潮气呼吸肺功能测定在婴幼儿伴喘息的支气管肺炎中的应用
发布时间：2018-08-20 09:50
【摘要】：目的潮气呼吸肺功能检查不像传统检查需按指令配合,只需平静自主呼吸下进行,无创伤,特别适用于测定婴幼儿肺功能,在婴幼儿呼吸系统疾病应用中有着广泛前景,潮气呼吸肺功能参数指标及潮气呼吸流速一容量环(tidal breath flow volume curve,TBFV环)的变化可反映患儿肺功能损害性质及程度,可间接评估患儿病情严重程度及评定药物或治疗方法的疗效,本研究喘息性支气管肺炎治疗过程中潮气呼吸肺功能的特点,探讨潮气呼吸肺功能测定在婴幼儿喘息性支气管肺炎中的应用价值,为婴幼儿喘息性支气管肺炎准确的诊断与合理的治疗提供参数指标依据。第一部分方法选择2013年11月-2015年12月安徽医科大学xx医院儿科因喘息性支气管肺炎住院婴幼儿共100例,健康对照组80例。分别对喘息性支气管肺炎组入院时急性期及出院前缓解期进行潮气肺功能检测,观察喘息性支气管肺炎急性期与缓解期潮气呼吸肺功能参数指标、潮气呼吸流速一容量环(TBFV环)的变化,患儿在潮气呼吸肺功能检测前半小时进行临床症状严重程度评分,将喘息性支气管肺炎分为轻度、中度、重度,比较轻、中、重度患儿之间主要潮气呼吸肺功能参数指标差别及临床症状严重程度评分与入院时潮气呼吸肺功能参数指标的相关性。结果1、喘息性支气管肺炎急性期观察组患儿RR(respiratory rate,呼吸频率)高于对照组(P0.05),TI/TE(inspiratory time/expiratory time,吸呼气比值),TV/kg(tidal volume/kg,每千克体重潮气量),TPTEF/TE(time to tidal peak expiratory flow/expiratory time,达峰时间比),VPEF/VE(expirator y volume at tidal peak expiratory flow/expiratory time,达峰容积比),TEF25%(the 25%tidal volume during expiratory flow,25%潮气量时呼气流速),TEF50%(the 50%tidal volume during expiratory flow,50%潮气量时呼气流速)均低于对照组(P0.05);PTEF(tidal peak expiratory flow,潮气呼吸呼气峰流速),TEF75%(the 75%tidal volume during expiratory flow,75%潮气量时呼气流速)高于对照组,但差异无显著性(P0.05)。观察组患儿急性期RR高于缓解期(P0.05),TI/TE,TV/kg,TPTEF/TE,VPEF/VE,TEF25%、TEF50%均低于缓解期(P0.05);PTEF,TEF75%高于缓解期,但差异无显著性(P0.05)。观察组患儿缓解期TI/TE,TPTEF/TE,VPEF/VE,TEF25%,TEF50%均低于对照组(P0.05),其余指标比较差异无显著性(P0.05)。2、喘息性支气管肺炎潮气呼吸流速一容量环(TBFV环)急性期时表现为最大呼气气流速度降低,呼气高峰明显前移,呼气时间延长,下降支斜率增大,甚至向容量轴凹陷,图形呈矮胖型,经过入院积极治疗后呼气降支的斜率较入院时降低,曲线呼气高峰明显后移,TFV环变宽,呼气环降支远离容积轴。3、以TPTEF/TE和VPEF/VE作为潮气呼吸肺功能的主要观察指标,比较急性期喘息性支气管肺炎患儿临床症状严重程度评分为轻、中、重度的潮气呼吸肺功能差别,结果发现:急性期评分为轻度、中度及重度患者与对照组比较,中度与轻度之间比较的变化有统计学意义,但中、重度之间则无统计学的差异。喘息性支气管肺炎临床症状严重程度评分与入院时潮气呼吸肺功能主要参数指标经Spearman等级相关分析发现:临床评分与TPTEF/TE,VPEF/VE呈负相关,而临床评分与VT/kg,RR,TI/TE,PTEF,TEF75%,TEF50%,TEF25%无相关性。第二部分方法选择2013年11月-2015年12月安徽医科大学xx医院儿科因喘息性支气管肺炎住院婴幼儿共80例,健康对照组80例,根据哮喘预测指数,分为喘息性支气管肺炎组(哮喘预测指数阳性组)、喘息性支气管肺炎组(哮喘预测指数阴性组),分别在入院时急性期及急性期第一次潮气呼吸肺功能检测后立即雾化后15分钟,出院前缓解期,出院后第14天,出院后第30天进行潮气呼吸肺功能检测,比较不同潮气呼吸肺功能参数指标的差别及两组支气管舒张试验特点。结果1、急性期喘息性支气管肺炎(哮喘预测指数阳性组)和喘息性支气管肺炎(哮喘预测指数阴性组)肺功能指标TPTEF/TE,VPEF/VE较对照组降低,但急性期两组TPTEF/TE,VPEF/VE降低幅度未见明显差异,缓解期喘息性支气管肺炎(哮喘预测指数阳性组)肺功能指标TPTEF/TE,VPEF/VE和急性期相比较无统计学差异(P0.05),缓解期哮喘预测指数阴性组患儿的肺功能指标TPTEF/TE,VPEF/VE较急性期上升,差异有统计学意义(P0.05),但仍低于正常对照组,出院后第14天哮喘预测指数阴性组的TPTEF/TE及VPEF/VE与对照组无差异,但哮喘预测指数阳性组的TPTEF/TE及VPEF/VE仍低于对照组,出院后第30天后哮喘预测指数阳性组的TPTEF/TE及VPEF/VE仍未恢复正常。2、喘息性支气管肺炎(哮喘预测指数阳性组)雾化吸药后肺功能指标TPTEF/TE,VPEF/VE较吸药前明显改善,差异有统计学意义(P0.05),喘息性支气管肺炎(哮喘预测指数阴性组)雾化吸药后肺功能指标TPTEF/TE,VPEF/VE较吸药前无明显改善,差异无统计学意义(P0.05),喘息性支气管肺炎(哮喘预测指数阳性组)支气管舒张实验的阳性率为73%,喘息性支气管肺炎(哮喘预测指数阴性组)支气管舒张实验的阳性率为21%。结论1、喘息性支气管肺炎潮气呼吸肺功能参数指标治疗在急性期与缓解期呈不同变化,治疗后临床症状虽缓解,但TPTEF/TE,VPEF/VE仍未恢复正常,小气道仍存在阻塞。