应用脉冲振荡仪测定呼吸阻抗评估哮喘患者运动反应(英文)  

Evaluation of exercise response in asthmatics: Impulse oscillometry in measurement of respiratory impedance

作　　者：张路[1] 梁永杰[1] 雷撼[1] 郭忠良[1] 汪蜀[1] 任涛[1] 陶梦非[1] 尹琦[1] 

机构地区：[1]同济大学附属东方医院呼吸内科,上海市200092

出　　处：《中国组织工程研究与临床康复》2007年第31期6311-6314,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:评估哮喘患者运动反应的传统方法是测定第1秒用力呼气量,但运动激发后,受试者有明显气促,常影响第1秒用力呼气量测定。脉冲振荡仪仅需受试者自然呼吸,依从性较好。目的:应用脉冲振荡仪测定运动激发前后健康志愿者和哮喘患者呼吸阻抗的改变,探讨运动激发和脉冲振荡仪检测在支气管哮喘诊断中的意义。单位:同济大学附属东方医院呼吸内科。设计:同期非随机病例对照实验。对象:选择2006-01/10上海市东方医院呼吸内科已出院的支气管哮喘患者14例男性为哮喘组。受试期间均处于临床稳定期。选择同期本院健康体检者14例男性为对照组。两组对象年龄均为29￣50岁,且对实验目的知情同意。方法:①应用脉冲振荡仪测定呼吸阻抗基础值,随后进行踏车运动激发试验,夹鼻经口呼吸室内空气,递增负荷,在三四分钟内使心率达到最大预计值90%并维持6min,运动结束后1,5,10,15和20min重复测定呼吸阻抗:脉冲频率5,20,35Hz下的气道黏性阻力、呼吸总阻抗、中央气道阻力、周围气道阻力以及共振频率、脉冲频率5Hz和35Hz时弹性阻力及惯性阻力(X5和X35),并计算脉冲频率5Hz与20Hz下的气道黏性阻力之差和哮喘组中央气道阻力和周围气道阻力变化率[(运动后最高值-运动前基础值)/运动前基础值×100%]。主要观察指标:脉冲振荡仪测定的两组呼吸阻抗基础值和踏车运动激发试验后的呼吸阻抗值。结果:支气管哮喘患者14例和健康体检者14例均进入结果分析。①哮喘患者以周围气道阻力增高为主。周围气道阻力变化率比中央气道阻力变化率明显增高(P<0.01)。哮喘组运动前后呼吸总阻抗在第5～10分钟达到最高,其变化率幅度明显大于对照组。哮喘组运动激发前后共振频率响应点均比对照组明显增高(P<0.01),其激发前后变化率比对照组亦明显增高(P<0.01)。运动激发后哮喘组脉冲BACKGROUND：Traditionally, forced expiratory volume in one second （FEV1） was used to evaluate exercise response of patients with asthma; however, patients obviously had panting after exercise, so FEV1 was affected commonly. Impulse oscillometry （IOS） is a new technique for measuring respiratory impedance that do not require maximal inspiration and forced expiration. OBJECTIVE： To study airway resistance with IOS before and after exercise in healthy and asthmatic patients and investigate the significance of exercise excitation and IOS assessment.DESIGN： Synchronically non-randomized case contrast study. SETTING： Department of Respiratory Medicine, East Hospital Affiliated to Tongji University. PARTICIPANTS： A total of 14 male patients with bronchial asthma who were regarded as the asthmatic group were selected from Department of Respiratory Medicine of Shanghai East Hospital from January to October 2006. They were in a clinical stationary phase. Another 14 male healthy subjects were selected as the control group and ages of all subjects ranged from 29 to 50 years. All subjects provided the confirmed consent. METHODS： IOS was used to measure basic value of respiratory resistance, and then subjects underwent exercise challenge. Nose of subjects was clipped breathing through mouth. Within 3-4 minutes, heart rate was increased to 90% and maintained for 6 minutes during challenge. Respiratory resistance was repeatedly measured at 1, 5, 10, 15 and 20 minutes after exercise, including airway hyperresponse （AHR）, total respiratory resistance, central resistance, peripheral resistance and resonance frequency at 5, 20 and 35 Hz of pulse frequency, elasrtic resistance and inertia resistance （X5 and X35） at 5 and 10 Hz of pulse frequency. In addition, difference of AHR at 5 and 35 Hz was calculated, and change ratios of both Rcentral and Rperipheral were calculated as （highest value after exercise-baseline value）/baseline value × 100%. MAIN OUTCOME MEASURES： Basic value of respiratory re

关 键 词：哮喘 运动诱发性 脉冲振荡法 呼吸阻抗 

分 类 号：R318[医药卫生—生物医学工程]