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目的 :探讨呼气相气道内负压法(NEP)检测呼气流速受限(EFL)在儿童哮喘缓解期、急性发作期以及支气管激发和扩张试验中实施的可行性,及其与常规阻塞性肺通气功能指标第一秒用力呼气容积(FEV1)、呼吸困难严重程度(MRC评分)的相关性。方法 :选取儿童哮喘患者80例,先给予MRC评分,然后分别进行常规肺通气功能检测及NEP法检测EFL。从48例缓解期患儿中随机选取35例进行支气管组胺激发试验。对32例哮喘急性发作的患儿同时行支气管扩张试验。结果 :48例哮喘缓解期患儿坐位和仰卧位均未出现EFL,35例进行支气管组胺激发试验的缓解期哮喘患儿,激发试验前无1例病人出现EFL,激发试验后有1例病人出现仰卧位EFL,而无1例病人出现坐位EFL。32例哮喘急性发作患儿雾化吸入支气管扩张剂前12例坐位和仰卧位均存在EFL,20例坐位时无EFL,仅仰卧位出现EFL,在雾化吸入支气管扩张剂后20分钟:所有患儿无论坐位还是仰卧位EFL均消失。结论 :(1)NEP法检测EFL与FEV1显著相关。(2)NEP法检测EFL指标与FEV1均与MRC评分显著相关,但EFL与MRC评分的相关性更强。(3)NEP法检测EFL能应用于支气管扩张试验以检测气道阻塞的可逆性。(4)NEP法检测EFL应用于支气管激发试验时,不能敏感反映支气管激发试验阳性判断指标(FEV1下降≥20%)的变化。
OBJECTIVE: To investigate the feasibility of using expired airway pressure (NEP) to detect limited expiratory flow (EFL) in childhood asthma remission, acute exacerbation and bronchial provocation and dilatation, and to compare with conventional obstructive Pulmonary ventilatory function indicators of the first second forced expiratory volume (FEV1), the severity of dyspnea (MRC score) correlation. Methods: Eighty children with asthma were selected. The MRC score was given first, then the routine pulmonary ventilation test and NEP test were performed respectively. Thirty-five patients were randomly selected from 48 children with remission to undergo bronchial histamine challenge test. Bronchodilator test was performed in 32 children with acute asthma at the same time. Results: No EFL was found in the sitting and supine position of 48 children with asthma. 35 children with remission asthma undergoing bronchial histamine challenge test showed no EFL before the challenge test, and 1 patient after the challenge test There was supine EFL, but none of the patients showed seat EFL. There were EFLs in sitting position and supine position in 12 patients with acute exacerbation of asthma, EFL in sitting position in 20 patients, EFL only in supine position, and 20 minutes after aerosolizing bronchodilator in all patients Children regardless of sitting or supine EFL disappeared. Conclusion: (1) NEP method was significantly correlated with FEV1. (2) Both EFL index and FEV1 in NEP test were significantly correlated with MRC score, but EFL was more correlated with MRC score. (3) NEP test EFL can be applied to bronchodilator test to detect reversibility of airway obstruction. (4) When the NEP method is used to detect bronchial provocation test, EFL can not sensitively reflect the change of bronchial provocation test positive judgment index (FEV1decreased≥20%).