体积描记仪评估新生儿肺炎的肺功能改变  

Lung function measurement by using baby body plethysmography in newborns with pneumonia

作　　者：蒋高立[1] 王立波[1] 陈超[2] 万成宙[1] 张晓波[1] 

机构地区：[1]复旦大学附属儿科医院呼吸科,上海201102 [2]复旦大学附属儿科医院新生儿科,上海201102

出　　处：《中华实用儿科临床杂志》2014年第10期737-741,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：上海市科委医学引导项目（134119a4200）;上海市卫生和计划生育委员会项目（20134249）

摘　　要：目的 了解新生儿肺炎的肺功能改变,探讨婴幼儿体积描记仪（体描仪）在新生儿呼吸系统疾病诊疗中的价值.方法 采用体描仪检测117例急性期轻症新生儿肺炎（肺炎组,排除需氧疗、机械通气或有肺炎并发症者）和126例健康新生儿（健康对照组）的功能残气量（FRCP）、有效呼吸道阻力（Reff）和潮气呼吸参数.根据日龄,分为4～7d、8～14d、15 ～21 d、22～ 28 d等4个年龄段加以比较.结果 117例肺炎患儿中79例（67.5％）肺功能异常,肺炎组与健康对照组的达峰时间比（TPTEF/TE）分别为（26.5±10.0）％、（36.8±9.9）％,达峰容积比（VPTEF/VE）分别为（27.9±7.3）％、（35.6±8.4）％,肺内剩余25％潮气量时的潮气呼气流速（TEF25）分别为（36.3±11.7） mL/s、（40.1±12.4）mL/s,前者均显著低于后者,差异均有统计学意义（P均＜0.05）;而潮气呼吸峰流速（PTEF）分别为（59.4±16.6）mL/s、（52.9±16.6）mL/s,肺内剩余75％潮气量时的潮气呼气流速（TEF75）分别为（57.4±16.7） mL/s、（49.5±16.7） mL/s,特殊有效呼吸道阻力（sReff）中位数分别为0.48 kPa ·s、0.27 kPa ·s,Reff分别为6.96 kPa·s/L、4.82 kPa·s/L,公斤体质量有效呼吸道阻力（Reff/kg）分别为1.99 kPa·s/（L·kg）、1.44 kPa·s/（L·kg）,肺炎组均明显高于健康对照组,差异均有统计学意义（P均＜ 0.001）;肺炎组的呼吸频率、FRCp、FRCP/kg略高于健康对照组,但差异无统计学意义.进一步按日龄分组比较发现,15～ 28 d忠儿与≤14 d忠儿相比,前者主要肺功能指标与健康对照组间的差异较明显,肺功能损害程度较重.结论 新生儿肺炎的肺功能异常率较高,为67.5％,病变主要累及小呼吸道,以阻塞性病变为主,肺功能损害以15 ～ 28 d日龄的大龄新生儿更为明显.体描仪评估新生儿肺功能确切有效,可敏感反映肺功能的异常.Objective To access the changes of lung function of newborns with pneumonia and to investigate the feasibility of measuring lung function in the body plcthysmograph for diagnosing and treating respiratory diseases.Methods There were 117 infants,1 day after being diagnosed with mild or moderate pneumonia,aged 4-28 days,involved in the study,those who needed oxygen cure,mechanical ventilation,or had complications from pneumonia were ruled out.Pulmonary function tests （PFTs） were performed in the baby body plethysmography to access tidal breathing,plethysmographic functional residual capacity （FRCp）,and effective airway resistance （Reff）.The other 126 contemporaneous healthy children took the same test for comparison.According to their ages,infants were grouped into 4-7 d,8-14 d,15-21 d and 22-28 d.Results Of the 117 infants with pneumonia,79 （67.5 % equivalently） had abnormal lung function.Compared with the controls,infants with pneumonia had significantly higher values of peak tidal expiratory flow [（59.4 ± 16.6） mL/s vs （52.9 ± 16.6） mL/s],expiratory flow at 75% tidal volume [（57.4 ± 16.7） mL/s vs （49.5 ± 16.7） mL/s],special effective airway resistance （0.48 kPa · s vs O.27 kPa · s）,Reff [6.96 kPa · s/L vs 4.82 kPa · s/L] and Reff per kilogram [1.99 kPa · s/（L · kg） vs 1.44 kPa · s/（L · kg）],but lower values of time to peak tidal expiratory flow as a percentage of total expiratory time [（26.5 ± 10.0） % vs （36.8 ± 9.9） %],volume to peak tidal expiratory flow as a percentage of total expiratory volune [（27.9 ± 7.3） % vs （35.6 ± 8.4） %]and expiratory flow at 25% tidal volume [（36.3 ± 11.7） mL/s vs （40.1 ± 12.4） mL/s].There were no sig± nificant differences in the values of respiratory rate,FRCp and FRCp/kg between the pneumonia children and the healthy control chidren.Compared with the infants aged ≤ 14 days,there were more significant differences in relative parameters of lung funetion between the pneumonia group and the health

关 键 词：体积描记仪 肺功能 肺炎 婴儿 新生 

分 类 号：R722.135[医药卫生—儿科]