婴幼儿支气管肺炎潮气呼吸肺功能检测的特点

肺功能检测已经成为呼吸系统疾病诊断和鉴别诊断的重要检查方法。潮气呼吸肺功能测定是适用于3岁以下婴幼儿的检测方法，它不需要患儿的理解和配合，在镇静睡眠状态下，通过面罩平静呼吸，即可测出肺的容量、流速及阻力的变化。笔者应用潮气呼吸肺功能检测方法，对2005年10月-2006年3月住院的34例患支气管肺炎的婴幼儿进行测定，得出流速-容量曲线及其衍生参数的变化，以提供临床参考。     

潮气呼吸肺功能评估婴幼儿大叶性肺炎病情的价值

目的探讨潮气呼吸肺功能在婴幼儿大叶性肺炎临床病情评估中的价值。方法对72例婴幼儿大叶性肺炎(肺炎组)的肺功能进行动态监测,并与同期在门诊健康体检的80名同龄健康儿童(健康对照组)的肺功能指标进行对照,观察婴幼儿大叶性肺炎潮气流速-容量环的形态及各项指标的变化。回顾分析婴幼儿大叶性肺炎临床病情评分及住院天数与肺功能主要参数的相关性。结果①72例肺炎组患者,70例痊愈,2例死亡;②与健康对照组比较,大叶性肺炎组患儿急性期的潮气流速-容量环曲线形态显得瘦长,且呼气下降支斜率增大,高峰提前,降支呈波谷样向容量轴凹陷。③肺炎组入院时肺功能较同龄正常小儿明显下降;④随着治疗效果的逐渐好转,肺功能的各项指标逐渐恢复;⑤TPTEF/TE和VPTEF/VE与临床病情评分及住院时间呈负相关。结论潮气呼吸肺功能检测为客观判定婴幼儿大叶性肺炎预后及疗程提供依据。     

小儿潮气呼吸流速-容量环临床应用分析

目的：了解小儿潮气呼吸流速-容量环在儿童呼吸系统疾病中的应用。方法对2014年1～3月住院患儿中有适应证的240例进行潮气呼吸流速-容量环检查并进行分析。结果240例患儿中潮气呼吸流速-容量环分析结果异常232例,阳性率为96.7%,与疾病的最后诊断符合率达98.0%（235/240）。结论小儿潮气呼吸流速-容量环可广泛应用于儿童呼吸系统疾病中,对疾病的诊断,特别是早期未进行胸部X线片检查的肺炎有提示意义,对于喉炎及先天性喉喘鸣有明确的辅助诊断意义,有助于婴幼儿喘息及儿童哮喘的确诊及远期管理。     

肺功能在喘乐宁联合爱喘乐治疗喘息性支气管炎前后疗效评价的应用研究

目的 检测婴幼儿喘息性支气管炎喘乐宁联合爱喘乐雾化吸入前后的肺功能.方法 应用美国森迪公司生产的Vmax26婴儿肺功能仪对60例观察组患儿雾化治疗前后及对照组进行肺功能测定,选择潮气状态下的通气功能-呼吸频率(RR)、每公斤体重潮气量(TV/kg);潮气流速容量环的形态-吸气时间/总呼吸时间(Ti/Ttot)、到达潮气峰流速的时间/总呼吸间(T-PF/Ttot)、呼出75%潮气量时的呼气流速/潮气呼气峰流速(25/PF)作为观察的指标.结果 观察组雾化前后各项指标存在显著性差异((P＜0.05),观察组与对照组雾化前后各项指标存在显著性差异((P＜0.05).结论 肺功能测定可以了解喘息性支气管炎的气道阻塞情况和气道的可逆性,为该病的诊断、病情判断和疗效判断提供量化依据.     

