支气管舒张试验的临床应用探讨

Exploration of bronchodilatation test method

目的探讨科学合理的支气管舒张试验方法。方法对于临床怀疑有气道阻塞,基础肺功能FEV1小于70%预计值的病人,吸入福莫特罗(奥克斯都保)9.0 ug,吸入后分别于15 min3、0 min、60 min、120 min、240 min测定FEV1、PEF、FEF25、FEF50、FEF75、FEF25/75、FEV1/FVC,观察各个时间点不同指标的支气管舒张效果。以卡方检验的方式比较各个时间点的阳性率。结果①如果以15 min为一个时间点作为判定标准,FEV1作为判定指标,该组病人支气管舒张试验的阳性率为22%。如果继续观察到120 min时,其阳性率达到32%(P<0.05),当观察到240 min时阳性率为33%(P<0.01),有显著差异。②如以PEF作为判定指标,15 min时阳性率为19%,30 min阳性率达30.5%(P<0.05),120 min达39%(P<0.01),具有显著差异。③如果以FEF25/75为判定标准,15 min其阳性率为29%,60 min阳性率为49%(P<0.01),120 min阳性率为53.5%(P<0.01)。结论用福莫特罗吸入,采用多点连续检测的方法,进行支气管舒张试验,较既往单点检测的支气管舒张试验,更加科学,准确地反映支气管阻塞的可逆性,值得临床推广。

Objective We aimed to approach a more scientific and reasonable bronchodi]atation test method. Methods Patients were selected for their auspection of airway obstructing and basic FEV1 〈 70% pred. They inhaled formoterol （Oxis Tubuhaler） 9.0ug, then their FEV1, PEF, FEF25, FEF50, FEF75, FEF25/75 and FEV1/FVC were detected at the following 15mins,30mins,60mins, 120mins and 240mins to show different effects in the test. We compared the masccline rate of different index at each time point by X2 test. Results ① The masccline rate of FEVl in the bronchdilatation test was 22% at 15mins,32% at 120mins（P 〈 0.05）.The masccline rate was 33% at 240mins,and statistical difference was still shown （P 〈 0.01）.②The masccline rate of PEF was 19% at 15mins, 30.5% at 30mins （P 〈 0.05）,and it＇s even 39% at 120mins （P 〈 0.01）. There were statistical difference between these three indexs. ③Tbe masccllne rate of FEF25/75 was 29% at 15mins, 49% at 60mins （P〈0.01）, 53.5% at 120mins （P〈0.01）. They allshew statistical difference.Conclusion We applied formoterol and a muhidrop continuous detection in our bronchdilatation test. We proved it a more scientic test method in reflecting the reversibility of the airway obstruction than the single time point bronchdilatation test used to be.We believed the new test method deserved being generalized.