离线FeNO及潮气肺功能量化指标在<5岁儿童哮喘管理中的应用研究

目的探讨离线呼出气一氧化氮(FeNO)及潮气肺功能联合监测对年幼儿童哮喘控制的价值。方法回顾性研究。选取2017年10月至2019年10月于成都市妇女儿童中心医院哮喘门诊初次确诊的哮喘患儿81例,年龄范围为10~55个月(<5岁),其中男58例,女23例。选择同期儿童保健门诊非喘息健康体检儿童65名为对照组。比较2组血嗜酸粒细胞、总IgE、过敏原阳性率、离线FeNO及潮气肺功能的差异。哮喘组给予抗哮喘治疗3个月、6个月后,复查离线FeNO及潮气肺功能,比较两指标治疗前后的变化。结果(1)哮喘组患儿离线FeNO、过敏原阳性率均高于对照组,达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)均低于对照组,差异均有统计学意义(P值均<0.05)。(2)哮喘组治疗3个月随访肺功能TPTEF/TE、VPEF/VE与初期比较明显好转,差异均有统计学意义(P值均<0.05);离线FeNO变化不明显,差异无统计学意义(P>0.05)。治疗6个月随访,与治疗初期比较,离线FeNO明显下降,差异有统计学意义(P<0.05)。结论离线FeNO及潮气肺功能可作为<5岁哮喘儿童管理的量化指标。抗哮喘治疗后FeNO的改变滞后于肺功能的改善,FeNO及肺功能联合运用,更利于<5岁儿童哮喘的精准管理。     

潮气呼吸肺功能、FeNO检测及支气管舒张试验用于低龄儿童哮喘疾病管理价值探讨

目的探讨潮气呼吸肺功能、FeNO检测及支气管舒张试验用于低龄儿童哮喘疾病管理临床价值。方法选取初次诊断儿童哮喘的低龄患儿108例为观察组,以同期来我院体检健康儿童80例为对照组;比较观察组和对照组的潮气呼吸肺功能指标水平、FeNO水平及观察组支气管舒张试验前后肺功能指标水平,并分析肺功能指标和FeNO水平的相关性。结果观察组急性期TPEF/TE、VPEF/VE、VT/kg及Ti/Te水平均显著低于缓解期、对照组(P0.05);观察组缓解期TPEF/TE、VPEF/VE及Ti/Te水平均显著低于对照组(P0.05);观察组急性期RR水平均显著高于缓解期、对照组(P0.05);观察组急性期支气管扩张剂应用后TPEF/TE、VPEF/VE、VT/kg及Ti/Te水平均显著高于应用前(P0.05);观察组急性期支气管扩张剂应用后RR水平显著低于应用前(P0.05);观察组急性期FeNO水平显著高于缓解期、对照组(P0.05);同时观察组缓解期FeNO水平显著高于对照组(P0.05);重度阻塞的哮喘患儿支气管舒张试验阳性率显著高于中度、轻度(P0.05);同时中度阻塞的哮喘患儿支气管舒张试验阳性率显著高于轻度(P0.05);Pearson相关性分析显示,哮喘急性期和缓解期患儿FeNO水平与潮气呼吸肺TPEF/TE和VPEF/VE间均无相关性(r=-0.035,-0.040,-0.043,-0.075,P=0.74,0.82,0.80,0.63)。结论潮气肺功能、FeNO检测及支气管舒张试验联合检测,可更为全面反映儿童哮喘患儿病变严重程度,有助于提高低龄儿童哮喘疾病管理水平。     

