蔣高立%王立波%劉麗娟%施鵬%萬成宙%錢莉玲
장효파%장고립%왕립파%류려연%시붕%만성주%전리령
呼吸功能试验%体积描记术%呼吸道感染
呼吸功能試驗%體積描記術%呼吸道感染
호흡공능시험%체적묘기술%호흡도감염
Respiratory function tests%Plethysmography%Respiratory tract infections
目的 应用婴幼儿体积描记法(简称体描)评估急性下呼吸道感染(ALRI)患儿肺功能的改变及预后,探讨体描在婴幼儿ALRI中的应用价值.方法 于2012年1月至2013年1月采用体描仪检测444例1～36月龄ALRI患儿(喘息组195例,非喘息组249例)和103名呼吸生理正常婴幼儿(对照组)的潮气呼吸参数、功能残气量(FRC)、气道阻力(Raw),比较ALRI患儿的体描特有指标FRC、Raw与潮气呼吸主要指标的相关性,并于疾病恢复期随访36例喘息组患儿的肺功能.结果 喘息组、非喘息组、对照组的达峰时间比(TPTEF/TE)分别为(20.5±6.7)％、(22.8±6.5)％、(34.6±5.0)％,喘息组明显降低,组间差异有统计学意义(F=110.500,P＜0.001);达峰容积比(VPTEF/VE)分别为(23.0±6.3)％、(25.2±6.8)％、(34.5±4.2)％,组间比较差异有统计学意义(F=107.800,P＜0.001);喘息组、非喘息组、对照组体描法功能残气量(FRCP)的中位数分别为226、176、172 ml;千克体重功能残气量(FRCP/kg)分别为24.40、17.80、17.60 ml/kg;特殊有效气道阻力(sReff)分别为1.00、0.52、0.46 kPa·s;有效气道阻力(Reff)分别为3.90、2.74、2.20 kPa·s/L;千克体重有效气道阻力(Reff/kg)分别为0.42、0.29、0.22 kPa· s/(L·kg),组间比较差异均有统计学意义(x2=64.870、68.890、75.240、36.480、29.460,P＜0.001).喘息组患儿中仅有25例潮气呼吸参数正常者,与对照组中年龄、身长、体重、性别构成与之相近的30名婴幼儿的体描参数相比较,发现FRCP、FRCP/kg、sReff、Reff、Reff/kg均明显高于对照组(=2.221、1.997、2.502、2.587、2.539,P均＜0.05).FRCP、FRCP/kg、sReff、Reff及Reff/kg均与潮气呼吸主要指标TPTEF/TE、VPTEF/VE呈负相关(P均＜0.05).36例喘息组患儿疾病恢复期潮气呼吸主要参数TPTEF/TE、VPTEF/VE未见明显改善,而FRCP、FRCP/kg、sReff、Reff、Reff/kg等体描特有参数较急性期降低(Z=-1.999、-2.195、-2.038、-1.823、-2.054,P均＜0.05).结论 体描可用于ALRI患儿的肺功能评估,能敏感地反映ALRI(尤其是ALRI伴喘息发作)的呼吸生理改变,体描检测的FRC、Raw与潮气呼吸主要指标之间具有良好的相关性.
