脉冲振荡法在215例哮喘儿童支气管舒张试验中的应用价值

The clinical value of impulse oscillometry (IOS) in bronchodilation test of 215 children asthma

目的探讨脉冲振荡法(IOS)在哮喘儿童支气管舒张试验中的应用价值。方法选取215例哮喘发作期患儿,测定最大呼气流量—容积(MEFV)和IOS肺功能,并进行支气管舒张试验,以第1秒用力呼气容积(FEV1)为金标准,分别计算IOS参数:气道总阻抗(Zrs)、振荡频率5 Hz时气道黏性阻力(R5)、电抗(X5)在不同改善水平时其对诊断的敏感度和特异度,计算两种肺功能参数间的回归方程。结果两种肺功能主要参数的改善率显著相关(P<0.001)。其中以X5与FEV1的相关性最好,Zrs、R5次之。用FEV1≥15%作标准,IOS各参数中以Zrs、R5下降:≥20%,X5≥30%作为判断舒张试验阳性标准时有较高的敏感度和特异度,与回归方程结果一致。结论用IOS主要参数作为判断支气管舒张试验阳性标准时,当Zrs、R5下降:≥20%,X5≥30%时,可考虑支气管舒张试验阳性。因此,IOS用于支气管舒张试验是诊断、鉴别诊断支气管哮喘及观察药物疗效的有用工具。

Objective To investigate the clinical value of IOS technique in children bronchial dilation test.Methods Choose 215 acute asthmatic children to test their MEFV and the lung function measured by IOS,and carry on the bronchial dilation test with the results.By FEV1 for golden standard,compute the diagnose sensitivity and peculiarity of Zrs,R5 and X5 in different improvement levels,and compute the regression equation between these two parameters.Results The changes of parameter measured by MEFV were significantly correlated by the changes of parameters measured by IOS.X5 and FEV1 are the best,and Zrs and R5 are the second.The change of FEV1≥15% was considered standard,we got higher sensitivity and peculiarity and peculiarity when Zrs,R5 measured by IOS≥20% and X5≥30%,these parameters were considered positive standard in bronchial dilation test,the result is consistent with regression equation.Conclusion When the parameters measured by IOS were used to be positive standard in bronchial dilation test,the test can be considered positive when Zrs,R5 drop≥20%,X5≥30%.Therefore,IOS applied in bronchial dilation test is a very useful tool in diagnosis,differential diagnosis and the observation of medication effect.It could be widly practiced in clinic.