哮喘患儿应用便携式肺功能仪自主监测通气功能的初步研究  

Feasibility analysis on self monitoring of pulmonary function with portable spirometry equipment in children with asthma

作　　者：马俊娥 向莉[1] 王红 皇惠杰 侯晓玲[1] 杨世青 MA Jun-e;XIANG Li;WANG Hong;HUANG Hui-jie;HOU Xiao-ling;YANG Shi-qing(Key Laboratory of Major Diseases in Children,Ministry of Education,China National Clinical Research Center for Respiratory Diseases,Department of Allergy,Beijing Children’s Hospital,Capital Medical University,National Center for Children’s Health,Beijing 100045,China;Department of Pediatrics,Civil Aviation General Hospital,Beijing 100123,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院过敏反应科,国家呼吸系统疾病临床医学研究中心,儿科重大疾病研究教育部重点实验室,北京400045 [2]民航总医院儿科,北京100123

出　　处：《生物医学工程与临床》2022年第2期156-162,共7页Biomedical Engineering and Clinical Medicine

基　　金：国家呼吸系统疾病临床医学研究中心呼吸专项(HXZX-20210204);北京市医院管理中心儿科学科协同发展中心专项经费资助项目(XTCX201818)。

摘　　要：目的分析哮喘患儿应用便携式肺功能仪监测通气功能指标的准确度、日常自主监测的可行性及其影响因素,为探索哮喘患儿进行慢病个体化管理奠定基础。方法选择在首都医科大学附属北京儿童医院过敏反应科确诊的53例哮喘患儿,其中男性41例(77.4%),女性12例(22.6%);年龄5~14岁,平均年龄8.34岁。应用便携式肺功能设备(呼吸家A1型,简称A1)测定肺通气功能,获得用力呼气肺活量占预计值的百分比(FVC%pred)、第1秒用力呼气容积占预计值的百分比(FEV1%pred)、第1秒用力呼气容积占用力肺活量百分比(FEV1/FVC)、最大呼气流量占预计值的百分比(PEF%pred)、最大呼气中期流量占预计值的百分比(MMEF%pred)、用力呼出25%、50%、75%肺活量时的瞬间流量占预计值的百分比(FEF25%pred、FEF50%pred、FEF75%pred)共8项参数;与同日在肺功能检查室经压差传感器肺功能仪(Jaeger-Masterscreen型,简称MS)测定常规肺通气所得的上述参数结果进行一致性比较,获得A1测定肺通气功能的准确度。对以上患儿启用初始哮喘控制治疗,其中27例患儿可接受自备A1并接受指导应用A1进行每天通气功能自主监测、记录日夜间哮喘症状计分和遵嘱随访,在首次随访日评估自主监测肺功能的依从性、自主监测通气功能变化与哮喘症状计分的相关性。结果A1测定的参数FVC%pred、FEV1%pred、FEV1/FVC、PEF%pred、MMEF%pred、FEF25%-pred、FEF50%pred、FEF75%pred与MS所测各参数的组内相关系数(ICC)分别为0.698、0.903、0.713、0.889、0.879、0.915、0.907、0.772,统计分析显示一致性良好。治疗后随访评估自主监测肺功能依从性平均84.6%,监测中呼气时间不足为主要影响可行性问题,哮喘症状计分与监测指标PEF下降程度间呈正相关关系(rs=0.734,P<0.001)。结论在专业医务人员准确指导培训下,哮喘患儿可应用便携式肺功能仪获得多项具有临床参考价值的肺通气功能�Objective To analyze the accuracy,feasibility and influencing factors of ventilation function index monitored with portable spirometry equipment in children with asthma,and lay the foundation for the individualized management of chronic diseases in children with asthma.Methods A total of 53 asthmatic children were enrolled,which included 41 males(77.4%)and 12 females(22.6%),aged 5-14 years old with mean age of 8.34 years old.All of them were measured pulmonary ventilation function by portable pulmonary function equipment(A1),and 8 item parameters were obtained including percentage of forced vital capacity to predicted values(FVC%pred),percentage of forced expiratory volume in one second to predicted values(FEV1%pred),forced expiratory volume in one second to forced vital capacity(FEV1/FVC),percentage of peak expiratory flow to predicted values(PEF%pred),percentage of maximum midexpiratory flow to predicted values(MMEF%pred),percentage of forced expiratory flow at 25%,50%and 75%vital capacity to predicted values(FEF25%pred,FEF50%pred and FEF75%-pred).The consistency were compared with parameters measured on the same day by differential pressure transducer spirometry equipment(Brand of Jaeger-Masterscreen,MS)in lung function laboratory.The accuracy of A1 in monitoring the pulmonary ventilation function was obtained.All of the children were given initiating asthma control treatment.Twenty-seven of the children were capable and instructed to use A1 for daily self-monitoring of ventilation function,record day-night asthma symptom score and completed follow-up as required.On the first follow-up day,the compliance of self-monitoring lung function and the correlation between self-monitoring ventilation function change and asthma symptom score were evaluated.Results The interclass correlation coefficient(ICC)of parameters FVC%pred,FEV1%pred,FEV1/FVC,PEF%pred,MMEF%pred,FEF25%-pred,FEF50%pred and FEF75%pred measured by A1 and MS were 0.698,0.903,0.713,0.889,0.879,0.915,0.907 and0.772,respectively,statistical analysis result

关 键 词：儿童 哮喘 肺功能 便携式肺功能仪 自主监测 管理 

分 类 号：R725.6[医药卫生—儿科] R443.6[医药卫生—临床医学]