不同给药方法对潮气肺功能支气管舒张试验结果的影响观察
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摘要
目的探讨影响潮气肺功能支气管舒张试验参数改善的因素,为婴幼儿哮喘的诊断提供参考依据。方法选择2017年3月至2018年6月就诊于首都儿科研究所哮喘门诊、经临床明确诊断为支气管哮喘且处于急性发作期(喘息发作≤7d)的71例婴幼儿,将患儿依就诊顺序分为气雾剂组20例及雾化组51例,前者采用定量气雾剂给予支气管舒张剂,后者采用雾化吸入给予支气管舒张剂。2组患儿均进行潮气肺功能支气管舒张试验,比较两种给药方式对支气管舒张试验结果的影响,主要观察参数包括呼吸频率、潮气量、吸气时间、呼气时间、吸呼比、达峰时间比、达峰容积比、呼气峰流量;随后进行组内分析,进一步探讨各参数改善率的影响因素。结果给药后,气雾剂组患儿呼吸频率显著下降(P=0.003),吸气时间显著延长(P=0.011);雾化组患儿潮气量、吸气时间、吸呼比、达峰时间比、达峰容积比显著上升(均P<0.05)。雾化组患儿吸呼比、达峰容积比上升幅度显著高于气雾剂组(均P<0.05)。气雾剂组内,与气道轻度阻塞患儿比较,气道重度阻塞患儿给药后,吸呼比、达峰时间比、达峰容积比改善显著(均P<0.05);雾化组内,气道重度阻塞患儿给药后,以上参数亦明显改善。雾化组不同年龄组间比较,2岁以上患儿达峰时间比、达峰容积比上升幅度显著高于1岁以下患儿(均P<0.05)。结论通过潮气肺功能技术进行支气管舒张试验,雾化吸入给药方式的舒张效果优于定量气雾剂;给药后肺功能参数的改善与气道阻塞程度有关,也与患儿年龄有关。
Objective To investigate the factors influencing the improvement of tidal lung function bronchodilation test,and to provide evidence for the diagnosis of infant asthma. Methods Totally 71 infant patients diagnosed with asthma were included from clinic of Children's Hospital of Capital Institute of Pediatrics and alternativley assigned into two groups,who respectively received bronchodilator via pM DI(pMDI group)or nebulization(nebulization group),and bronchodilation test was performed. The effects of drug delivering methods on the bronchodilation test was compared,and the main observation indexes were respiratory rate(RR),VT/kg,inspiratory time(Ti),expiratory time(Te),Ti/Te,time to peak tidal expiratory flow as a proportion of expiratory time(TPTEF/TE),volume to peak expiratory flow as a proportion of exhaled volume(VPEF/VE)and peak tidal expiratory flow(PTEF). Further analysis was carried within each group. Results Twenty patients received bronchodilator via pM DI,and fifty-one patients received bronchodilator via nebulization. After drug delivery,the RR of the children in the pMDI group decreased significantly(P=0.003),and the Ti increased significantly(P=0.011). The VT/kg,Ti,Ti/Te,TPTEF/TE and VPEF/VE increased significantly in nebulization group(all P<0.05). In the nebulization group,the improvement rate of TPTEF/TE and VPEF/VE were significantly higher than that of pMDI group(all P<0.05). In the pMDI group,the Te,Ti/Te,TPTEF/TE and VPEF/VE significantly improved in patients with severe airway obstruction(all P<0.05). The above parameters also improved after bronchodilation test in nebulization group. Compared in difference age groups,TPTEF/TE and VPEF/VE in children over 2 years improved more significantly than those in children under 1 year(all P<0.05). Conclusion The effects of nebulization are better than pMDI in tidal lung function bronchodilation test. The improvement rate of tidal lung function is related to the degree of airway obstruction and the age of patients.