婴幼儿重症肺炎治疗前后潮气呼吸肺功能指标的变化及意义

目的探讨治疗前后重症肺炎婴幼儿潮气呼吸肺功能各项指标的变化及意义。方法采用潮气呼吸法检测58例1~32个月的重症肺炎婴幼儿的肺功能,并绘出流速-容量环;同期检测43名同龄健康婴幼儿作对照。结果肺炎治疗前患儿呼吸频率为(60.3±5.1)次/min,较同龄健康对照组的(33.2±7.9)次/min明显增快(P<0.01)。吸气和呼气时间均缩短,但以前者更明显,吸呼比(TI/TE)降低。反映小气道阻塞的指标:TPEF/TE和VPEF/VE分别为(18.39±4.84)%和(18.9±8.57)%,低于对照组的(32.2±5.89)%和(33.2±6.9)%(P<0.01)。经治疗后,患儿呼吸频率逐渐下降为(39±6.9)次/min,TPEF/TE、VPEF/VE显著增高为(24.8±5.49)%和(22.4±9.04)%(P<0.01),但仍低于健康儿童相应指标。正常组流速-容量环呈椭圆型,而重症肺炎组在治疗前该环降支的斜率较正常组明显增大。而且病情越重,斜率越大,严重者甚至向内凹陷。结论重症肺炎婴幼儿潮气呼吸肺功能明显受损,而且在临床症状缓解后,其肺功能损害仍可持续存在。潮气呼吸肺功能检测能反映重症肺炎婴幼儿病变的严重程度、肺功能的损害状况和治疗的效果。     

甲型H1N1流感肺炎患儿潮气呼吸肺功能的改变

目的探讨甲型H1N1流感肺炎患儿的肺功能变化及其在临床诊断和治疗评估中的意义。方法测定53例甲型H1N1流感肺炎患儿(A组)潮气呼吸肺功能,并与87例同年龄段健康儿童(B组)对照。结果 A组潮气流速-容量环变窄,呼气曲线升枝陡峭,高峰提前,降枝呈波谷样凹陷。与B组比较,A组通气功能指标反映呼气功能障碍,尤其1个月~3岁年龄组患儿(P<0.05)。结论甲型H1N1流感肺炎患儿其急性期肺功能改变主要表现为气道阻塞性通气功能障碍;潮气呼吸肺功能测定可为甲型H1N1流感肺炎患儿评判病情程度及预后评估提供客观依据。     

潮气呼吸肺功能在婴幼儿腺病毒肺炎中的应用

目的探究潮气呼吸肺功能在婴幼儿腺病毒肺炎中的应用效果。方法选取50例腺病毒肺炎患儿作为观察组,另随机抽选常规检查的健康婴幼儿作为对照组。所有研究对象均进行潮气呼吸肺功能检查,对比两组的肺功能各项指标[呼吸频率(RR)、潮气量(VT)、吸气时间(Ti)、潮气呼气峰流速(PTEF)、到达潮气呼气峰流速的时间/呼气时间(TPTEF/Te)、到达潮气呼气峰流速的呼气量/潮气呼气量(VPTEF/Ve)、潮气呼气峰流速/潮气呼气量(PTEF/Ve)]。结果观察组RR(34.16±7.14)次/min、PTEF(136.48±18.01)ml/s、PTEF/Ve(1.58±0.29)%高于对照组的(22.64±5.01)次/min、(123.54±10.64)ml/s、(1.31±0.35)%,Ti(0.78±0.12)s短于对照组的(0.84±0.13)s,VT(6.78±0.54)ml/kg、TPTEF/Te(38.97±6.98)%、VPTEF/Ve(40.13±9.13)%低于对照组的(8.46±0.85)ml/kg、(45.16±8.46)%、(46.58±7.15)%,差异具有统计学意义(P<0.05)。结论婴幼儿腺病毒肺炎在急性期呈现小气道阻力增高、潮气量下降、混合性通气功能障碍改变,肺功能检查是监测婴幼儿腺病毒肺炎病情的理想方法。     

