ѧ��ǰ��ͯ�����λ����ⶨ���������Ʒ���

目的探讨学龄前儿童用力肺活量测定的质量控制标准。方法2004年4～9月,对深圳地区3～7岁正常儿童343例(男184例,女159例),采用意大利COSMED公司生产的COSMED流量传感仪,参考美国胸科协会可接受曲线标准,通过测定用力肺活量(FVC)、0.5s用力呼气容积(FEV0.5)、0.75s用力呼气容积(FEV0.75)、1s用力呼气容积(FEV1)以及0.5s用力呼气容积占用力肺活量比值(FEV0.5/FVC)、0.75s用力呼气容积占用力肺活量比值(FEV0.75/FVC)、1s用力呼气容积占用力肺活量比值(FEV1/FVC)、外推容量(VBE)、外推容量占用力肺活量比值(VBE/FVC)、呼气时间(FET100%)及最佳2次的FVC、FEV0.75、FEV0.5、FEV1变异等指标,分析学龄前儿童用力肺活量测定的质量控制标准。结果279名(81.3%)儿童能够成功完成测试。平均VBE为(42.71±13.61)mL,95百分位数为64mL,最大为72mL;VBE/FVC为(3.93±1.34)%,95百分位数为6.36%,最大为9.26%;52例(18.6%)VBE/FVC>5%;年龄越小的儿童其VBE/FVC越高;VBE/FVC与身高呈负相关(P<0.05)。儿童平均呼气时间为(1.61±0.52)s,5百分位数为0.9s,18例(6.5%)呼气时间<1s。儿童最佳2次的FVC、FEV1、FEV0.75、FEV0.5变异均<0.2L;约63.1%儿童最佳2次的FEV0.75的变异<5%;约66.2%最佳2次的FEV1变异<5%,各变异<0.1L的百分比为90%～93%。结论建议对于中国学龄前儿童用力肺活量的质控标准为:曲线起始以VBE为标准,VBE/FVC<6.5%或VBE<65mL,取最大值;曲线终止以呼气时间≥0.9s,且呼气相时间容积曲线显示呼气容量出现平台,持续时间≥1s为标准;FEV0.5及FEV0.75需在报告中报告;曲线的重复性标准为最佳2次FVC及FEV0.75的变异<10%或<0.1L(取最大值)。

Quality control for spirometry in pre-school children

??AbstractObjectiveTo probe into the criteria of quality control for spirometry in preschool children.MethodsA survey in 343 healthy preschool children(184 boys,159girls) aged 3 to 7 years old was carried out in Shenzhen in 2004.Eleven flow volume tests parameters [forced vital capacity(FVC),forced expiratory volume at o.5 second(FEV0.5),forced expiratory volume at 0.75 second(FEV0.75),forced expiratory volume at one second(FEV1),extrapolated volume(VBE),extrapolated volume to FVC ratio(VBE/FVC),the difference between the two highest values of FVC or FEV0.5,FEV0.75,FEV1 and forced expiratory time(FET 100%)?? were measured by using COSMED spirometry of Italian.ResultsThe average extrapolated volume(VBE) was 42.71??13.61 mL?? 95??Percentile value being 64mL??the average VBE/FVC was (3??93??1??34)%??95??Percentile value being 6??36% in this group.Fifty??two of 279 children (18.6%) were not able to produce a VBE/FVC value less than 5%.The younger children tended to have higher VBE/FVC values.There was significant relationship between VBE/FVC and height (P< 0.05).The average forced expiratory time(FET) was 1.61??0.52sec??5??Percentile value being 0??9sec,and 18 of 279 (6.5%) children produced a FET less than 1 second.Forced expiratory volume in 0.50 and 0.75 sec(FEV0.5,FEV0.75) were thus measured in preschool children.All children presented their two best efforts(FVC??FEV0.75??FEV0.5??FEV1 FVC ) no more than 0.2L.About 63.1%of the tested children presented their two best efforts(FEV0.75) no more than 5%.About 66.2% of the tested children presented their two best efforts( FEV1) no more than 5%.More than 90% of the tested children presented their two best efforts(FVC??FEV0.75??FEV0.5??FEV1 FVC ) no more than 0.1L.ConclusionStart of test can be quantitatively assessed as in adults,but results greater than 65 mL for VBE or 6.5% for VBE/ FVC should be indications for visual reinspection of the flow volume trace,rather than automatic exclusion.Expiratory time should not be less than 0.9s and expiration continues until there is a clear plateau on the volume time trace,and there should be no volume change for 1 second.In all preschool children both FEV0.75 and FEV0.5 should be reported in addition to FEV1.Repeatability can be assessed as for adults,but criteria of 100 mL and 10% of best effort for FVC and FEVt may be more appropriate than the criteria applied to adults