蒸馏水激发试验对于咳嗽变异型哮喘的诊断价值

Value of distilled water provocative test in diagnosis of cough variant asthma

目的探索蒸馏水激发试验对于诊断咳嗽变异型哮喘的临床价值。方法分析我院2013年所诊断的97例咳嗽超过8周,胸部影像学检查阴性的慢性咳嗽患者,均进行了肺功能及蒸馏水激发试验。检测基础肺通气功能后,经鼻面罩吸入超声雾化蒸馏水30m L/20min,复查肺通气功能,试验过程中密切监测患者是否出现喘鸣、呼吸困难。监测呼气相哮鸣音,若出现则停止雾化复查肺通气功能。以前后两次肺通气功能检查FEV1.0下降大于20%为蒸馏水激发试验阳性。结果所有诊断咳嗽变异型哮喘患者中男性15例,女性22例,年龄(32.3±2.5)岁。其中经蒸馏水激发试验阳性诊断的有25例,另有10例蒸馏水激发试验阴性,但随后经呼气峰流速变异率诊断支气管哮喘或在临床随访中哮喘急性发作经支气管舒张试验阳性诊断为支气管哮喘。蒸馏水激发试验诊断支气管哮喘阳性率为71.43%。进行蒸馏水激发试验过程中,1例患者出现哮喘急性发作,口唇紫绀,经吸氧、静推甲基强的松龙,雾化沙丁胺醇后缓解。结论蒸馏水激发试验是一种安全可靠的肺功能试验,用于诊断咳嗽变型哮喘具有较高的临床价值。

Objective To explore the clinical value of distilled water provocative test in diagnosis of cough variant asthma. Methods 97 chronic cough patients who coughed for more than 8 weeks and whose thoracic iconography examinations were negative were received pulmonary function test and distilled water provocative test in our hospital. Pulmonary ventilation functions of patients were received basic test. Patients were inhaled ultrasonically nebulized distilled water 30ml/20 min by oronasal mask and then they were received pulmonary ventilation function reexamination. Wheezing and dyspnea of patients were closely detected during the test. If the patients developed wheezing, nebulization reexamination of pulmonary ventilation function would be stopped immediately. A decrease of more than 20% of FEV1 of the two pulmonary ventilation function test was accepted that distilled water provocative test was positive. Results 15 male and 22 female patients, whose average age was（32.3±2.5）, were diagnosed cough variant asthma. 25 patients were diagnosed positive by distilled water provocative test and 10 patients were diagnosed negative by distilled water provocative test. But bronchial asthma was diagnosed by air peak expiratory flow variability or it was diagnosed by bronchodilation test of acute asthma attack in clinical follow-ups showing positive. The positive rate of bronchial asthma by distilled water provocative test was 71.43%. During distilled water provocative tests, one patient was occurred acute asthma attack and cyanotic oral lip. After those symptoms were released by oxygen inhalation, iv bolus methylprednisolone and nebulizing salbutamol. Conclusion Distilled water provocative test is a safe and reliable pulmonary function test and it has higher clinical value in diagnosis of cough variant asthma.