健康幼儿肺功能测定的意义

The clincal significace of pulmonary function detection in normal toddler

目的研究1—3岁健康幼儿肺功能状况。方法将115例1—3岁健康幼儿分组：〈2岁组和2～3岁组，观察婴幼儿肺功能的潮气量、大小气道指标和呼吸系统静态顺应性（Crs）、总气道阻力（Rrs）、功能残气量（FRC）。结果1—3岁健康幼儿各项功能测定值男、女间差异均无统计学意义（均P〉0．05）。〈2岁组与2～3岁组呼吸频率（RR）差异无统计学意义（277次／min与26次／min，t=1．512，P〉0．05）。2～3岁组潮气量（TV）水平显著高于〈2岁组（0．123L与0．091L，t=8．586，P〈0．01），但经体质量校正后，差异无统计学意义（0．0091与0．0087，t=1．958，P〉0．05）。2～3岁组潮气呼气峰流速（PTEF）水平显著高于〈2岁组（0．159与0．135，t=3．788，P〈0．01）。呼气时间／总呼吸时间（Ti／Tt）、呼出气量／潮气量（％V—PF）、呼出75％潮气量时的呼气流速／潮气呼气峰流速（25／PF）和潮气呼气中期流速／潮气吸气中期流速（ME／MI）等，两组问差异均无统计学意义（均P〉0．05），而〈2岁组潮气呼气峰流速／潮气量（PF／Ve）水平显著高于2—3岁组（1．257与1．095，t=2．099，P〈0．05）。〈2岁组Rrs水平显著高于2—3岁组（2．698与2．071，t=3．762，P〈0．01）；2～3岁组Crs水平显著高于〈2岁组（0．353与0．254，t=4．296，P〈0．01），但经体质量校正后，差异无统计学意义（0．026与0．024，t=1．051，P〉0．05）；2～3岁组FRC水平显著高于〈2岁组（0．272与0．212，t=8．469，P〈0．01），但经体质量校正后，差异无统计学意（0．0198与0．0198，t=0．000，P〉0．05）。TV、FRC、Crs和FIEF随年龄增大而增大，尤与体质量密切相关，两组间差异有统计学意义（1：0．572、0．849、Q457、0．319，均P〈0．01）。结论健康幼儿TV、FRC、Crs和PTFF与体质量呈正相关，符合幼儿生长发育的规律。

Objective To explore the development of pulmonary function of normal toddlers between 1 and 3 years old. Methods Totally 115 normal toddlers were divided into 2 groups according to their age, i. e, 1 -2 years old ,2 -3 years old. The indicator of small and big airway examine respiratory system static compliance, total airway resistance and functional residual volume were observed. Results No significant difference was found between male and female toddler（ P 〉 0.05 ）. Between the two groups, the difference of respiratory rate was not significant（ 27 vs 26, t = 1. 512 ,P 〉0.05 ）. The values of tidal volumes in the 2 -3 years group was notably higher than in the 1 -2 years group （0. 123 vs 0.091, t = 8. 586, P 〈 0.01 ）, but the values of tidal volumes per kilogram body weight was not signif- icantly different（0.0091 vs 0. 0087 ,t = 1. 958 ,P 〉0.05 ）. The peak tidal expiratory flow in the elder group was simi- larly distinctly higher than that in the other group. The measured tidal breathing flow volume loops were both displayed uncharacteristic ellipse. The rations of inspiratory time to total respiratory time, the volume to reach peak tidal expiratory flow to total expiratory volume, tidal expiratory flow at 25% remaining expiration to peak expiratory flow and mid- tidal expiratory flow to mid-tidal inspiratory flow were not significantly different between two groups（P 〉 0.05 ）. But the ratio of peak tidal flow to tidal volume（ 1. 257 vs 1. 095 ,t = 2. 099,P 〈 0.05 ） and the respiratory system resist- ances （2. 698 vs 2. 071, t = 3. 762, P 〈 0.01 ）were evidently lower in the elder group than in the younger. The respiratory system compliances （ 0.353 vs 0.254, t = 4. 296, P 〈 0.01 ） and functional residual capacities （ 0. 272 vs 0. 212, t = 8. 469 ,P 〈0.01 ） were significantly higher in the elder group than that in the younger,but the values per kilogram body weight was not significantly different（ P 〉 0.05 ）. It was shown that the values Of tidal volume ,peak tidal expira- tory flow,respiratory system static compliance, residual volume were significantly different （0. 0198 vs 0. 0198, t = 0. 000 ,P 〉0. 05 ） ,between two groups. The values of each parameter mentioned above were increased with age,and were positively correlated with body weight（y = 0.457,0. 849,0. 572,0. 319 all P 〈 0. 01 ）. Condusion Tidal breathing flow volume loop could show functions of small and large airways and partially replace the maximum expiratory flow loop. The parameters were stable in toddlers and could be used as reasonable index to evaluate the pulmonary function changes in pulmonary diseases. The ventilatory function, residual volume, respiratory system static compliance and peak tidal flow were increased with the age,which coincides with the rule of development of toddlers.