布地奈德吸入治疗对毛细支气管炎患儿潮气呼吸肺功能的影响及意义

目的探讨布地奈德吸入治疗对毛细支气管炎患儿潮气呼吸肺功能的影响及应用价值。方法以2018年1-9月在我院三病区住院的65例毛细支气管炎患儿为研究对象,观察组34例,常规对照组31例,分别记录患儿相应临床资料。常规对照组入院后予止咳化痰、补液等常规治疗,病情需要者予吸氧、静脉甲强龙输注、抗生素等治疗;观察组在上述治疗的基础上加用布地奈德雾化吸入1～2周,分别在急性期(治疗前)及恢复期(规范治疗后1～2周,出院前)进行潮气呼吸肺功能检查;选取同期同年龄健康体检儿童20例作为健康对照组,进行上述检查。比较各组患儿检测结果。结果与健康对照组比较,毛细支气管炎组患儿急性期潮气量(VT/kg)、吸呼比(Ti/Te)、达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)均降低,呼吸频率(RR)升高,差异均有统计学意义(P<0.05)。治疗后,两组患儿VT、TPTEF/TE、VPEF/VE均高于急性期,差异均有统计学意义(P<0.05)。两组患儿缓解期TPTEF/TE、VPEF/VE升高,RR降低,与健康对照组比较差异仍有统计学意义(P<0.05)。治疗后,观察组患儿VT、VPEF/VE高于常规对照组,RR低于常规对照组,差异均有统计学意义(P<0.05)。结论潮气呼吸肺功能可反映毛细支气管炎病情严重程度。布地奈德吸入能有效改善儿童毛细支气管炎的潮气呼吸肺功能。     

学龄前健康儿童最大呼气流速值影响因素分析

峰流速(PEFR)即深吸气后用力呼气的最大瞬时流速。它是肺容量、胸肺组织弹性回缩力和呼吸肌强度以及气道阻力等因素的综合反应。其生理与临床意义与用力呼气量、最大通气量相同。我国对学龄前健康儿童PEFR的正常参考值及其影响因素的研究报道尚少。为了了解青岛市市区学龄前儿童的PEFR及其影响因素,我们于1999年6月对青岛市区791名健康学龄前儿童进行了测试,现报告如下。 1 研究对象和方法 1.1 研究对象 受检儿童系青岛市区3所幼儿园3.5～7岁791名健康儿童,男404名,女387名。均符合以下条     

潮气呼吸肺功能检测在婴幼儿哮喘诊治中的意义

目的 0探讨肺功能检测在婴幼儿哮喘诊治中的指导意义.方法 采用肺功能仪分别测定46例健康及96例哮喘婴幼儿在哮喘急性发作期和缓解期的呼吸生理参数.结果 患儿轻、中度哮喘发作时阻塞型通气功能障碍占72.6%,重度发作时阻塞型通气功能障碍占33.3%,而混合型通气功能障碍占60%,缓解期仍有79%患儿存在轻、中度阻塞型通气功能障碍.结论 潮气呼吸肺功能测定在婴幼儿哮喘病情判定、疗效观察及随访中有重要意义.     

A simple method of bronchoprovocation using a valved holding chamber.

This study was undertaken to ascertain whether the use of a valved holding chamber (VHC) during bronchial provocation testing might increase lung deposition and repeatability of the test relative to the tidal breathing method. The 2-min tidal breathing results were compared to five inhalations from a VHC device in patients using the Pari-provoII nebulizer (MMD = 2.1mkm). Lung and mouth deposition, losses though the exhaled air and losses before aerosol delivery to the patient's mouth were measured in patients using a radiolabeled 99Tc-DTPA solution and gamma camera. The study revealed that lung deposition was 67% with the VHC method, and losses with exhaled air were 29% of the inhaled amount. The tidal breathing method resulted in lung deposition of 20.9 +/- 3.4%, and losses with exhaled air were 77.5 +/-3.5%. Mouth deposition did not differ significantly between methods. Variability in lung deposition was 15.3% for the VHC and 32.0% for the tidal breathing method. In addition to greater lung deposition and reproducibility, the VHC method allows easier calculation of the inhaled dose.     

