气道阻力指标在哮喘诊治中的价值探讨

目的探讨气道阻力指标在哮喘诊治中的价值。方法对比观察51例原因不明拟诊咳嗽变异性哮喘（CVA）的慢性咳嗽患者最大通气量（MVV）测定前后气道阻力变化与支气管激发试验（BPT）（30例）或舒张试验（21例）,用脉冲振荡法（IOS）测定气道阻力,计算MVV测定前后气道阻力实测值的变化率并作组间及组内比较。结果①激发阳性患者激发前后各气道阻力观测指标的比较和变化率（％）中,除呼吸总阻抗（ZRS）、中心气道阻力（Reent）、周围气道阻力（Rp）、R5、R5-R20、ZRS％及R5％等在激发前后差异有统计学意义（P〈0．05）外,其余观察指标差异无统计学意义（P〉0．05）;激发阴性受试者激发前后各气道阻力观测指标的比较和变化率（％）在试验前后差异无统计学意义（P〉0．05）。两个激发组间激发前后变化率（％）的比较,除ZRS、Reent、Rp、R5、R5-R20及ZRS％差异有统计学意义（P〈0．01）外,其余观察指标差异无统计学意义（P〉0．05）。②舒张试验前后各气道阻力指标的变化中,Rcent、Rc／Rp及1／20差异无统计学意义（P〉0．05）,除1120％变化率〉15％外,其余各项观察指标的变化率均〉20％（P〈0．05）。舒张试验前后各指标的变化率与激发组阳性的变化率相比较及舒张试验前后各指标的变化率与激发阴性的变化率相比较与上述结果相一致。结论气道阻力升高明显（IOS）以ZRS、R5升高20％和／或R20升高15％为阳性标准是符合临床的判别指标,同时,Rp、R5、R5-R20等实测值的变化率也有一定价值,但其变化率应〉30％。

The value of airway resistance index in the diagnose and treatment of asthma

Objective To explore the diagnostic value of airway resistance index in asthma. Methods The changes of airway resistances were measured and the changed rates of diretory measured values of the airway resistance in bronchi provocation test（BPF） （ n = 30）before and after maximal voluntary ventilation（MVV）, or before and after bronchi dilatation test（BDT） （ n = 21 ）were eontrastivedly observed prospectively with JEAGER impulse oseillometry（IOS） hmg function instrument in 51 cases of patients suffered from chronic cough which was diagnosed CVA and were compared in groups and between before and after MVV.Results ①Related parameters and changed rates of positive BPT patients before and after MVV showed that there were distinguished difference in ZRS, Rcent, Rp, RS, RS- R20,ZRS% and R5% （ P 〈 0.05） except other observed parameters no difference（ P 〉 0.05）, but there were no difference in all parameters in negative BPT （ P 〉 0.05 ）. The changed rates before and after BPT between two BPT groups showed that there were distinguished difference in ZtLS.Rcent, Rp,R5,RS-R20 and ZRS%（ P 〈 0.01） except other observed parameters no difference（ P 〉 0.05） ,②Related parameters observed in asthmatic patients before and after BDT showed that there was no difference in Rcent,Rc/Rp, R20 （ P 〉 0.05） ; and the variable percentage of other parameters were more than 20 % （ P 〈 0.05 ） except variable percentage of R20 % over 15% ,The variable percentage of every parameters before and after BPT compared with the variable percentage in positive BPT and the variable percentage of every parameters before and after BPT compared with the variable percentage in negative BF＇T had coincidence changes with above results. Conclusion The airway resistance ifiereased values of ZRS, R5 over 20% or/and R20% over 15% can he a positive standard in clinic distinguish index , and the variable percentage of Rp, R5, R5-R20 have some value if it is more than 30%.