桂西地区婴幼儿喘息性疾病潮气呼吸肺功能变化的研究

目的研究桂西地区婴幼儿喘息性疾病潮气呼吸肺功能的特点,探讨潮气呼吸肺功能测定对婴幼儿喘息性疾病的临床应用价值。方法对来自广西西部的百色、河池两地区80例3岁以下婴幼儿喘息性疾病患儿进行潮气呼吸肺功能测定,并与同期同地区60例非喘息性呼吸道疾病婴幼儿进行比较,对比两组儿童肺功能指标的变化。结果观察组患儿肺功能性质以阻塞性改变为主(占85%),与对照组比较,阻塞越严重,TBFV环呼气下降支斜率越大,甚至出现向内凹陷。观察组患儿达峰时间比(TPTEF/TE)、达峰容积比(VPTEF/VE)、每千克体重潮气量(TV/kg)、吸呼比(Ti/Te)、呼出75%潮气量时呼气流速(TEF75%)低于对照组(P0.05);呼吸频率(RR)、潮气呼气峰流速(PTEF)、潮气量时呼气流速(TEF25%)高于对照组(P0.05);50%潮气量时呼气流速(TEF50%)与对照组差异无统计学意义(P0.05)。对其中20例患儿予平喘治疗后呼吸频率有一定减低,达峰时间比(TPTEF/TE)、达峰容积比(VPTEF/VE)高于治疗前(P0.05)。结论桂西地区婴幼儿喘息性疾病肺功能损害以阻塞性通气障碍为主。潮气呼吸肺功能测定对婴幼儿喘息性疾病病情评估、治疗以及预后判断均有重要的临床价值。     

喘息对支气管肺炎患儿潮气呼吸肺功能的影响

目的观察喘息对支气管肺炎患儿潮气呼吸肺功能的影响。方法对54例支气管肺炎患儿分为观察组喘息组25例和对照组非喘息组29例,在肺炎急性期及恢复期分别测定潮气呼吸流速容量(TBFV)环图形及参数呼吸频率(RR)、每公斤体重潮气量(VT/kg)、达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)、吸呼比(Ti/Te)、呼出和吸入50%潮气容积时的呼气流速与吸气流速之比(TEF50/TIF50),进行分析。结果 1.观察组急性期TBFV环图形分析及相关参数较对照组无统计学意义。2.观察组恢复期TBFV图形分析正常17例、阻塞性改变8例,较对照组正常26例、阻塞性改变3例,经χ2检验P0.05,有统计学意义。观察组恢复期达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)较对照组低,经t检验有统计学意义(P0.05)。结论观察组气道阻塞性病变恢复较对照组慢,喘息可影响支气管肺炎患儿气道阻塞性功能障碍的恢复。     

婴幼儿潮气呼吸肺功能的临床应用研究

目的研究潮气呼吸肺功能检查在婴幼儿常见的呼吸系统疾病诊断的临床价值。方法选择年龄2个月-3岁我院同期住院婴幼儿支气管肺炎48例、支气管哮喘37例、毛细支气管炎26例,完成潮气呼吸肺功能舒张试验,并对吸入支气管扩张剂前后的主要肺功能参数进行比较。结果吸入支气管扩张剂前哮喘组、毛支组分别与肺炎组比较达峰时间比TPTEF/Te和达峰容积比VPEF/Ve均有统计学差异(P 0. 05)。吸入支气管扩张剂后肺炎组、哮喘组、毛支组TPTEF/Te和VPEF/Ve均有所改善,且差异有统计学意义(P 0. 05)。结论通过潮气呼吸肺功能测定支气管肺炎、支气管哮喘、毛细支气管炎患儿均有不同程度的气道阻塞,给予支气管扩张剂后气道阻塞程度均有所改善。     

支气管舒张试验在0～6岁儿童喘息性疾病中的应用

目的利用潮气呼吸法进行儿童的支气管舒张试验,探讨其在0～6岁儿童喘息性疾病中的应用价值。方法2006年4～11月就诊于安徽医科大学附属省立医院儿科门诊及住院的儿童喘息性疾病244例,以沙丁胺醇作为支气管舒张药物,用潮气呼吸法分析评价小年龄喘息性疾病儿童吸入药物前后肺功能的变化,以探讨支气管舒张试验在该年龄段的应用价值。结果(1)吸入支气管舒张剂前后,以达峰时间比(TPTEF/TE)和达峰容积比(VPEF/VE)任意一个改善率≥15%为阳性标准,肺功能异常组阳性率明显高于正常组。(2)吸入支气管舒张药物,肺功能差值为负值率正常组明显高于异常组。(3)肺功能异常组各年龄段间支气管舒张试验阳性率无明显差异。结论支气管舒张试验在肺功能异常时应用较正常时更有价值。     

