婴幼儿反复喘息对潮气肺功能影响及危险因素分析

Effect of repeated wheezing on tidal pulmonary function and risk factors in infants

目的反复喘息患儿容易进展为儿童哮喘,严重影响其身心健康。本研究探讨婴幼儿反复喘息对潮气肺功能影响及危险因素。方法选取梅州市妇幼保健计划生育服务中心儿科2018-01-01-2019-10-31收治的80例的反复喘息患儿作为病例组,按照匹配的原则选取同期在院门诊健康体检的80名儿童作为对照组,采用调查问卷表调查其临床资料,采用单因素及多因素Logistic回归分析其危险因素。结果单因素分析结果显示,病例组超重/肥胖(χ^(2) =19.856,P<0.001)、居住地区域(χ^(2)=16.049,P<0.001)、母孕期吸烟(χ^(2)=13.237,P<0.001)、湿疹(χ^(2)=22.500,P<0.001)、食物过敏(χ^(2)=9.001,P=0.003)及父母有哮喘或过敏性鼻炎史(χ^(2)=22.227,P<0.001)高于对照组,差异有统计学意义。多因素Logistic回归分析结果显示,超重/肥胖(OR=12.803,95%CI为1.905~90.445,P=0.017)、居住地(OR=7.056,95%CI为1.201~42.552,P=0.029)、母孕期吸烟(OR=7.568,95%CI为1.096~48.134,P=0.028)、湿疹(OR=19.897,95%CI为3.369~96.389,P=0.009)以及父母有哮喘或过敏性鼻炎(OR=9.206,95%CI为1.351~61.875,P=0.024)是反复喘息的独立危险因素。病例组呼吸频率(RR)水平为(30.49±3.82)次/min,高于对照组的(26.84±4.82)次/min,t=5.308,P<0.001;达峰时间比[TPTEF/TE(%)]为(24.69±5.17)%,低于对照组的(34.01±5.48)%,t=11.064,P<0.001;达峰容积比[VPEF/VE(%)]为(23.69±5.75)%,低于对照组的(33.97±4.41)%,t=12.689,P<0.001。急性期反复喘息患儿RR水平为(32.69±4.78)次/min,高于缓解期的(28.46±4.64)次/min,t=5.440,P<0.001;TPTEF/TE为(21.78±6.24)%,低于缓解期的(27.05±5.31)%,t=6.871,P<0.001;VPEF/VE水平为(18.98±4.87)%,低于缓解期的(25.97±5.17)%,t=9.003,P<0.001。结论婴幼儿反复喘息发作的危险因素较多,包括超重或肥胖、湿疹、母孕期吸烟和生活居住地等,通过监测潮气肺功能,可作为预测婴幼儿哮喘的客观指标。

Objective Children with recurrent wheezing were easy to develop into children’s asthma,which seriously affected their physical and mental health.This study investigated the effects of repeated wheezing on tidal pulmonary function and risk factors in infants.Methods A total of 80 children with recurrent wheezing treated in pediatrics of Meizhou Maternal and Child Health and Family Planning Service Center from January 1,2018 to October 31,2019 were selected as the case group.According to the matching principle,80 children undergoing outpatient physical examination in the same period were selected as the control group.The clinical data were investigated by questionnaire,and the risk factors were analyzed by univariate and multi factor Logistic regression.Results Univariate analysis showed that the case group in overweight/obese(χ^(2)=19.856,P<0.001),residential area(χ^(2)=16.049,P<0.001),smoking during pregnancy(χ^(2)=13.237,P<0.001),eczema(χ^(2)=22.500,P<0.001),food allergy(χ^(2)=9.001,P=0.003)and parents with a history of asthma or allergic rhinitis(χ^(2)=22.227,P<0.001),which were significantly higher than that in the control group.Multivariate Logistic regression analysis showed that overweight/obesity(OR=12.803,95%CI was 1.905-90.445,P=0.017),residence area(OR=7.056,95%CI was 1.201-42.552,P=0.029),smoking during pregnancy(OR=7.568,95%CI was 1.096-48.134,P=0.028),eczema(OR=19.897,95%CI was 3.369-96.389,P=0.009)and parents had asthma or allergic rhinitis(OR=9.206,95%CI was 1.351-61.875,P=0.024)were independent risk factors for recurrent wheezing.The respiratory rate(RR)level in the case group was(30.49±3.82)times/min,which was higher than that in the control group(26.84±4.82)times/min,t=5.308,P<0.001.The time to peak expiratory flow versus the time of expiratory[TPTEF/TE(%)]was(24.69±5.17)%,which was lower than that in the control group(34.01±5.48)%,t=11.064,P<0.001.The volume to peak expiratory flow versus the volume of expiratory[VPEF/VE(%)]was(23.69±5.75)%,which was lower than that in the control group(33.97±4.41)%,t=12.689,P<0.001.The RR level of children with recurrent wheezing in acute stage was(32.69±4.78)times/min,which was higher than that in remission stage(28.46±4.64)times/min,t=5.440,P<0.001.TPTEF/TE was(21.78±6.24)%,lower than that in remission(27.05±5.31)%,t=6.871,P<0.001.The level of VPEF/VE was(18.98±4.87)%,lower than that in remission(25.97±5.17)%,t=9.003,P<0.001.Conclusions There are many risk factors for recurrent wheezing in infants,including overweight or obesity,eczema,smoking during pregnancy and living place.Monitoring tidal pulmonary function can be used as an objective index to predict infant asthma.