2、喘息性支气管肺炎潮气呼吸流速一容量环(TBFV环)治疗前后急性期与缓解期呈不同改变,可判断患儿气道阻塞部位及程度,评估治疗效果。3、喘息性支气管肺炎严重程度临床评分与潮气呼吸肺功能主要参数指标TPTEF/TE,VPEF/VE为负相关,TPTEF/TE,VPEF/VE可反映小气道阻塞程度,评估病情的严重程度及变化,对疾病的临床诊疗提供客观依据。4、喘息性支气管肺炎(哮喘预测指数阳性组)和喘息性支气管肺炎(哮喘预测指数阴性组)相比较,喘息性支气管肺炎(哮喘预测指数阳性组)肺功能恢复较喘息性支气管肺炎(哮喘预测指数阴性组)慢,肺功能损害持续存在,需早期积极干预治疗,预防发展为支气管哮喘。5、喘息性支气管肺炎组(哮喘预测指数阳性组)支气管舒张实验的阳性率明显高于喘息性支气管肺炎组(哮喘预测指数阴性组),说明喘息性支气管肺炎组(哮喘预测指数阳性组)气道可逆性程度较高,可反映两组气道病理生理特点,为后续合理选择治疗方案的提供重要依据。
[Abstract]:Objective Tidal breathing pulmonary function test is not required to follow the instructions of the traditional examination, just calm and spontaneous breathing, non-invasive, especially suitable for the determination of infant pulmonary function, in infant respiratory diseases have a wide range of prospects, tidal breathing lung function parameters and tidal breath flow VO loop (tidal breath flow vo) The changes of lume curve and TBFV loop can reflect the nature and degree of pulmonary function impairment in infants. It can indirectly assess the severity of the disease and evaluate the efficacy of drugs or treatments. The purpose of this study was to investigate the characteristics of tidal breathing and pulmonary function during the treatment of asthmatic bronchopneumonia and to explore the application of tidal breathing and pulmonary function test in infants with asthmatic bronchopneumonia. The application value of asthmatic bronchopneumonia in infants and young children is to provide parameters for accurate diagnosis and reasonable treatment of asthmatic bronchopneumonia.The first part is to select 100 infants hospitalized with asthmatic bronchopneumonia in the Department of pediatrics, XX Hospital of Anhui Medical University from November 2013 to December 2015, and 80 healthy controls. In the pneumonia group, tidal pulmonary function was tested at the acute stage and remission stage before discharge, tidal respiratory function parameters, tidal breathing velocity-volume loop (TBFV loop) were observed at the acute and remission stages of asthmatic bronchopneumonia, and the severity of clinical symptoms was scored half an hour before tidal respiratory function test. Asthmatic bronchopneumonia was divided into mild, moderate, severe, mild, moderate, and severe children with major tidal breathing lung function parameters and clinical symptom severity score and admission tidal breathing lung function parameters of the correlation. results 1, asthmatic bronchopneumonia acute observation group of children RR (respiratory rate, expiratory) Inspiration frequency was higher than control group (P 0.05), TI / TE (inspiratory time / expirator