潮气肺功能检查鉴别胸内大、小气道阻塞性病变的价值  

Value of tidal lung function in differentiating central and small intrathoracic airway obstructive lesions

作　　者：刘莎[1] 刘芳君[1] 符州[1] 龚财惠[1] 刘铮[1] Liu Sha;Liu Fangjun;Fu Zhou;Gong Caihui;Liu Zheng(Department of Respiratory Medicine,Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing Key Laboratory of Pediatric,Children′s Hospital of Chongqing Medical University,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院呼吸中心,儿童发育疾病研究教育部重点实验室,国家儿童健康与疾病临床医学研究中心,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,重庆400014

出　　处：《中华实用儿科临床杂志》2021年第11期817-821,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：重庆医科大学附属儿童医院转化医学/疑难罕见病专项(223-zhyx2013-4)。

摘　　要：目的探讨潮气肺功能检查区分胸内大、小气道阻塞性病变的价值。方法以2014年4月至2019年6月在重庆医科大学附属儿童医院确诊的124例胸内阻塞性疾病[包括闭塞性细支气管炎(BO)、毛细支气管炎、气道异物和中心气道狭窄]婴幼儿为研究对象,根据疾病不同的病变位置分为小气道病变组(BO、毛细支气管炎)和大气道病变组(气道异物、中心气道狭窄),以同期在该院就诊的111例健康婴幼儿作为健康对照组。采用体积描记法检测潮气肺功能。结果达峰时间比(TPTEF/TE)、达峰容积比(VPTEF/VE)测量值相比较,各疾病组均低于健康对照组TEF/TE:BO组13.2(10.3,16.3)%、毛细支气管炎组15.9(13.2,19.7)%、气道异物组24.5(16.7,30.7)%、气道狭窄组20.7(16.1,29.3)%、健康对照组30.2(25.6,36.5)%;VPTEF/VE:BO组18.2(17.8,22.3)%、毛细支气管炎组20.3(17.0,21.6)%、气道异物组26.0(20.5,30.7)%、气道狭窄组22.9(20.2,29.1)%、健康对照组31.5(28.1,37.0)%](P<0.05),小气道病变组低于大气道病变组(P<0.05)。各疾病组功能残气量高于健康对照组[BO组(501.6±166.5)mL、毛细支气管炎组(334.6±149.6)mL、气道异物组(392.2±130.1)mL、气道狭窄组(350.1±127.9)mL、健康对照组(191.6±73.8)mL](P<0.05)。小气道病变组潮气呼气峰流速/剩余25%潮气量时呼气流速(PF/TEF_(25))高于健康对照组及大气道病变组[BO组232.7(183.2,261.2)%、毛细支气管炎组186.4(153.3,247.7)%、气道异物组143.1(126.8,168.9)%、气道狭窄组140.3(122.9,186.0)%、健康对照组132.3(123.1,147.8)%](P<0.05),大气道病变组PF/TEF_(25)与健康对照组比较差异无统计学意义(P>0.05)。各组间气道阻力比较差异无统计学意义(P>0.05)。小气道病变组潮气呼吸流速容量曲线(TBFV)呼气相下降支斜率增加且向横轴凹陷,大气道病变组TBFV下降支斜率无明显增加。结论TPTEF/TE、VPTEF/VE下降,同时PF/TEF_(25)升高提示小气道阻塞性病变。PF/TEF_(25)是反映�Objective To explore the value of tidal lung function in distinguishing central and small intrathoracic airway obstructive lesions.Methods A total of 124 infants with intrathoracic obstructive diseases,including bronchiolitis obliterans(BO),bronchiolitis,airway foreign body,and airway stenosis,were confirmed in Children′s Hospital of Chongqing Medical University from April 2014 to June 2019 and selected as subjects,and 111 normal infants were enrolled as healthy control group.According to the location of lesions,these subjects suffering from intrathoracic obstructive diseases were divided into small airway lesion group(BO,bronchiolitis)and central airway lesion group(airway foreign body,airway stenosis).Lung function was assessed by plethysmography.Results As for the ratio of time to reach peak tidal expiratory flow to total expiratory time(TPTEF/TE)and the ratio of volume to reach peak tidal expiratory flow to total expiratory volume(VPTEF/VE),all disease groups were lower than that in healthy control group TEF/TE:BO 13.2(10.3,16.3)%,bronchiolitis 15.9(13.2,19.7)%,airway foreign body 24.5(16.7,30.7)%,airway stenosis 20.7(16.1,29.3)%,healthy control group 30.2(25.6,36.5)%;VPTEF/VE:BO 18.2(17.8,22.3)%,bronchiolitis 20.3(17.0,21.6)%,airway foreign body 26.0(20.5,30.7)%,airway stenosis 22.9(20.2,29.1)%,healthy control group 31.5(28.1,37.0)%](P<0.05)and the lesion in the small airway lesion group was significantly lower than that in central airway lesion group.Compared with the healthy control group,the functional residual capacity(FRC)was higher in each disease group[BO(501.6±166.5)mL,bronchiolitis(334.6±149.6)mL,airway foreign body(392.2±130.1)mL,airway stenosis(350.1±127.9)mL,healthy control group(191.6±73.8)mL](P<0.05).The ratio of peak expiratory flow to tidal expiratory flow at 25%remaining expiration(PF/TEF_(25))was obviously higher in small airway lesion group than that in central airway lesion and healthy control group[BO 232.7(183.2,261.2)%,bronchiolitis 186.4(153.3,247.7)%,airway foreign body 143.1(

关 键 词：潮气肺功能 婴幼儿 阻塞性病变 

分 类 号：R725.6[医药卫生—儿科]