Objective To investigate the factors influencing the improvement of tidal lung function bronchodilation test,and to provide evidence for the diagnosis of infant asthma. Methods Totally 71 infant patients diagnosed with asthma were included from clinic of Children's Hospital of Capital Institute of Pediatrics and alternativley assigned into two groups,who respectively received bronchodilator via pM DI(pMDI group)or nebulization(nebulization group),and bronchodilation test was performed. The effects of drug delivering methods on the bronchodilation test was compared,and the main observation indexes were respiratory rate(RR),VT/kg,inspiratory time(Ti),expiratory time(Te),Ti/Te,time to peak tidal expiratory flow as a proportion of expiratory time(TPTEF/TE),volume to peak expiratory flow as a proportion of exhaled volume(VPEF/VE)and peak tidal expiratory flow(PTEF). Further analysis was carried within each group. Results Twenty patients received bronchodilator via pM DI,and fifty-one patients received bronchodilator via nebulization. After drug delivery,the RR of the children in the pMDI group decreased significantly(P=0.003),and the Ti increased significantly(P=0.011). The VT/kg,Ti,Ti/Te,TPTEF/TE and VPEF/VE increased significantly in nebulization group(all P<0.05). In the nebulization group,the improvement rate of TPTEF/TE and VPEF/VE were significantly higher than that of pMDI group(all P<0.05). In the pMDI group,the Te,Ti/Te,TPTEF/TE and VPEF/VE significantly improved in patients with severe airway obstruction(all P<0.05). The above parameters also improved after bronchodilation test in nebulization group. Compared in difference age groups,TPTEF/TE and VPEF/VE in children over 2 years improved more significantly than those in children under 1 year(all P<0.05). Conclusion The effects of nebulization are better than pMDI in tidal lung function bronchodilation test. The improvement rate of tidal lung function is related to the degree of airway obstruction and the age of patients.
引文
[1]全国儿科哮喘防治协作组,中国疾病预防控制中心环境与健康产品安全所.第三次中国城市儿童哮喘流行病学调查[J].中华儿科杂志,2013,51(10):729-735.
[2]中华医学会呼吸病学分会肺功能专业组.肺功能检查指南(第四部分)-支气管舒张试验[J].中华结核和呼吸杂志,2014,37(9):655-658.
[3]冯雍,尚云晓.婴幼儿肺功能检测及其在喘息性疾病应用进展[J].中国实用儿科杂志,2014,29(60):424-428.
[4]韩文,谢勇,任淑颖,等.潮气呼吸肺功能检测在1~4岁儿童喘息性疾病中的临床应用[J].中国当代儿科杂志,2014,16(8):800-804.
[5]王俊平,张皓,王立波,等.支气管舒张试验在0~6岁儿童喘息性疾病诊断中的作用[J].中国实用儿科杂志,2006,21(10):768-771.
[6]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志,2016,54(3):167-181.
[7]中华医学会儿科学分会呼吸学组肺功能协作组,《中华实用儿科临床杂志》编辑委员会.儿童肺功能系列指南(四):潮气呼吸肺功能[J].中华实用临床儿科杂志,2016,31(21):1617-1621.
[8]李硕,刘传合,宋欣,等.喘息患儿潮气呼吸肺功能改变的特征[J].临床儿科杂志,2006,24(6):483-511.
[9]潘志伟,林雪华,刘志刚.婴幼儿哮喘与潮气呼吸肺功能的相关性[J].广东医学,2016,37(Suppl):67-69.
[10]Deerojanawong,Manuyakorn W,Prapphal N,et al.Randomized controlled trial of salbutamol aerosol therapy via metered dose inhaler-spacer vs.jet nebulizer in young children with wheezing[J].Pediatr Pulmonol,2005,39(5):466-472.
[11]Yasmin S,Mollah AH,Basak R,et al.Efficacy of salbutamol by nebulizer versus metered dose inhaler with home-made non-valved spacer in acute exacerbation of childhood asthma[J].Mymensingh Med J,2012,21(1):66-71.
[12]李硕,刘传合,宋欣,等.潮气肺功能测定支气管舒张试验对婴幼儿哮喘的诊断价值[J].实用儿科临床杂志,2007,19(22):1475-1480.
[13]王彩姣,饶花平,张林,等.支气管舒张试验在婴幼儿支气管哮喘中的应用价值[J].实用儿科临床杂志,2012,27(4):283-284.
[14]张皓.婴幼儿肺功能检查的方法[J].国际儿科学杂志,2004,31(2):73-75.