非紫绀型先天性心脏病儿童术前潮气呼吸肺功能研究

目的:探讨非紫绀型先天性心脏病儿童术前潮气呼吸肺功能相关参数改变及其影响因素。方法:选择非紫绀型先天性心脏病儿童107例为研究对象,健康体检儿童48例为对照组,分别进行潮气呼吸肺功能检查。先天性心脏病儿童介入术中测定肺动脉平均压,并分别采集上腔静脉、肺动脉及主动脉(或左心房)血检测血氧饱和度及血红蛋白;按肺动脉平均压分为非肺高压组65例和肺高压组42例,并计算血流动力学指标。将3组儿童肺功能进行比较,对先天性心脏病儿童血流动力学指标与肺功能参数进行相关性分析。结果:从对照组、非肺高压组到肺高压组,每分钟通气量(MV)、潮气呼气峰流速(PTEF)、潮气峰流速/潮气量(PF/VE)水平逐渐增高,达峰时间(TPTEF)、达峰时间比(TPTEF/TE)、达峰容积(VPTEF)和达峰容积比(VPEF/VE)水平则逐渐降低,差异有统计学意义(P0.05)。肺动脉平均压与PF/VE、RR、Ti/Te呈正相关(r=0.31、0.25、0.257,P0.05),与TPTEF、Te呈负相关(r=-0.26、-0.283,P0.05);肺血管阻力与PF/VE、RR、Ti/Te呈正相关(r=0.306、0.247、0.218,P0.05),与MV、Ti、Te呈负相关(r=-0.205、-0.207、-0.264,P0.05)。结论:非紫绀型先天性心脏病儿童存在阻塞性通气功能障碍,随着肺动脉平均压力及肺血管阻力的升高,可合并限制性通气功能障碍。     

婴幼儿哮喘患儿潮气呼吸肺功能改变的特征

目的观察婴幼儿哮喘患儿在发作期与缓解期的潮气呼吸流速——容量曲线测定结果。方法选择婴幼儿哮喘患儿40例，于镇静后进行潮气呼吸流速容量曲线测定（TBFV）。主要参数有：每公斤潮气量（VT／kg）、呼吸频率（RR）、吸气时间（Ti）、呼气时间（Te）、吸呼比（Ti／Te）、达峰时间比（TPTEF／TE）、达峰容积比（VPEF／VE），并对30例哮喘患儿经正规吸入治疗1～3月的缓解期进行复查。观察其改善情况。同时对40例无呼吸道疾病的婴幼儿进行肺功能检测，作为正常对照。结果哮喘组的潮气量与正常对照组无显著差异，其他各指标差异均有显著性（P〈0．01）。哮喘组经1～3月治疗后，复查TPEF／TE，VPEF／VE显著上升，但与对照组仍有显著差异，未能恢复正常水平。结论潮气呼吸肺功能测定能反映出婴幼儿哮喘的病理生理特点，可成为呼吸系统疾病诊断的重要补充。     

婴幼儿支气管哮喘和支气管肺发育不良伴喘息患儿的肺功能比较

目的比较婴幼儿哮喘和支气管肺发育不良伴喘息(bronchopulmonary dysplasia with wheezing,BPDW)患儿潮气肺功能的差异。方法对29例BPDW患儿进行潮气呼吸肺功能测试,同时选取潮气肺功能阻塞程度与BPDW患儿一致的婴幼儿哮喘患儿33例,所有患儿均给予吸入布地奈德气雾剂100μg/次,2次/天,治疗3个月后,对两组患儿再次进行肺功能检测,评估两组患儿肺功能恢复情况。结果哮喘组和BPDW组患儿肺功能参数(MV、RR、VT/Kg、TI/TE、t PF%t E、VPF%VE)在治疗前比较差异无统计学意义(P0.05);哮喘组患儿治疗前后肺功能参数比较,差异有统计学意义(P0.05);BPDW组患儿在治疗前后肺功能参数比较,差异无统计学意义(P0.05);哮喘组和BPDW组患儿在治疗后肺功能参数比较,差异有统计学意义(P0.05)。结论与婴幼儿支气管哮喘相比,BPDW患儿的肺功能在治疗后恢复不明显,存在不可逆的气道受损;潮气呼吸肺功能在一定程度上可用来鉴别BPDW患儿。     

