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目的探讨并分析目前临床支气管激发试验阳性率过低的问题,思考提高阳性率的方法。方法回顾性分析我院2014年1月至2014年5月共171例门诊怀疑支气管哮喘的患者进行支气管激发试验。我院采用的仪器是Jaeger肺功能仪,以乙酰甲胆碱作为激发原,采用机器配置的雾化吸入方式进行药物吸入,药物浓度分别为0.9%NaCL(0.072mg),MCH4mg/mL(0.0512mg),4mg/mL(0.07mg),32mg/mL(0.5095mg),32mg/mL(0.5095mg),32mg/mL(0.5089mg),32mg/mL(0.852mg)。激发试验后舒张试验采用乙丙托溴铵气雾剂4PUFFS,15分钟后行舒张试验。结果 171例患者中支气管激发试验阴性者共131例,支气管激发试验阳性者共40例,阳性率为23.4%。结论引起支气管阳性率过低的原因很多,现归纳以下4点,(1)患者的选择,严格选择高度怀疑支气管哮喘的患者。(2)诊断标准的敏感性,目前国内多采用FEV1%下降率大于等于20%为阳性,但目前国外的一些研究证实反映气道反应性的较敏感指标为sGaw,在FEV1下降20%的时候sGaw已下降50%以上,故采用sGaw来判断阳性可提高哮喘患者的检出率。(3)激发原的选择,目前临床上所用的激发原有很多种,不同的哮喘患者可能对不同的激发原敏感,这也是造成有些哮喘患者激发试验为阴性的原因,故针对不同的患者选择不同的激发原为以后研究的重点,可以提高哮喘的检出率。(4)支气管激发试验后加做支气管舒张试验,可以排除由于各种原因引起的激发试验阴性的患者的检出率。如果激发试验是阴性,而后加做舒张试验是阳性也能做出哮喘的诊断。
Objective To explore and analyze the current clinical bronchial provocation test positive rate is too low, think about ways to improve the positive rate. Methods A retrospective analysis of our hospital from January 2014 to May 2014 a total of 171 outpatients suspected of bronchial asthma in patients with bronchial provocation test. The instrument used in our hospital was Jaeger’s lung function meter. Methacholine was used as the provoking agent to inhale the drug by atomized inhalation. The drug concentrations were 0.9% NaCL (0.072mg), MCH4mg / mL (0.0512mg ), 4 mg / mL (0.07 mg), 32 mg / mL (0.5095 mg), 32 mg / mL (0.5095 mg), 32 mg / mL (0.5089 mg), 32 mg / mL (0.852 mg). Post-challenge diastolic test using propofol bromide aerosol 4PUFFS, 15 minutes after the relaxation test. Results A total of 131 patients with negative bronchial provocation test were found in 171 patients. Forty patients with bronchial provocation test were positive, with a positive rate of 23.4%. Conclusions There are many reasons for the bronchial positive rate is too low, are summarized in the following 4 points, (1) the patient’s choice, the strict selection of patients with high suspicion of bronchial asthma. (2) The diagnostic sensitivity of the diagnostic criteria, the current use of more than 20% of the decline rate of FEV1% positive, but some foreign studies confirm that the more sensitive indicator of airway responsiveness is sGaw, FEV1 decreased by 20% sGaw has dropped more than 50%, so the use of sGaw to determine the positive can increase the detection rate of asthma patients. (3) the original choice of excitation, the current clinical use of the original excitation of many, different asthma patients may be different for the original excitation-sensitive, which is caused by some asthma excitation test is negative reason, so the choice of different patients Different stimuli were the focus of future research, can improve the detection rate of asthma. (4) After the bronchial provocation test added bronchodilator test, can exclude due to various reasons, the negative test of excitation test the detection rate. If the provocation test is negative, then add diastolic test is positive can make a diagnosis of asthma.