喘息伴鼻塞患儿潮气呼吸肺功能与气道阻力的变化研究  

Association of Nasal Obstruction with Pulmonary Function and Airway Resistance during Tidal Breathing in Infants with Wheezing

作　　者：沈北兰 高怡[1] 陈德晖[2] 郑劲平[1] SHEN Beilan;GAO Yi;CHEN Dehui;ZHENG Jinping(The First Affiliated Hospital of Guangzhou Medical University/National Clinical Research Center of Respiratory Disease/National Respiratory Medical Center,State Key Laboratory of Respiratory Disease/Guangzhou Institute of Respiratory Health,Guangzhou 510120,China;Department of Pediatrics,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院国家呼吸系统疾病临床医学研究中心国家呼吸医学中心呼吸疾病国家重点实验室广州呼吸健康研究院,广东省广州市510120 [2]广州医科大学附属第一医院儿科,广东省广州市510120

出　　处：《中国全科医学》2022年第32期4035-4040,共6页Chinese General Practice

基　　金：国家重点研发计划项目(2018YFC1311900,2016YFC1304603)。

摘　　要：背景潮气呼吸肺功能检查是婴幼儿呼吸道疾病诊治及病情严重度评估的重要手段,鼻塞是呼吸道感染常见的合并症,严重的鼻塞可影响肺功能检查结果。目的观察鼻塞对喘息婴幼儿潮气呼吸功能和气道阻力的影响,并评估0.9%氯化钠溶液滴鼻对缓解鼻塞及改善肺功能的效果。方法回顾性选取2015年6月—2016年5月在广州医科大学附属第一医院就诊的以喘息为主诉的55例婴幼儿为研究对象,采用潮气呼吸法、单次阻断法、体积描记法对喘息患儿进行检测,根据鼻塞症状评分进行分组,0分者纳入喘息不伴鼻塞组,1~2分者纳入喘息伴鼻塞组。3分者不纳入研究。并对比喘息不伴鼻塞组和喘息伴鼻塞组通鼻处理前及喘息伴鼻塞组通鼻处理前后患儿的肺功能差异。结果共纳入55例喘息患儿,其中喘息伴鼻塞组25例,喘息不伴鼻塞组30例。喘息伴鼻塞组患儿特殊有效气道阻力(sReff)和有效气道阻力(Reff)较喘息不伴鼻塞组患儿高(P<0.05)。通鼻处理后患儿达峰时间比(TPTEF/TE)和达峰容积比(VPEF/VE)分别为(24.58±6.15)%、(26.38±5.19)%,较通鼻处理前的(21.12±4.16)%、(22.98±3.75)%改善(P<0.05)。喘息伴鼻塞组通鼻处理后呼吸阻力(RrsSO)、sReff、Reff较通鼻处理前下降(P<0.05)。结论鼻塞可增加患儿气道阻力(sReff和Reff),检查前清理鼻腔是婴幼儿肺功能检查的质控要点之一,少量0.9%氯化钠溶液滴鼻后进行鼻腔分泌物清除可有效缓解因分泌物堵塞引起的鼻塞。鼻塞缓解后,喘息儿童的潮气呼吸肺功能(TPTEF/TE、VPEF/VE)和气道阻力(RrsSO、sReff、Reff)均有所改善。Background Measurement of lung function during tidal breathing is an important method in the diagnosis,management and severity assessment for infants with respiratory diseases.Nasal obstruction is a common comorbidity of respiratory tract infections,and severe nasal obstructionmay affect the results of pulmonary function test.Objective To assess the association of nasal obstruction with pulmonary function and airway resistance during tidal breathing,and to evaluate the effect of normal saline nasal drops on relieving nasal congestion and improving pulmonary function in infants with wheezing.Methods A total of 55 children with wheezing were included,including wheezing with nasal congestion in 25 cases and wheezing without nasal congestion in 30 cases.Fifty-five infants with wheezing as the chief symptom who were treated in the First Affiliated Hospital of Guangzhou Medical University were retrospectively selected from June 2015 to May 2016.They received the measurement of pulmonary function during tidal breathing,respiratory resistance using the respiratory resistance tester with single-breath method and body plethysmography.Nasal obstruction was assessed,and those with three points were excluded,the remaining infants with 0 and 1-2 points were assigned to wheezing without nasal obstruction group(n=30),wheezing with nasal obstruction group(n=25),respectively.Baseline lung functions were compared between wheezing with nasal obstruction group before nasal obstruction treatment and without nasal obstruction group.And pulmonary functions of wheezing with nasal obstruction group were compared before and after nasal obstruction treatment.Results Wheezing infants with nasal obstruction had higher specific effective airway resistance(sReff)and effective airway resistance(Reff)than those without(P<0.05).The ratio of the proportion of time to reach peak tidal expiratory flow to total expiratory time(TPTEF/TE)〔(24.58±6.15)%vs.(21.12±4.16)%〕and the ratio of the volume until peak expiratory flow to the total expiratory v

关 键 词：鼻塞 呼吸功能不全 潮气呼吸功能检查 体积描记法 气道阻力 滴鼻剂 

分 类 号：R765.2[医药卫生—耳鼻咽喉科]