潮气呼吸肺功能检测对婴幼儿喘息性疾病的诊断价值

目的探讨潮气呼吸肺功能检测对婴幼儿喘息性疾病的诊断价值。方法收集2012年1月—2014年1月在我院住院的支气管哮喘患儿40例(哮喘组)、毛细支气管炎患儿40例(毛细组)及门诊体检健康婴幼儿40例(对照组)。均于平静呼吸状态下监测潮气呼吸肺功能,指标包括:单位质量内潮气量(Vt)、呼气时间(Te)、吸气时间(Ti)、呼吸频率(RR)、达到峰流速时间(TPTEF)、达到呼气峰流速时所呼吸气体体积(VPTEF)以及呼吸容积(Ve),计算呼吸比(Ti/Te)、达峰时间比(TPTEF/Te)以及达峰容积比(VPTEF/Ve)。哮喘组和毛细组患儿完成测试后,均给予0.5%沙丁胺醇雾化吸入治疗,3个月后进行复测。结果治疗前哮喘组和毛细组患儿RR高于对照组,Te、Ti、TPTEF/Te及VPTEF/Ve低于对照组(P0.05)。吸入沙丁胺醇后,哮喘组Vt、VPTEF/Ve及TPTEF/Te高于治疗前,毛细组RR、TPTEF/Te低于治疗前(P0.05)。结论潮气呼吸肺功能检测能够间接反映婴幼儿喘息性疾病的病理生理特征,为临床诊断提供参考。     

体位改变对喘息婴幼儿潮气呼吸肺功能的影响

目的比较仰卧位和侧卧位两种体位下潮气呼吸肺功能测定结果。方法同时测定在仰卧位和侧卧位下32例喘息患儿的潮气呼吸肺功能,观察肺功能参数变化。结果侧卧位与仰卧位相比潮气呼吸肺功能参数均有改变,差异具有显著性。侧卧位达峰时间比、达峰容积比升高,每千克体重潮气量减少,呼吸频率减慢,吸气时间延长,潮气呼吸峰流速下降。结论体位改变能影响潮气呼吸肺功能检测结果;检测时应统一体位。     

Inhaled fluticasone dipropionate decreases levels of nitric oxide in recurrenty wheezy infants

We examined the effect of inhaled fluticasone diproprionate (FDP) on symptoms, lung function (FEV(0.5)), and exhaled nitric oxide (Fe(NO)) in infants with recurrent wheeze and raised Fe(NO). Thirty-one infants aged 6-19 months (mean, 12.7 months; 12 girls) completed the study. All infants had a history of recurrent wheeze and a parental history of atopy. All children had raised Fe(NO), as determined by an offline tidal breathing technique prior to randomization. Lung function and Fe(NO) were assessed before and after 4 weeks of treatment with FDP or placebo. The parents recorded daily symptoms during the treatment period. Sixteen infants received FDP and 15 the placebo for 4 weeks. At completion of the study, infants treated with FDP had a significant reduction in Fe(NO) (35.0 ppb to 16.5 ppb) compared to those that received placebo (35.2 ppb to 30.2 ppb) (P = 0.05). Small increases in FEV(0.5) were observed in both groups, but these changes were not different between groups (P = 0.8). Symptom scores were not significantly different in either group following the intervention. We showed that a moderate dose of inhaled FDP reduces levels of Fe(NO), a potential marker of airway inflammation, even in the absence of significant changes in lung function and symptoms.     

Assessment of tidal breathing parameters in infants with cystic fibrosis.

Simple methods are needed to assess lung function in infants with cystic fibrosis (CF). This study determined the relationship between simple measurements obtained from tidal breathing with those from more complicated forced expiratory manoeuvres. Healthy infants and infants with CF were recruited from two maternity units and five specialist CF hospitals, respectively. Respiratory rate, tidal volume, minute ventilation and the tidal breathing ratio (TPTEF:TE) were measured in sedated infants and compared with forced expiratory volume in 0.4 seconds (FEV0.4) measured by the raised volume technique. Altogether, 95 healthy infants and 47 infants with CF of similar age, sex, ethnicity and proportion exposed to maternal smoking were recruited. There was no difference in TPTEF:TE and tidal volume between healthy infants and those with CF. Minute ventilation was significantly greater in infants with CF due to a mean (95% confidence interval) increase in respiratory rate of 5.8 (3.2-8.4) min(-1). Thirteen (28%) infants with CF had a respiratory rate elevated by >2 SD. However, no association between respiratory rate and FEV0.4 could be identified. Tidal breathing ratio was not useful in identifying diminished airway function in infants with cystic fibrosis. An elevated respiratory rate may be due in part to ventilation heterogeneity but is poorly predictive of diminished airway function measured by forced expiration.     