目的 應用嬰幼兒體積描記法(簡稱體描)評估急性下呼吸道感染(ALRI)患兒肺功能的改變及預後,探討體描在嬰幼兒ALRI中的應用價值.方法 于2012年1月至2013年1月採用體描儀檢測444例1～36月齡ALRI患兒(喘息組195例,非喘息組249例)和103名呼吸生理正常嬰幼兒(對照組)的潮氣呼吸參數、功能殘氣量(FRC)、氣道阻力(Raw),比較ALRI患兒的體描特有指標FRC、Raw與潮氣呼吸主要指標的相關性,併于疾病恢複期隨訪36例喘息組患兒的肺功能.結果 喘息組、非喘息組、對照組的達峰時間比(TPTEF/TE)分彆為(20.5±6.7)％、(22.8±6.5)％、(34.6±5.0)％,喘息組明顯降低,組間差異有統計學意義(F=110.500,P＜0.001);達峰容積比(VPTEF/VE)分彆為(23.0±6.3)％、(25.2±6.8)％、(34.5±4.2)％,組間比較差異有統計學意義(F=107.800,P＜0.001);喘息組、非喘息組、對照組體描法功能殘氣量(FRCP)的中位數分彆為226、176、172 ml;韆剋體重功能殘氣量(FRCP/kg)分彆為24.40、17.80、17.60 ml/kg;特殊有效氣道阻力(sReff)分彆為1.00、0.52、0.46 kPa·s;有效氣道阻力(Reff)分彆為3.90、2.74、2.20 kPa·s/L;韆剋體重有效氣道阻力(Reff/kg)分彆為0.42、0.29、0.22 kPa· s/(L·kg),組間比較差異均有統計學意義(x2=64.870、68.890、75.240、36.480、29.460,P＜0.001).喘息組患兒中僅有25例潮氣呼吸參數正常者,與對照組中年齡、身長、體重、性彆構成與之相近的30名嬰幼兒的體描參數相比較,髮現FRCP、FRCP/kg、sReff、Reff、Reff/kg均明顯高于對照組(=2.221、1.997、2.502、2.587、2.539,P均＜0.05).FRCP、FRCP/kg、sReff、Reff及Reff/kg均與潮氣呼吸主要指標TPTEF/TE、VPTEF/VE呈負相關(P均＜0.05).36例喘息組患兒疾病恢複期潮氣呼吸主要參數TPTEF/TE、VPTEF/VE未見明顯改善,而FRCP、FRCP/kg、sReff、Reff、Reff/kg等體描特有參數較急性期降低(Z=-1.999、-2.195、-2.038、-1.823、-2.054,P均＜0.05).結論 體描可用于ALRI患兒的肺功能評估,能敏感地反映ALRI(尤其是ALRI伴喘息髮作)的呼吸生理改變,體描檢測的FRC、Raw與潮氣呼吸主要指標之間具有良好的相關性.
목적 응용영유인체적묘기법(간칭체묘)평고급성하호흡도감염(ALRI)환인폐공능적개변급예후,탐토체묘재영유인ALRI중적응용개치.방법 우2012년1월지2013년1월채용체묘의검측444례1～36월령ALRI환인(천식조195례,비천식조249례)화103명호흡생리정상영유인(대조조)적조기호흡삼수、공능잔기량(FRC)、기도조력(Raw),비교ALRI환인적체묘특유지표FRC、Raw여조기호흡주요지표적상관성,병우질병회복기수방36례천식조환인적폐공능.결과 천식조、비천식조、대조조적체봉시간비(TPTEF/TE)분별위(20.5±6.7)％、(22.8±6.5)％、(34.6±5.0)％,천식조명현강저,조간차이유통계학의의(F=110.500,P＜0.001);체봉용적비(VPTEF/VE)분별위(23.0±6.3)％、(25.2±6.8)％、(34.5±4.2)％,조간비교차이유통계학의의(F=107.800,P＜0.001);천식조、비천식조、대조조체묘법공능잔기량(FRCP)적중위수분별위226、176、172 ml;천극체중공능잔기량(FRCP/kg)분별위24.40、17.80、17.60 ml/kg;특수유효기도조력(sReff)분별위1.00、0.52、0.46 kPa·s;유효기도조력(Reff)분별위3.90、2.74、2.20 kPa·s/L;천극체중유효기도조력(Reff/kg)분별위0.42、0.29、0.22 kPa· s/(L·kg),조간비교차이균유통계학의의(x2=64.870、68.890、75.240、36.480、29.460,P＜0.001).천식조환인중부유25례조기호흡삼수정상자,여대조조중년령、신장、체중、성별구성여지상근적30명영유인적체묘삼수상비교,발현FRCP、FRCP/kg、sReff、Reff、Reff/kg균명현고우대조조(=2.221、1.997、2.502、2.587、2.539,P균＜0.05).FRCP、FRCP/kg、sReff、Reff급Reff/kg균여조기호흡주요지표TPTEF/TE、VPTEF/VE정부상관(P균＜0.05).36례천식조환인질병회복기조기호흡주요삼수TPTEF/TE、VPTEF/VE미견명현개선,이FRCP、FRCP/kg、sReff、Reff、Reff/kg등체묘특유삼수교급성기강저(Z=-1.999、-2.195、-2.038、-1.823、-2.054,P균＜0.05).결론 체묘가용우ALRI환인적폐공능평고,능민감지반영ALRI(우기시ALRI반천식발작)적호흡생리개변,체묘검측적FRC、Raw여조기호흡주요지표지간구유량호적상관성.
