动态呼吸监测在儿童哮喘控制管理中的应用价值

Application value of dynamic respiratory monitoring in the control and management of asthma in children

目的探讨动态呼吸监测在儿童哮喘控制管理中的应用价值。方法选取2020年11月至2022年6月在上海市普陀区人民医院儿科就诊的5~14岁首诊为哮喘的儿童120例为研究对象,按随机数表法分为研究组和对照组,每组60例。研究组患儿在接受常规哮喘管理6个月的同时在初始治疗时使用智能肺功能仪进行动态呼吸监测3个月,对照组患儿仅接受常规的哮喘管理6个月。比较两组儿童在初诊、随访1个月、3个月、6个月时的肺功能指标[第一秒用力呼气容积(FEV_(1))、呼气峰流速(PEF)、最大呼气中段流量(MMEF)、用力呼出气体50%时最大呼气流量(MEF50)与用力呼出气体75%,剩余25%时最大呼气流量(MEF25)]、呼出气一氧化氮(FeNO)、哮喘控制评分(C-ACT评分)和用药依从性。6个月后随访,比较两组儿童的哮喘控制水平、哮喘发作的频率及再就医次数。结果研究组儿童的FEV_(1)、PEF、MMEF、MEF25在随访3个月、6个月时明显高于对照组,而MEF50在随访1个月、3个月、6个月时明显高于对照组,差异均具有统计学意义(P<0.05);研究组儿童的FeNO在随访3个月、6个月时分别为(12.4±2.2)ppb、(7.3±2.8)ppb,明显低于对照组的(16.6±1.7)ppb、(10.7±2.6)ppb,差异均有统计学意义(P<0.05);研究组儿童的哮喘C-ACT评分在随访3个月、6个月时分别为(25.75±1.23)分、(26.40±0.53)分,明显高于对照组的(21.13±0.94)分、(22.32±0.57)分,差异均有统计学意义(P<0.05);研究组儿童的用药依从性在随访3个月、6个月时明显优于对照组,差异均有统计学意义(P<0.05);随访6个月后,研究组儿童的哮喘控制总有效率为91.7%,明显高于对照组的73.3%,而研究组儿童累计哮喘急性发作次数和再就医次数分别为(0.56±0.08)次、(0.42±0.06)次,明显低于对照组的(1.94±0.25)次、(2.45±0.38)次,差异均有统计学意义(P<0.05)。结论与传统儿童哮喘管理方法比较,动态呼吸监测辅助儿童哮喘管理可以提高哮喘管理水平,弥补传统儿童哮喘管理方法的不足。

Objective To explore the application value of dynamic respiratory monitoring in the control and management of asthma in children.Methods From November 2020 to June 2022,120 children aged 5 to 14 who were first diagnosed with asthma in the Department of Pediatrics,Shanghai Putuo District People's Hospital were selected and were divided into a study group and a control group according to random number table method,with 60 cases in each group.Children in the study group received conventional asthma management for 6 months and dynamic respiratory monitoring with intelligent lung function instrument at the time of initial treatment for 3 months,while children in the control group only received conventional asthma management for 6 months.Lung function indexes of forced expiratory volume in the first second(FEV_(1)),peak expiratory flow(PEF),maximum mid-expiratory flow(MMEF),maximal expiratory flow at 50%forced exhalation(MEF50),maximal expiratory flow at 75%forced exhalation and 25%remaining(MEF25),fractional exhaled nitric oxide(FeNO),asthma control score(C-ACT score),and medication compliance were compared between the two groups at initial treatment,1,3,and 6 months of follow-up.After 6 months of follow-up,the level of asthma control,the frequency of asthma attacks,and the number of re-visits were compared between the two groups.Results The lung function of FEV_(1),PEF,MMEF,and MEF25 in the study group were significantly higher than those in the control group at 3 and 6 months of follow-up(P<0.05).The MEF50 in the study group were significantly higher than that in the control group at 1,3,and 6 months of follow-up(P<0.05).FeNO of the study group were(12.4±2.2)ppb and(7.3±2.8)ppb at 3 and 6 months of follow-up,which were significantly lower than(16.6±1.7)ppb and(10.7±2.6)ppb in the control group(P<0.05).The C-ACT scores of the study group were(25.75±1.23)points and(26.40±0.53)points at 3 and 6 months of follow-up,which were significantly higher than(21.13±0.94)points and(22.32±0.57)points in the control group(P<0.05).The medication compliance of children in the study group was significantly better than that of the control group at 3 and 6 months of follow-up(P<0.05).After 6 months of follow-up,the control level of asthma in the study group(total effective rate 91.7%)was significantly better than that in the control group(total effective rate 73.3%),P<0.05;the accumulative times of acute asthma attacks and re-visits of children in the study group were(0.56±0.08)times and(0.42±0.06)times,which were significantly lower than(1.94±0.25)times and(2.45±0.38)times in the control group(P<0.05).Conclusion Compared with traditional methods of asthma management in children,dynamic respiratory monitoring-assisted asthma management can improve the level of children's asthma management and make up for the shortcomings of traditional management of children asthma.