肺功能变化在间质性肺炎婴幼儿临床病情评估中的价值

Changes of Pulmonary Function of Infants with Interstitial Pneumonia and Its Value in Clinical Evaluation

目的探讨肺功能变化在间质性肺炎婴幼儿临床病情评估中的价值。方法对57例间质性肺炎婴幼儿(肺炎组)进行肺功能测定,并与40例健康婴幼儿(健康对照组)肺功能指标进行对照,观察间质性肺炎婴幼儿潮气流速-容量环的形态及各项指标的变化。回顾性调查间质性肺炎婴幼儿临床病情评分及住院天数,与肺功能各主要参数进行相关性分析。结果与健康对照组比较,肺炎组患儿急性期的潮气流速-容量环曲线形态显得瘦长,且呼气下降支斜率增大,高峰提前,降支呈波谷样向容量轴凹陷。肺炎组患儿呼吸频率、潮气呼气峰流速、潮气呼气峰流速与呼出75%潮气量时的呼气流速的比值(PF/V25)、呼吸系统阻力均较健康对照组升高(Pa<0.01);呼气达峰时间比、呼气达峰容积比、每千克体质量潮气量,吸气时间和呼气时间的比值、潮气呼气中期流速和吸气中期流速的比值,每千克体质量顺应性(Crs/kg)均较健康对照组降低(Pa<0.001)。相关性分析显示PF/V25与临床病情评分、住院天数呈正相关(r=0.532、0.265,Pa<0.05);Crs/kg与临床病情评分呈负相关(r=-0.269,P<0.05)。结论间质性肺炎婴幼儿急性期肺功能主要表现为大、小呼吸道阻塞性通气功能障碍及限制性通气功能障碍,肺功能检查可为该病临床病情及预后提供客观评估的依据。

Objective To explore the value of changes of pulmonary function in evaluating the clinical pathogenetic condition appraisal of interstitial pneumonia in infants.Methods Fifty-seven patients with interstitial pneumonia （pneumonia group） and 40 healthy children （healthy control group） were chosen to measure the lung function,their shape of tidal breath flow volume loop were observed and the clinical pathogenetic condition score and hospital day were reviewed,then the correlation of main data with pulmonary function was analyzed.Results Compared with healthy children,the shape of tidal breath flow volume loop in pneumonia group appeared longer and thinner,the slope rate of expiration decent increased,the peak time advanced,and the expiration decent depressed to the volume axle.In pneumonia group,the respiratory rate,peak tidal expiratory flow,ratio of peak tidal expiratory and expiratory flow at 75% of tidal volume （PF/V25）,respiratory resis-tance increased,while the ratio of expiratory time till peak-flow and total expiratory time,ratio of expiratory volume till peak-flow and total expiratory volume,tidal volume per kilogram body weight,ratio of inspiratory time and expiratory time,ratio of mean expiratory flow and mean inspiratory flow,compliance per kilogram body weight （Crs/kg） were decreased significantly compared with those in healthy control group （Pa0.001）.There were positive correlation in PF/V25 with hosptital day（r=0.265,P〈0.05） and clinical pathogenetic condition score（r=0.532,P〈0.05）,negative correlation was found between Crs/kg and clinical pathogenetic condition score （r=-0.269,P〈0.05）.Conclusions Small or large airway obstruction and restriction ventilation functional disturbance appeared in pediatric patients with interstitial pneumonia,pulmonary function provides an useful tool to appraise the clinical pathogenetic condition and prognosis.