[15]邓力.婴幼儿肺功能检查原理和临床应用[J].国际儿科学杂志,2007,34(3):389-391.
[16]侯萍,单丽沈,蔡栩栩,等.哮喘儿童呼出气一氧化氮与肺功能及哮喘控制测试相关性研究[J].中国实用儿科杂志,2014,29(9):708-712.
[17]张惠琴,张静静,陶小娟,等.潮气呼吸肺功能与呼出气一氧化氮检测对2~5岁哮喘患儿临床价值研究[J].中国实用儿科杂志,2018,33(3):229-232.
[18]段涛,刘铭.早产两个临床热点问题探讨[J].中国实用妇科与产科杂志,2017,33(1):36-39.
[19]杨雪梅,赵谦谦,尚丽新.未足月胎膜早破残余羊水量对妊娠结局的影响[J].中国实用妇科与产科杂志,2017,33(5):512-516.
[2]中华医学会呼吸病学分会肺功能专业组.肺功能检查指南(第四部分)-支气管舒张试验[J].中华结核和呼吸杂志,2014,37(9):655-658.
[3]冯雍,尚云晓.婴幼儿肺功能检测及其在喘息性疾病应用进展[J].中国实用儿科杂志,2014,29(60):424-428.
[4]韩文,谢勇,任淑颖,等.潮气呼吸肺功能检测在1~4岁儿童喘息性疾病中的临床应用[J].中国当代儿科杂志,2014,16(8):800-804.
[5]王俊平,张皓,王立波,等.支气管舒张试验在0~6岁儿童喘息性疾病诊断中的作用[J].中国实用儿科杂志,2006,21(10):768-771.
[6]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志,2016,54(3):167-181.
[7]中华医学会儿科学分会呼吸学组肺功能协作组,《中华实用儿科临床杂志》编辑委员会.儿童肺功能系列指南(四):潮气呼吸肺功能[J].中华实用临床儿科杂志,2016,31(21):1617-1621.
[8]李硕,刘传合,宋欣,等.喘息患儿潮气呼吸肺功能改变的特征[J].临床儿科杂志,2006,24(6):483-511.
[9]潘志伟,林雪华,刘志刚.婴幼儿哮喘与潮气呼吸肺功能的相关性[J].广东医学,2016,37(Suppl):67-69.
[10]Deerojanawong,Manuyakorn W,Prapphal N,et al.Randomized controlled trial of salbutamol aerosol therapy via metered dose inhaler-spacer vs.jet nebulizer in young children with wheezing[J].Pediatr Pulmonol,2005,39(5):466-472.
[11]Yasmin S,Mollah AH,Basak R,et al.Efficacy of salbutamol by nebulizer versus metered dose inhaler with home-made non-valved spacer in acute exacerbation of childhood asthma[J].Mymensingh Med J,2012,21(1):66-71.
[12]李硕,刘传合,宋欣,等.潮气肺功能测定支气管舒张试验对婴幼儿哮喘的诊断价值[J].实用儿科临床杂志,2007,19(22):1475-1480.
[13]王彩姣,饶花平,张林,等.支气管舒张试验在婴幼儿支气管哮喘中的应用价值[J].实用儿科临床杂志,2012,27(4):283-284.
[14]张皓.婴幼儿肺功能检查的方法[J].国际儿科学杂志,2004,31(2):73-75.
[15]邓力.婴幼儿肺功能检查原理和临床应用[J].国际儿科学杂志,2007,34(3):389-391.
[16]侯萍,单丽沈,蔡栩栩,等.哮喘儿童呼出气一氧化氮与肺功能及哮喘控制测试相关性研究[J].中国实用儿科杂志,2014,29(9):708-712.
[17]张惠琴,张静静,陶小娟,等.潮气呼吸肺功能与呼出气一氧化氮检测对2~5岁哮喘患儿临床价值研究[J].中国实用儿科杂志,2018,33(3):229-232.
[18]段涛,刘铭.早产两个临床热点问题探讨[J].中国实用妇科与产科杂志,2017,33(1):36-39.
[19]杨雪梅,赵谦谦,尚丽新.未足月胎膜早破残余羊水量对妊娠结局的影响[J].中国实用妇科与产科杂志,2017,33(5):512-516.