酪氨酸蛋白激酶抑制剂对大鼠呼吸机所致肺损伤的保护作用

目的研究酪氨酸蛋白激酶抑制剂金雀异黄素(genistein)对大鼠呼吸机所致肺损伤(VILI)的保护作用。方法30只健康SD大鼠随机均分成A、B、C3组,A组为正常潮气量机械通气组:潮气量(VT)=8ml·kg-1;B组为大潮气量机械通气组:潮气量(VT)=40ml·kg-1;C组为大潮气量通气加Genistein处理组:潮气量(VT)=40ml·kg-1,C组大鼠实验前30min腹腔注射Genistein溶液(50mg·kg-1)。A、B、C3组机械通气频率(P)均为每分钟80次,通气时间均为2h。实验完毕收集肺组织和肺灌洗液标本。光镜观察肺病理改变,TUNEL法检测肺组织细胞凋亡情况,同时测定肺灌洗液中总蛋白、肺湿/干比、白细胞计数、肿瘤坏死因子(TNF-α)等指标以及肺组织中中性粒细胞髓过氧化物酶(MPO)的水平。结果和A组相比,B组肺病理改变明显,肺细胞凋亡数量增加,肺湿/干比、总蛋白、白细胞计数、MPO、TNF-α等指标均增高(P<0.01);和B组比较,C组肺病理改变明显减轻,肺细胞凋亡数量减少,肺湿/干比、总蛋白、白细胞计数、MPO、TNF-α等指标均降低(P<0.05)。结论酪氨酸蛋白激酶抑制剂genistein对大鼠呼吸机所致的肺损伤具有较好的保护作用。     

Use of asthmatic pulmonary function test data to predict lung deposition.

Asthma is a complex disease that alters both breathing patterns and airway morphology. Lack of experimental data or model simulations utilizing realistic in vivo breathing conditions severely limit the ability to assess the relative risk of inhaled pathogens for asthmatics. In this study, a one-dimensional Eulerian modeling approach was used to simulate particle deposition in both asthmatic and healthy subjects. The model was based on the hypothesis that the component reactions of bronchial smooth muscle spasms, submucosal connective tissue swelling, and exudation into the airway lumen manifest themselves as altered lung function, which can be quantified by the parameters measured in subject pulmonary function tests. The asthmatic airway morphology was simulated by altering two parameters, functional residual capacity (FRC) and airway resistance (Raw), which are increased in asthmatic subjects. The amounts in excess of the healthy case were uniquely distributed in the airway generations based on knowledge of the changes in the anatomy and physiology of the airway walls during an asthmatic episode. Specifically, increased Raw was distributed preferentially in the bronchioles and excess FRC was distributed in the pulmonary region. Lung volumes, Raw, and breathing conditions of healthy and asthmatic subjects were compiled from 18 clinical studies. Significant differences were found between healthy and asthmatic Raw, FRC, and tidal volume (TV). In vivo flow fields were simulated using population average TV, breathing frequency, and cycle time fractions. Results showed that using asthmatic conditions in the simulation increased particle deposition over the healthy case by an average of 54% for the range of particles tested. This deposition increase was large compared to the difference due to intersubject variability of the healthy case. Comparisons to experimental data were limited by the number of unreported parameters. This study showed that using asthmatic breathing conditions resulted in significantly different particle deposition compared to using the controlled breathing patterns reported in experimental studies. Therefore, caution should be taken when using experimental data to assess particle deposition in vivo if realistic subject breathing is not used.     

Safety pharmacology of the respiratory system: Techniques and study design

The known effects of drugs from a variety of pharmacologic/therapeutic classes on the respiratory system and worldwide regulatory requirements support the need for conducting respiratory evaluations in safety pharmacology. The objective of these studies is to evaluate the potential for drugs to cause secondary pharmacologic or toxicologic effects that influence respiratory function. Changes in respiratory function can result either from alterations in the pumping apparatus that controls the pattern of pulmonary ventilation or from changes in the mechanical properties of the lung that determine the transpulmonary pressures (work) required for lung inflation and deflation. Defects in the pumping apparatus are classified as hypo- or hyperventilation syndromes and are evaluated by examining ventilatory parameters in a conscious animal model. The ventilatory parameters include respiratory rate, tidal volume, minute volume, peak (or mean) inspiratory flow, peak (or mean) expiratory flow, and fractional inspiratory time. Defects in mechanical properties of the lung are classified as obstructive or restrictive disorders and can be evaluated in animal models by performing flow-volume and pressure-volume maneuvers, respectively. The parameters used to detect airway obstruction include peak expiratory flow, forced expiratory flow at 25 and 75% of forced vital capacity, and a timed forced expiratory volume, while the parameters used to detect lung restriction include total lung capacity, inspiratory capacity, functional residual capacity, and compliance. Measurement of dynamic lung resistance and compliance, obtained continuously during tidal breathing, is an alternative method for evaluating obstructive and restrictive disorders, respectively, and is used when the response to drug treatment is expected to be immediate (within minutes post-dose). The species used in the safety pharmacology studies conducted in our laboratory are the same as those used in toxicology studies since pharmacokinetic and toxicologic/pathologic data are available in these species. These data can be used to help select test measurement intervals and doses and to aid in the interpretation of functional change. The techniques and procedures for measuring respiratory function parameters are well established in guinea pigs, rats, and dogs.     