Comparison of single-breath and tidal breathing exhaled nitric oxide levels in infants.

The aim of this study was to compare two different methods, tidal breathing (TB) and single-breath (SB), for measuring fractional exhaled nitric oxide (FENO) in infants. FENO was measured in 71 infants with either recurrent wheeze (n=32), recurrent cough (n=16) or no symptoms (healthy, n=23) using both methods. For TB measurements five breaths were collected into a gas sampling bag (off-line reservoir sampling). The SB method was modified from the raised volume rapid thoraco-abdominal technique. Agreement between the two methods was investigated and both methods were used to compare FENO in infants with and without symptoms. Flow dependence of SB FENO was demonstrated using two expiratory flows (11 and 40 mL x s(-1)). There was a moderate correlation (r=0.60) but poor agreement between levels using the TB and SB methods. A significant difference in FENO between healthy children and children with wheeze was found using the SB but not the TB method. Due to lower expiratory flow and reduced nasal nitric oxide contamination the single-breath technique may be more sensitive than the tidal breathing method for detecting differences in exhaled nitric oxide between infants with and without respiratory symptoms.     

未控制支气管哮喘患者痰嗜酸粒细胞水平与肺功能相关性分析

目的分析未控制支气管哮喘(哮喘)患者不同水平痰嗜酸粒细胞的临床特点,探讨未控制哮喘患者痰嗜酸粒细胞与肺功能的相关性。方法纳入2017年8月至2019年9月就诊于内蒙古自治区人民医院呼吸与危重症医学科的未控制哮喘患者167例病例资料进行回顾性研究,根据诱导痰嗜酸粒细胞百分比结果将患者分为2组,以痰嗜酸粒细胞百分比≥2.5%为嗜酸粒细胞增高组(105例),痰嗜酸粒细胞百分比<2.5%为嗜酸粒细胞正常组(62例)。分析2组患者血嗜酸粒细胞计数、呼出气一氧化氮(FeNO)、吸入沙丁胺醇后第1秒用力呼气容积(FEV1)增加量等的差异以及上述指标与痰嗜酸粒细胞的相关性。结果与嗜酸粒细胞正常组相比,嗜酸粒细胞增高组血嗜酸粒细胞计数、FeNO及合并过敏性疾病比例更高;哮喘病程及吸入沙丁胺醇后FEV1增加量则低于嗜酸粒细胞正常组(P值均<0.05)。痰嗜酸粒细胞与血嗜酸粒细胞、FeNO呈正相关(r=0.398、0.584,P值均<0.05),与吸入沙丁胺醇后FEV1增加量呈负相关(r=-0.426,P<0.01)。采用受试者工作特征曲线分析FeNO及血嗜酸粒细胞的诊断价值。FeNO诊断气道嗜酸性炎症的最佳截断值为28.5 ppb,其敏感度为86.9%,特异度为66.0%(曲线下面积为0.812)。血嗜酸粒细胞计数诊断气道嗜酸性炎症的最佳截断值为185个/μl,其敏感度为62.9%,特异度为69.4%(曲线下面积为0.667)。结论未控制哮喘患者的气道炎症表型多为嗜酸粒细胞型,嗜酸粒细胞性哮喘对支气管扩张剂反应较差,气道嗜酸性炎症可能有导致气道重塑的风险;同时血嗜酸粒细胞、FeNO对判断哮喘的气道炎症表型有一定的辅助作用。     

The effect of inhaled adrenaline on lung function of recurrently wheezy infants less than 18 months old

