职业性哮喘患者肺功能变化的临床观察

Clinical observation on the changes of pulmonary function of occupational asthma patients

目的了解职业性哮喘患者的肺功能变化特点。方法对15例职业性哮喘患者行支气管现场激发试验时的肺功能参数进行分析,并同时记录发生时间及患者症状、体征。结果①发作期和激发前肺功能值比较,大部分肺功能参数差异有统计学意义(P<0.05)。发作期用力肺活量(FVC)、第1秒用力呼气容量(FEV1)、最大用力呼气流速(PEF)、最大呼气中段流速(MMEF)、25%和50%肺活量时的最大呼气流速(FEF25、FEF50)显著低于激发前;②经直线相关分析,FEV1与FVC下降率之间,FEF50与MMEF下降率之间以及FEV1与MMEF下降率之间均呈直线相关(rs=0.825,P=0.006;rs=0.992,P=0.000;rs=0.881,P=0.004)。③激发后60 min内现场支气管激发试验阳性10例,且全部出现全身发汗、颜面发绀及肺部哮鸣音等严重临床表现,占67%;激发2 h后的现场支气管激发试验阳性5例,占33%。结论职业性变应原致使患者的大小气道功能受限,职业性哮喘可呈速发相反应或迟发相反应。呈速发相反应患者的临床表现明显。

[Objective]To investigate the changes of pulmonary function in occupational asthma patients.[Methods]The data of pulmonary function of 15 occupational asthma patients by the allergen bronchial provocation test（A-BPT） were analyzed,while the symptoms,physical signs of patients and occurrence time were recorded.[Results]① Lung function values between the exacerbation period and the period before exacerbation were not significantly different（P0.05）.The data indexes of FVC,FEV1,PEF,MMEF,FEF25%,FEF50% at the exacerbation period were significantly higher than those before A-BPT.② By linear correlation statistical analysis,the decline rate of FEV1 showed positive correlation with that of FVC（rs=0.825,P=0.006）.Similarly,the positive correlation was found between the decline rate of FEF50% and that of MMEF,and between the decline rate of FEV1 and that of MMEF（rs=0.992,P=0.000;rs=0.881,P=0.004）.③ It showed positive in 10 cases（67%） within 60 minutes in the A-BPT,and the serious clinical manifestation such as sweating,cyanosis and wheezing were found in these patients.The A-BPT after 2 hours was positive in 5 cases（33%）.[Conclusion]All airway in patients are restricted after allergen stimulating.Occupational asthma can be an immediate reaction or delayed reaction.And the clinical manifestation is seriously in the immediate reaction patients