婴幼儿人工支气管激发试验的可靠性研究

Study on the reliability of artificial bronchial provocation test in infants

目的评价婴幼儿人工乙酰甲胆碱支气管激发试验(通过肺部听诊进行气道高反应性结果判断)的可靠性。方法选择82例在绵阳市中心医院按照《儿童慢性咳嗽诊断和治疗指南》诊断为慢性咳嗽的婴幼儿做为试验对象,用乙酰甲胆碱从低浓度开始逐渐递增浓度进行激发试验,每次雾化吸入药物后首先进行肺部听诊,再进行潮气肺通气功能检查,肺部任何区域出现哮鸣音、氧饱和度下降大于5%或MCH浓度已达到16 mg/ml时终止激发试验,对两种方式判断的结果进行比较。结果根据潮气肺功能判断的阳性率为68.3%,通过肺部听诊的人工激发试验判断阳性率为59.8%,潮气肺功能判断为阴性的病例通过人工听诊方法均判断为阴性。结论婴幼儿人工支气管激发试验方法可靠,特异性高,敏感性略低于潮气肺通气功能检查的结果,有一定的假阴性,但仅为8.5%,为不具备潮气肺功能仪的医院完成支气管激发试验的一种替代手段。

Objective To evaluate the reliability of artificial methacholine bronchial provocation test in infant（judging by auscultation of the lungs airway hyperresponsiveness）. Methods Eighty-two infants in our hospital who were diagnosed as chro-nic cough in accordance with the“guidelines for the diagnosis and treatment of chronic cough in children”were choseas test ob-jects. Provocation test was made by gradually increasing the concentration of methacholine. Each time after given aerosolized drugs,the lung auscultation was made,then tidal pulmonary ventilation function test was made. The provocation test was termi-nated when any regional pulmonary wheezing occurred,oxygen saturation decreased more than 5% or MCH concentration reached 16 mg/ ml. The results of two methods were compared. Results The positive rate of judgment according to the tidal pulmonary function was 68. 3% ,and the positive rate of judgment of artificial stimulation test through the lungs auscultation 59. 8% ,the moisture of pulmonary function judged as negative cases by artificial auscultation method judged as negative. Conclusion Artifi-cial methacholine bronchial provocation test is reliable and has high specificity. Its sensitivity was slightly lower than the moisture breathing lung function test results. The false negative results was 8. 5% . It can be recommend as an alternative judgement meth-od of methacholine bronchial provocation test in hospital without the pulmonary function instrument.