快速胸腹挤压肺功能测定技术临床价值探讨

Clinical value of lung function measurement by rapid thoracic-abdominal compression technique in infants

目的探讨新型肺功能测定技术——快速胸腹挤压法(RTC)在婴幼儿中的临床应用价值。方法选择102例2～24月龄的呼吸系统疾病患儿。入选患儿均行潮气呼吸肺功能和RTC肺功能测定,其中23例发作期哮喘患儿在支气管舒张试验后再行上述两项肺功能测定。比较不同呼吸系统疾病患儿之间,以及发作期哮喘患儿在支气管舒张试验前后,两项肺功能指标的改变及相关性。结果 RTC肺功能指标——功能残气量位的最大呼气流速(VmaxFRC)在不同呼吸系统疾病患儿之间差异无统计学意义(P>0.05),其改变情况与潮气呼吸肺功能25%潮气量位的流速(TEF25)类似。与哮喘缓解期患儿比较,哮喘发作期患儿的VmaxFRC降低幅度远高于潮气肺功能指标,如VmaxFRC与主要潮气肺功能指标TEF25、达峰时间比具有较好的相关性(r=0.526、0.489,P均<0.01)。发作期哮喘患儿经支气管舒张试验后,VmaxFRC较其基础值显著升高,差异有统计学意义(P<0.01);VmaxFRC改善率亦显著高于潮气呼吸肺功能指标(P<0.05);而潮气呼吸肺功能指标在支气管舒张试验前后的差异无统计学意义。结论 RTC肺功能指标VmaxFRC是反映不同呼吸系统疾病婴幼儿肺功能受损的敏感指标,与潮气呼吸肺功能主要指标之间具有良好的相关性,并在支气管舒张试验方面表现出一定的优越性。

Objective To investigate the clinical value of lung function test by rapid thoracic-abdominal compression （RTC） technique in infants. Methods One hundred and two 2- to 24-month-old infants were included in this study. Lung function test via tidal breathing and RTC were measured in all infants. Twenty-three infants of them had episodic asthma and their lung functions were measured after bronchial relaxation test. The changes and correlations of parameters from above two techniques are compared among infants with different pulmonary diseases and among infants with episodic asthma before and after bronchial relaxation test. Results The maximal expiratory flow at functional residual capacity （VmaxFRC） from RTC technique showed no significant difference among infants with different pulmonary diseases （P 〉 0.05）. The changes of VmaxFRC were similar to that of observed in expiratory flow at 25% of tidal volume （TEF25） from lung function test via tidal breathing. Compared with infants with asthma in remission, the decremented VmaxFRC of infants with episodic asthma was much wider than changes from lung function test via tidal breathing. Significant correlations among VmaxFRC and major parameters of lung function via tidal breathing, i.e. TEF25, TPTEF/TE （ratio of time to peak tidal expiratory flow to total expiratory time）, were observed （r = 0.526, 0.489, P 〈 0.01 respectively）. VmaxFRC of infants with episodic asthma increased significantly after receiving bronchial relaxation test （P 〈 0.01 ） and the improvement rate of VmaxFRC was also significantly higher than parameters via tidal breathing （P 〈 0.05）. There was no significant difference found in lung function test via tidal breathing before and after bronchial relaxation test. Conclusions VmaxFRC, as a lung function testing parameter of RTC, was a sensitive index reflecting impairment of lung function in infants with different pulmonary diseases, and shows significant correlation with parameters from lung function testing via tidal breathing. It also shows advantage in some degree in bronchial relaxation test.