Inhaled bronchodilators have been shown not to improve lung function in infants with wheeze. This observation has led to the suggestion that airway wall edema may be more important than bronchoconstriction in infants with airway narrowing. Inhaled adrenaline is used to relieve upper airway edema in children with croup and has been demonstrated to improve clinical scores and lower pulmonary resistance in some infants with wheeze associated with bronchiolitis. The aim of the present study was to examine the effect of inhaled adrenaline on lung function in a group of infants with recurrent wheeze. Eleven infants aged 10 to 18 months with a history of recurrent wheeze were studied during an asymptomatic interval. Respiratory function was assessed (1) by measuring maximal expiratory flow at functional residual capacity (V?_maxFRC) during a forced partial expiratory maneuver and (2) by measuring conductance of the respiratory system G_rs using a single expiratory occlusion technique. Following baseline measurements, the infants received 0.5 mg/kg adrenaline by nebulizer and serial lung function tests were repeated at 5 min intervals. Ten infants had abnormal baseline lung function (median V?_maxFRC 44.2% predicted; median G_rs 34% predicted). Using a random effects model, V?_maxFRC and G_rs declined significantly at 10 and 5 min after adrenaline, respectively. No significant improvements from baseline were observed in either measurement for up to 30 min following adrenaline delivery. It is concluded that inhaled adrenaline did not relieve airways obstruction in this group of asymptomatic infants with recurrent wheeze. Pediatr Pulmonol. 1995; 20:9–15 . © 1995 Wiley-Liss, Inc.     

Transient early wheeze is not associated with impaired lung function in 7-yr-old children.

The aim of the present study was to analyse determinants of lung function in 7-yr-old children with different wheezing patterns (early, persistent and late onset) in a prospective cohort study. The German Multicentre Allergy Study (MAS) followed 1,314 children from birth onwards. Annual assessments included clinical check-ups, a structured interview and repeated measurement of specific immunoglobulins Ig(E) directed against food and inhalant allergens. At the age of 7 yrs, lung function was measured by body plethysmography in 800 children. Episodes of wheezing in the past 12 months ("current wheeze") were strongly associated with reduced lung function at age 7 yrs. Children with wheezing episodes only during the first 3 yrs of life showed a slight impairment in maximal expiratory flow when 50% of the forced vital capacity remains to be exhaled (98.9 +/- 24.2 versus 103.2 +/- 22.8% of the predicted value in children who never wheeze). Separate analysis of determinants of pulmonary function within these subgroups resulted in distinctly different patterns. Determinants of impaired lung function in the group of current wheezers were: time in years since first wheeze, a parental history of atopy, current sensitisation to indoor allergens, elevated cord blood IgE levels and a low ponderal index at birth. In the group of transient early wheezers, frequent lower respiratory tract infections early in life and maternal smoking during pregnancy were significant but weak determinants of impaired lung function. The present results indicate that determinants of pulmonary function in 7-yr-old children differ with respect to different wheezing phenotypes, demanding different therapeutic strategies. Although transient early wheezers were found to have normal-to-subnormal lung function, children with asthmatic symptoms (persistent and late-onset disease) at age 7 yrs already show significant impairment of expiratory flow volumes.     

Efficacy of fluticasone propionate on lung function and symptoms in wheezy infants

The role of inhaled corticosteroids in the treatment of recurrent or persistent wheeze in infancy remains unclear. We evaluated the effect of 3 months of treatment with inhaled fluticasone propionate, 200 microg daily (FP200), on lung function and symptom scores in wheezy infants. Moreover, we evaluated whether infants with atopy and/or eczema respond better to FP200 as compared with non-atopic infants. Forced expiratory flow (Vmax(FRC)) was measured at baseline and after treatment. Sixty-five infants were randomized to receive FP200 or placebo, and 62 infants (mean age, 11.3 months) completed the study. Mean Vmax(FRC), expressed as a Z score, was significantly below normal at baseline and after treatment in both groups. The change from baseline of Vmax(FRC) was not different between the two treatment arms. After 6 weeks of treatment, and not after 13 weeks, the FP200 group had a significantly higher percentage of symptom-free days and a significant reduction in mean daily cough score compared with placebo. Separate analysis of treatment effect in infants with atopy or eczema showed no effect modification. We conclude that in wheezy infants, after 3 months of treatment with fluticasone, there was no improvement in lung function and no reduction in respiratory symptoms compared with placebo.