学龄前儿童用力肺活量测定的质量控制分析  

Quality control for spirometry in pre-school children

作　　者：张清玲[1] 郑劲平[2] 袁本通[1] 何桦[2] 王健[1] 安嘉颖[2] 张敏[1] 罗定芬[2] 陈桂莲[1] 

机构地区：[1]深圳市第二人民医院呼吸内科,广东深圳518026 [2]广州医学院附属第一医院广州呼吸疾病研究所,广东广州510120

出　　处：《中国实用儿科杂志》2006年第4期259-264,共6页Chinese Journal of Practical Pediatrics

基　　金：深圳市科技项目基金资助(基金编号:200404071)

摘　　要：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)。Objective To probe into the criteria of quality control for spirometry in preschool children. Methods A 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, FEVt and forced expiratory time（ FET 100% ） ] were measured by using COSMED spirometry of Italian. Results The 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. 9see, and 18 of 279 （ 6.5 % ） children produced a FET less than 1 second. Forced expiratory volume in 0. 50 and 0. 75 sec （ FEVos, FEV0.75） were thus measured in preschool children. All children presented their two best efforts （FVC,FEVo75, FEV0.5 ,FEV1 FVC ） no more than 0.2L. About 63. l%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 0.1 L. Condusion Start 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

关 键 词：肺通气 肺活量 学龄前儿童 质控标准 

分 类 号：R72[医药卫生—儿科]