婴幼儿反复喘息危险因素分析及其潮气肺功能检测的临床意义

Analysis of risk factors for recurrent wheezing in infants and clinical significance of Tidal breath analysis for infant pulmonary function testing

目的分析婴幼儿反复喘息危险因素及其与潮气肺功能的相关性。方法 2015年3月-2017年3月选择湖北省武汉市第一医院儿科反复喘息≥3次住院治疗的患儿为观察组,同时选取同期儿科门诊健康体检儿为对照组,采用问卷调查法对危险因素进行研究。采用CareFusion公司肺功能仪对两组婴幼儿呼吸频率(RR)、每公斤体重潮气量(TV/kg)、吸/呼比(Ti/Te)、达峰时间比(TPTEF/TE)及达峰容积时间比(VPEF/VE)进行测定。结果 1)湿疹(OR=5.86,95%CI:1.72~22.06)、被动吸烟(OR=2.16,95%CI:1.36~5.29)、父母有哮喘或过敏性鼻炎病史(OR=7.83,95%CI:2.56~30.31)、居住地城市(OR=3.12,95%CI:1.17~12.46)、临近马路(OR=2.05,95%CI:1.08~3.03)是婴幼儿反复喘息的独立危险因素。2)与对照组比较,喘息急性期、缓解期的RR均显著增快(均P<0.05);与喘息急性期比较,喘息缓解期RR显著降低(P<0.05)。与对照组比较,喘息急性期组、喘息缓解期组TPTEF/TE、VPEF/VE均显著降低(P均<0.01);且经积极治疗后,与喘息急性期比较,喘息缓解期TPTEF/TE、VPEF/VE均显著升高(P均<0.05)。结论湿疹、被动吸烟、父母有哮喘或过敏性鼻炎病史、居住地城市、临近马路是婴幼儿反复喘息的独立危险因素。潮气肺功能是婴幼儿哮喘早期监测的良好客观指标。

Objective To analyze the risk factors of recurrent wheezing in infants,and to evaluate its correlation with tidal breathing pulmonary function. Methods Infants with ＂recurrent wheezing＂over three times hospitalized in the Department of Pediatrics of the First Hospital of Wuhan were enrolled in observation group from March 2015 to March2017.Meanwhile,healthy children in outpatient were selected as control group.Questionnaires were used to analyze risk factors of recurrent wheezing.Tidal breathing pulmonary function was tested at admission（acute phase）and discharge（remission phase）.And respiratory rate（RR）,TV/kg、Ti/Te、TPTEF/TE、VPEF/VE of two groups were tested. Results 1）Eczema（OR=5.86,95%CI：1.72～22.06）,secondhand smoking（OR=2.16,95%CI：1.36～5.29）,parents′history of asthma or allergic rhinitis（OR=7.83,95%CI：2.56～30.31）,city residence（OR=3.12,95%CI：1.17～12.46）and dwelling adjacent to road（OR=2.05,95%CI：1.08～3.03）were the independent risk factors for recurrent wheezing.2）Compared with the control group,RR was significantly faster in both acute stage and wheezing stage of wheezing group（both P〈0.05）;RR in wheezing remission stage was significantly lower than that in acute wheezing stage（P〈0.05）.TPTEF/TE and VPEF/VE were significantly lower in both acute wheezing stage and wheezing remission stage than those in control group（both P〈0.01）.After positive treatment,TPTEF/TE and VPEF/VE in wheezing remission stage were significantly higher than those in acute wheezing stage（both P〈0.05）. Conclusions Eczema,secondhand smoking,parents′history of asthma or allergic rhinitis,city residence and dwelling adjacent to road are the independent risk factors for recurrent wheezing.Tidal breathing analysis of pulmonary function may be a reliable and objective indicator for clinical diagnosis of asthma in infants.