Objective Body plethysmography is a typical method to measure functional residual capacity (FRC) and airway resistance (Raw).The aim of the study was to test the feasibility of measuring lung function with the body plethysmography in young children with acute lower respiratory tract infection (ALRI) by evaluating changes and prognosis of lung function for infants with ALRI with or without wheezing via body plethysmograph.Method Pulmonary function tests (PFTs) were performed by using body plethysmography in 444 children with ALRI,aged 1-36 months,to assess their tidal breathing parameters such as ratio of time to peak tidal expiratory flow to total expiratory time (TPTEF/TE),ratio of volume to peak tidal expiratory flow to total expiratory volume (VPTEF/VE),plethysmographic functional residual capacity (FRCP),FRCP per kilogram (FRCP/kg),specific effective airway resistance (sReff),effective airway resistance (Reff),Reff per kilogram (Reff/kg),etc.According to whether there was wheezing or not,children who had ALRI with wheezing were classified as Group-W,or without wheezing as GroupN.Changes or correlations of tidal breathing parameters and plethysmographic parameters were compared.One hundred and three contemporaneous healthy controls aged 1-36 months underwent the same tests for comparison.And 36 wheezing children accepted PFTs at follow-up in recovery phase.Result Mean values of TPTEF/TE in Group-W,Group-N and the Control respectively were (20.5 ± 6.7) ％,(22.8 ± 6.5) ％,(34.6 ± 5.0) ％ (F =110.500,P ＜ 0.001),while VPTEF/VE respectively were (23.0 ± 6.3) ％,(25.2 ± 6.8) ％,(34.5 ± 4.2) ％ (F =107.800,P ＜ 0.001).Compared to the Control,Group-W and Group-N had significantly higher values of FRCP(226 vs.176 vs.172 ml,x2 =64.870,P ＜0.001),FRCP/ kg(24.40 vs.17.80 vs.17.60 ml/kg,x2 =68.890,P ＜0.001),sReff(1.00 vs.0.52 vs.0.46 kPa · s,x2 =75.240,P＜0.001),Reff (3.90 vs.2.74 vs.2.20 kPa · s/L,x2 =36.480,P ＜0.001) and Reff/kg [0.42 vs.0.29 vs.0.22 kPa · s/ (L · kg),x2 =29.460,P ＜ 0.001].Although 25 (12.8％) wheezing children with ALRI had normal values of tidal breathing parameters,they already had increased FRCP,FRCP/kg,sReff,Reff and Reff/kg (t =2.221,1.997,2.502,2.587,2.539,all P ＜0.05).Values of FRCP and Reff in infants caught ALRI were inversely correlated to that of TPTEF/TE and VPTEF/VE (P ＜ 0.05) ;36 children with wheezing who accepted PFTs at follow-up had shown significant decline in the specific parameters of plethysmography such as FRCP,FRCP/kg,sReff,Reff and Reff/kg (Z =-1.999,-2.195,-2.038,-1.823,-2.054,all P ＜ 0.05),while no improvement in the main parameters of tidal breathing such as TPTEF/TE.Conclusion Measuring lung function with the body plethysmography in young children with ALRI is feasible.FRC and Raw,as special lung function testing parameters of body plethysmography,were sensitive indicators reflecting impairment of lung function in infants with ALRI (especially for children caught ALRI with wheezing) and shows significant correlation with parameters from lung function testing via tidal breathing.Therefore plethysmography is worthy of clinical promotion.
