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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