儿童腺病毒性肺炎肺潮气功能特点分析

Characteristics of tidal volume function in children with adenovirus pneumonia

目的分析儿童腺病毒性肺炎的潮气功能特点,指导临床对患儿病情的评估、治疗及预后判断。方法选取2018至2021年在河北省儿童医院呼吸一科住院的腺病毒性肺炎患儿102例,按照中华医学会儿科学分会呼吸学组2013年制定的儿童社区获得性肺炎管理指南标准,分为重症腺病毒性肺炎组49例及非重症腺病毒性肺炎组53例,收集其肺潮气功能数据,进行对比分析。结果腺病毒性肺炎患儿潮气功能特点以呼吸频率(RR)增快,每公斤体重潮气量(VT/kg)减小,呼气相各流量增快,呼气峰流量(PTEF)提前出现,达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)降低为特点,其中重症腺病毒性肺炎组RR快于非重症腺病毒性肺炎组(P<0.05),VT/kg、TPTEF/TE、VPEF/VE、呼出75%潮气容积时的呼气流量(TEF25)均低于非重症腺病毒性肺炎组(P<0.05)。腺病毒性肺炎潮气呼吸流量-容积曲线(TBFV)以阻塞性通气功能障碍为主要特征,呼气相降支后段向横轴倾斜,重症腺病毒性肺炎患儿小气道阻塞更重,TBFV呼气相降支中后段斜率偏大,呈现向横轴凹陷趋势。结论腺病毒性肺炎患儿肺功能主要表现为小气道阻塞,重症肺炎患儿小气道受损更为严重,易引起闭塞性细支气管炎等后遗症,加强对腺病毒性肺炎患儿小气道功能的管理是减少和预防腺病毒性肺炎呼吸系统后遗症的关键。

Objective To analyze the features of tidal volume function in children with adenovirus pneumonia,and to guide the clinical assessment,treatment and prognosis prediction.Methods A total of 102 children with adenovirus pneumonia who were hospitalized in the First Department of Respiratory Medicine of Hebei Children’s Hospital from January 2018 to December 2021 were enrolled.They were divided into severe pneumonia group(n=49)and non-severe pneumonia group(n=53)according to Guidelines for the management of community-acquired pneumonia in children formulated by the Respiratory Branch of Chinese Pediatric Society of Chinese Medical Association in 2013.Data of tidal volume function were collected and compared.Results The tidal function of children with adenovirus pneumonia was characterized by a faster respiratory rate(RR),decreased tidal volume per kilogram of body mass(VT/kg),faster expiratory flow,early appearance of peak tidal expiratory flow(PTEF),and declines of time at PTEF to total expiratory time(TPTEF/TE)and ratio of volume to peak expiratory flow and expiratory volume(VPEF/VE).The RR of the severe adenovirus pneumonia group was significantly faster than that of the non-severe adenovirus pneumonia group(P<0.05).VT/kg,TPTEF/TE,VPEF/VE,and the tidal expiratory flow at 75%of the remaining tidal volume(TEF25)were significantly lower than those of the non-severe adenovirus pneumonia group(P<0.05).The tidal breathing follow-volume(TBFV)curve of adenovirus pneumonia was mainly characterized by obstructive ventilatory dysfunction.The posterior part of the descending branch of the expiratory phase was inclined to the horizontal axis.The small airway obstruction in children with severe adenovirus pneumonia was more severe,and the slope of the middle and posterior part of the descending branch of the TBFV curve was too large,showing a tendency to sink toward the horizontal axis.Conclusion The lung function of children with adenovirus pneumonia is mainly manifested as small airway obstruction.In children with severe pneumonia,the small airway is more severely damaged,and it is easy to cause sequelae like bronchiolitis obliterans.Strengthening the management of small airway function in children with adenovirus pneumonia is the key event to reduce and prevent the respiratory sequelae.