Effects of ambient air particulate exposure on blood-gas barrier permeability and lung function

Particulate air pollution is associated with increased risk of pulmonary diseases and detrimental outcomes related to the cardiovascular system, including altered vessel functions. This study's objective was too evaluate the effects of ambient particle exposure on the blood-gas permeability, lung function and Clara cell 16 (CC16) protein release in healthy young subjects. Twenty-nine nonsmokers participated in a randomized, two-factor crossover study with or without biking exercise for 180 min and with 24-h exposure to particle-rich (6169-15,362 particles/cm(3); 7.0-11.6 microg/m(3) PM(2.5); 7.5-15.8 microg/m(3) PM(10-2.5)) or filtered (91-542 particles/cm(3)) air collected above a busy street. The clearance rate of aerosolized (99m)Tc-labeled diethylenetriamine pentaacetic acid ((99m)Tc-DTPA) was measured as an index for the alveolar epithelial membrane integrity and permeability of the lung blood-gas barrier after rush-hour exposure. Lung function was assessed using body plethysmography, flow-volume curves, and measurements of the diffusion capacity of carbon monoxide. CC16 was measured in plasma and urine as another marker of alveolar integrity. Particulate matter exposure had no significant effect on the epithelial membrane integrity using the methods available in this study. Exercise increased the clearance rate of (99m)Tc-DTPA indicated by a 6.8% (95% CI: 0.4-12.8%) shorter half-life and this was more pronounced in men than women. Neither particulate matter exposure nor exercise had an effect on the concentration of CC16 in plasma and urine or on the static and dynamic volumes or ventilation distribution of the lungs. The study thus demonstrates increased permeability of the alveolar blood-gas barrier following moderate exercise, whereas exposure to ambient levels of urban air particles has no detectable effects on the alveolar blood-gas barrier or lung function.     

Rat model of lung fibrosis: comparison of functional, biochemical, and histopathological changes 4 months after single irradiation of the right hemithorax

This study investigated changes in lung function, hydroxyproline (OH-pro) content of lung tissue and histopathology in anesthetized, spontaneously breathing rats after a single, selective irradiation of the right hemithorax with a single dose of 20 Gy. The objective of this animal model was to examine as to whether non-invasive lung function measurements (LFM) could be used to analyze the magnitude of the irradiation-related pneumonitis and its long-term sequel occurring in the right lung in the presence of a normal left lung. Four months after irradiation, the OH-pro content in the irradiated right lung was determined and compared with the non-irradiated contralateral left lung, as well as lungs from non-irradiated sham controls. LFM revealed significantly depressed flow-volume curves and reduced quasistatic compliance, suggesting a marked diminution of elastic recoil of the lung. Total lung capacity (TLC) was significantly decreased, while the residual volume (RV) and functional residual capacity (FRC) remained almost unchanged. One of the most predominant dysfunction of the lung was a severe maldistribution of ventilation shown by the single-breath N(2)-wash-out test. Single-breath carbon monoxide diffusing capacity (Dlco) was significantly decreased. The content of OH-pro, a marker of increased collagen, was significantly increased in the irradiated right lung but was indistinguishable from sham controls in the non-irradiated left lung. Histopathological examinations provided evidence of both inflammatory and fibrotic lesions in the irradiated lobes, including bronchiolo-alveolar hyperplasia. No changes were observed in the non-irradiated left lung. In summary, effects observed in the irradiated right lung were largely consistent with effects described in other animal models of human interstitial pulmonary fibrosis. Non-invasive LFM were considered to be particularly sensitive to study the overall extent of changes, however, the interpretation of findings appears to be complicated by the lobar heterogeneity of tissue- and flow-related functional end points.