呼吸道合胞病毒毛细支气管炎患婴的肺功能研究

目的：观察婴儿呼吸道合胞病毒（RSV）毛细支气管炎的肺功能动态变化情况并探讨其临床意义。方法：采用美国森迪公司2600婴幼儿肺功能仪,对31例RSV毛细支气管炎急性期婴儿（按月龄分为3组）进行肺功能检查;其中有17例患儿在临床恢复期复查了肺功能,此17例患儿中10例在出院1周后又复查了肺功能。同时,对74例健康婴儿进行了肺功能检查。统计方法用两样本均数t检验,配对资料t检验。结果：毛细支气管炎急性期呼吸频率（RR）,潮气呼气峰流速（PTEF）,潮气呼吸峰流速／潮气量（PF／Ve),呼吸系统阻力（Rrs),每千克体重功能残气量（FRC／kg)增加,潮气呼吸吸气量（Vi),每千克体重吸气量（Vi/kg),潮气呼吸呼气量（Ve),到达潮气呼气峰流速时呼出的气量／潮气量（％V－PF）,呼出75％潮气量时的呼气流速／潮气呼气峰流速（25／PF）,呼吸系统顺应性（Crs),每千克体重顺应性（Crs/kg)减少,与同龄正常组比较差异有显著意义;潮气呼气中期流速／潮气吸气中期流速（ME／MI）,呼吸系统时间常数（Trs)无显著性差异。潮气呼吸流速－容量环变窄,呼气曲线升枝陡,高峰提前,峰值较高,降支凹陷,临床恢复期上述异常指标明显好转,但与正常组相比％V－PF,25／PF,Crs/kg仍低,余项达到正常水平,出院1周后复查,肺功能正常。结论：RSV毛细支气管炎急性期,肺功能呈现小气道阻力增高,阻塞性通气障碍改变,临床恢复期小气道功能仍有异常,但RSV造成的小气道功能异常还是能在较短时间内恢复。肺功能是监测本病病程及预后较理想的方法。％V－PF,25／PF,FRC／kg可作为观察本病病情变化的敏感指标。

Pulmonary function in infants with respiratory syncytial virus bronchiolitis

Objective To observe the dynamics of pulmonary function in infants with respiratory syncytial virus (RSV) bronchiolitis. Methods The to test the pulmonary function of 31 infants with RSV bronchiolitis during acute phase at admission was tested. Pulmonary fuction test was performed for the second time among 17 out of the 31 infants during the clinical recovery phase, and performed for the third time among 10 out of the 17 infants one week after discharge. In the meantime pulmonary function test was performed in 74 healthy infants as controls. Results During the acute phase of RSV bronchiolitis, the respiratory rate (RR), peak tidal expiratory flow (PTEF), peak tidal flow/tidal volume (PF/Ve), respiratory system resistance (Rrs), and functional residual capacity per kilogram (FRC/kg) were significantly increased, while the inspiratory tidal volume (Vi), inspiratory volume per kilogram (Vi/kg), expiratory tidal volume (Ve), percent of tidal volume to peak tidal expiratory flow (%V PF), terminal flows/ peak expiratory flow (25/PF), respiratory system compliance (Crs), and respiratory system compliance per kilogram (Crs/kg) were significantly decreased as compared with those in healthy infants. Ratio of mid expiratory to mid inspiratory flow (ME/MI) and respiratory system time constant (Trs) showed no statistically significant differences. The tidal breathing flow volume (TBFV) loop displayed a concave expiratory curve. During the clinical recovery phase, the above abnormal indexes showed significant improvement, except for the %V PF, 25/PF and Crs/kg which were still lower as compared with those in healthy infants, most indexes had returned to normal. The TBFV loop showed mild decelerating expiratory limb. One week after discharge all of the indexes returned to normal. Conclusion In the acute phase of RSV bronchiolitis higher resistance in small airway and obstructive ventilatory disturbance can be seen. Some of the indexes remain abnormal during the clinical recovery phase. However, the abnormalities disapear in a short time. Pulmonary function test is a valuable way for surveillance of the course and prognosis of RSV bronchiolitis. %V PF, 25/PF, and FRC/kg are sensitive indexes.