功能残气量对婴幼儿支气管异物和毛细支气管炎的鉴别诊断价值

Differential diagnostic values of functional residual capacity plethysmograph for infant bronchial foreign body and bronchiolitis

目的 分析比较支气管异物婴幼儿和急性毛细支气管炎患儿的肺功能数据,探讨异物患儿肺功能特点及功能残气量(FRCp)在两种疾病中的鉴别诊断价值.方法 选取2016年1月至2018年1月期间于我院小儿呼吸内科病房住院经支气管镜确诊的支气管异物婴幼儿46例为研究对象,其年龄范围为10个月至3岁,纳入同时期诊断为急性毛细支气管炎的婴幼儿共50例为对照组.对所有患儿进行婴幼儿潮气呼吸肺功能检查、阻断法测定气道顺应性、体积描记法测定FRCp.采用受试者工作曲线(ROC)分析FRCp对于区分两种疾病的价值.结果 支气管异物组患儿呼吸频率(RR)为31±7次/min,潮气量(VT/kg)为7.7±1.5 ml/kg,达峰时间比(TPTEF/TE)为24.3％±9.4％,达峰容积比(VPEF/VE) 26.1±7.6％,吸呼比(Ti/Te)0.66±0.10,FRCp为280.6(208.4～396.1)ml.异物组患儿FRCp显著高于对照组(P＜0.01),呼吸频率高于对照组(P＜0.05),其他肺功能参数较对照组未见统计学差异.FRCp区分支气管异物和毛细支气管炎的最佳阈值202.95 ml,其对应的敏感性为85％,特异性为54％.结论 支气管异物婴幼儿肺功能特点为阻塞性通气功能障碍伴功能残气量升高,其功能残气量显著高于毛细支气管炎患儿.婴幼儿功能残气量测定有助于鉴别支气管异物和毛细支气管炎.

Objective To investigate the lung function data from infants of bronchial foreign body and bronchiolitis,and to explore the diagnostic values of functional residual capacity plethysmograph(FRCp) in the two diseases.Methods During January 2016 to January 2018,forty-six infants diagnosed with bronchial foreign body were selected as subjects.As well as 50 children diagnosed with bronchiolitis were selected as control group.All of the children had completed tidal breath pulmonary function test,lung compliance measurements using interrupter technique and plethysmographic measurements of FRCp.The differential diagnostic values of FRCp for the two diseases were analyzed with the receiver operating characteristic curve.Results In the bronchial foreign body group,respiratory rate (RR) was 31 ± 7 times per minute,VT/kg was 7.7 ± 1.5ml/kg,TPTEF/TE was 24.3 (9.4％,VPEF/VE was 26.1％ ± 7.6％,Ti/Te was 0.66 ± 0.10,and FRCp was 280.6(208.4 ～ 396.1) ml.In bronchial foreign body infants,FRCp was obviously higher than that in control group (P ＜0.01),RR was higher than that in control group(P ＜0.05).There were no significant differences found in other indicators between the two groups.The optimal cut-off value of FRCp was 202.95 ml for the differentiation between the two groups,with a sensitivity of 85％ and a specificity of 54％.Conclusion Most bronchial foreign body infants have obstructive ventilation dysfunction with elevated FRCp.FRCp in bronchial foreign body infants were obviously higher than that in bronchiolitis infants.Measurements of FRCp may be useful in the differential diagnosis of infant bronchial foreign body and bronchiolitis.