3岁以上儿童肺炎后肺功能的研究  

The pulmonary function after pneumonia in children over 3 years old

作　　者：韩鹏 刘军[1] 王风雨佳 徐保平[1,2] Han Peng;Liu Jun;Wang Fengyujia;Xu Baoping(Department of Respiratory,Beijing Children′s Hospital,Capital Medical University,China National Clinical Research Center for Respiratory Diseases,National Center for Children′s Health,Beijing 100045,China;Research Unit of Critical Infection in Children,Chinese Academy of Medical Sciences,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,国家呼吸系统疾病临床医学研究中心,首都医科大学附属北京儿童医院呼吸科,北京100045 [2]中国医学科学院儿童危重感染诊治创新单元,北京100045

出　　处：《中华实用儿科临床杂志》2021年第19期1492-1495,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：中国医学科学院医学与健康科技创新工程项目(2019-I2M-5-026CAMS,2020-I2M-C&T-B-098)。

摘　　要：目的研究3岁以上儿童肺炎后肺功能情况。方法本研究为观察性研究,通过对2016年1月1日至2017年12月31日首都医科大学附属北京儿童医院出院第一诊断为肺炎,且在出院后0.5~2.0年内门诊复诊的患儿进行肺功能检查,并收集其住院时病历资料、出院后临床信息和/或胸部影像学检查,观察肺炎后0.5~2.0年患儿的肺功能情况,并分析肺功能异常的危险因素。结果符合纳入排除标准,并进行门诊复诊者159例,完成肺功能检查者共100例,肺功能结果异常者46例。患儿性别和肺炎后肺功能结果比较差异无统计学意义(χ^(2)=0.975,P=0.323)。肺功能结果与感染的病原体无相关性(χ^(2)=0.549,P=0.908)。重症肺炎(χ^(2)=5.154,P=0.023)、肺炎后肺部影像学异常(χ^(2)=4.464,P=0.035)的患儿更容易出现肺功能异常。在74例>6岁儿童组中肺功能异常45例(60.81%),表现为1秒用力肺活量(FEV_(1)),用力肺活量(FVC),50%肺活量时的呼气流量,75%肺活量时的呼气流量,最大呼气中期流量实际值占预计值百分比以及FEV_(1)/FVC%的下降。结论儿童肺炎后可出现肺功能异常,以小气道功能异常、阻塞性通气功能障碍及混合性通气功能障碍为主。肺功能结果与患儿性别、肺炎病原学之间比较差异无统计学意义。重症肺炎患儿和肺部影像学长期异常的患儿更容易出现肺功能异常。Objective To analyze the pulmonary function after pneumonia in children over 3 years old.Methods This was an observational study recruiting children discharged from Beijing Children′s Hospital,Capital Medical University between January 1,2016 and December 31,2017 with the first diagnosis of pneumonia who were re-examined for pulmonary function within 0.5 to 2.0 years follow-up at outpatient department.Medical records during hospitalization,clinical information,pulmonary function and/or chest imaging examination were collected for analyzing lung function and relevant risk factors.Results A total of 159 eligible patients who were followed up at the outpatient department were recruited,involving 100 patients receiving the lung function examination,and among them,46 had abnormal lung function.There was no significant correlation between the gender and the pulmonary function after pneumonia(χ^(2)=0.975,P=0.323).No correlation was found between the pulmonary function and pneumonia pathogens(χ^(2)=0.549,P=0.908).Children with severe pneumonia(χ^(2)=5.154,P=0.023)and abnormal chest imaging after pneumonia(χ^(2)=4.464,P=0.035)were more likely to have lung dysfunction.Among 74 children over 6 years old,there were 45 cases(60.81%)had pulmonary dysfunction after pneumonia,manifesting as the reduced forced expiration volume in one second(FEV_(1)),forced vital capacity(FVC),forced expiratory flow at 50%vital capacity,forced expiratory flow at 75%vital capacity,maximum mid-expiratory flow and FEV_(1)/FVC%.Conclusions Lung dysfunction may occur after pneumonia,manifesting as small airway dysfunction,obstructive ventilation dysfunction and mixed ventilation dysfunction.The gender and etiology of pneumonia are not correlated with lung dysfunction after pneumonia.Children with severe pneumonia and continuous imaging abnormalities are more likely to have lung dysfunction.

关 键 词：儿童肺炎 肺功能 小气道功能异常 阻塞性通气功能障碍 

分 类 号：R725.6[医药卫生—儿科]