婴幼儿哮喘治疗前后的潮气呼吸肺功能变化

Analysis on Tidal Breathing Pattern in Infants with Asthma

【目的】了解婴幼儿哮喘治疗前后潮气呼吸肺功能变化。【方法】选择湖南省人民医院儿科2005年4月至2006年4月住院及门、急诊治疗的婴幼儿哮喘患儿35例,正常对照组38例。哮喘组在治疗前后、正常对照组分别进行潮气呼吸肺功能测定。主要参数:每分通气量(MV),呼吸频率(RR),潮气量(VT/kg),吸气时间(TI),呼气时间(TE),吸呼比(TI/TE),达峰时间(TPEF),达峰时间比(TPEF/TE),达峰容积(VPEF),达峰容积比(VPEF/VE),潮气呼吸呼气峰流速(PTEF),25%,50%或75%潮气量时呼气流速(TEF25%,TEF 50%,TEF 75%)。同时描绘出流速-容量环(TFV curve)。【结果】哮喘组治疗前VT/kg较对照组小(P<0.05);RR较对照组增快(P<0.05);TI、TI/TE较对照组明显缩短(P<0.01);TPEF、TPEF/TE、VPEF、VPEF/VE较对照组明显降低(P<0.01);PTEF较对照组明显增快(P<0.01);TEF25%较对照组降低(P<0.01)。哮喘组治疗后TI、TI/TE仍较对照组缩短(P<0.05);TPEF、TPEF/TE、VPEF、VPEF/VE较对照组明显降低(P<0.01);TEF25%较对照组明显降低(P<0.05)。哮喘组治疗后RR较治疗前减慢(P<0.05);TI较对照组明显缩短(P<0.01);TPEF、TPEF/TE、VPEF、VPEF/VE较治疗前明显增高(P<0.01);PTEF较治疗前减慢(P<0.05)。哮喘组大部分婴幼儿流速容积环变窄,呼气相升支陡峭,高峰提前,降支倾斜,甚至凹向容量轴,即流速容积环呈现特征性阻塞图形。【结论】TPEF/TE、VPEF/VE可作为反映小气道阻力及流速变化的指标,反映婴幼儿哮喘的气道阻塞程度。潮气呼吸肺功能检查是婴幼儿哮喘重要的辅助诊治手段。

[Objective]To investigate the features of various pulmonary function parameters of tidal respiration in infants while in spontaneously breathing and in asthma. [Methods]Thirty-five asthmatic infants and thirty-eight healthy infants were involved. Various pulmonary function parameters were assayed by method of tidal respiratory. Major parameters included minute ventilation （MV）, respiratory rate （RR）, tidal volume/kg （VT/kg）, inspiratory time （ TI ） , expiratory time （ TE ） , ratio of TI and TE （ TI/TE ）, peak tidal expiratory flow （ PTEF ） , time to PTEF （ TPEF ）, ratio of TPEF and total TE （ TPEF/TE ）, expiratory volume at PTEF（ VPEF ） ,ratio of VPEF and total VE （ VPEF/VE ）, TEF25% remaining, TEF50% remaining , TEF75% remaining （ TEF25% , TEF50% , TEF75% ）. And flow-volume cycles were described at the same time. [Results] VT/kg was lower in asthmatic infants than that of healthy subjects （ P 〈0.05 ）. TI and TI/ TE were remarkably shorter than those of healthy subjects （ P 〈0. 01）. TPEF, TPEF/TE, VPEF and VPEF/VE were significantly lower as compared with healthy subjects （ P 〈0.01）. PTEF was significantly faster and TEF25% was lower than those of healthy subjects （ P 〈0.01）. After treatment, TI and TI/TE were still shorter than those of healthy subjects （ P 〈0.05）. TPEF, TPEF/TE, VPEF and VPEF/VE were significantly lower as compared with healthy subjects （ P 〈0.01）, and TEF 25% was lower than those of healthy subjects yet （ P 〈0.05）. After treatment, RR was slower than that before therapy （ P 〈0.05）. TI was shorter （ P 〈0.01 ）, TPEF,TPEF/TE, VPEF and VPEF/VE were all remarkably higher （ P 〈0.01）, while PTEF was lower （ P 〈0. 05 ）. Before treatment, flow-volume curve in asthmatic infants was narrower and peak value in expiratory flow was higher than those of asthmatic infants after treatment, and the slope of tidal flow-volume curve （TFV curve） was remarkably increscent. [Conclusion] TPEF/TE and VPEF/VE can be used as the parameters of small airway resistance and flow rate for evaluating the degree of airway resistance and the therapeutic effect .