y time, inspiratory / expirator y time), TV / kg (tidal volume / kg, tidal volume per kg body weight), TPTEF / TE (time to tidal peak expirator y flow / expirator y time, peak time ratio), VPEF / VE (expirator y volume at tidal peak expirator y flow / expirator y time, peak volume at peak expirator y time, peak volume at peak expirator y flow / expirator y time). Compared with the control group, TEF 25% (the 25% tidal volume during expiratory flow, 25% tidal volume during expiratory flow), TEF 50% (the 50% tidal volume during expiratory flow, 50% tidal volume during expiratory flow) were lower than the control group (P 0.05); PTEF (tidal peak expiratory flow), TEF 75% (the 75% tidal volume during expiratory flow, Respiratory flow rate at 75% tidal volume was higher than that in control group, but there was no significant difference (P 0.05). RR in acute phase was higher than that in remission phase (P 0.05), TI/TE, TV/kg, TPTEF/TE, VPEF/VE, TEF 25%, TEF 50% were lower than that in remission phase (P 0.05); PTEF and TEF 75% were higher than that in remission phase, but there was no significant difference (P 0.05). TEF 50% was lower than that of the control group (P 0.05). There was no significant difference in the other indexes (P 0.05). In the acute phase of asthmatic bronchopneumonia, the maximum expiratory velocity decreased, the peak of expiratory flow moved forward, the expiratory time prolonged, the slope of descending branch increased, even to the axis of volume depression, and the figure was short. In obese patients, after active treatment, the slope of the descending branch of the expiratory system was lower than that at admission, the peak of the curve was obviously backward, the TFV ring became wider, and the descending branch of the expiratory system was far away from the volume axis.3 Mild, moderate, and severe tidal breathing pulmonary function differences were found: acute stage score for mild, moderate and severe patients compared with the control group, moderate and mild changes in comparison with statistical significance, but no significant difference between moderate and severe. Asthmatic bronchopneumonia clinical symptom severity score and hospitalization tidal breathing Spearman rank correlation analysis showed that clinical score was negatively correlated with TPTEF / TE and VPEF / VE, while clinical score was not correlated with VT / kg, RR, TI / TE, PTEF, TEF 75%, TEF 50%, TEF 25%. Methods The second part was selected from the children hospitalized with asthmatic bronchopneumonia in XX Hospital of Anhui Medical University from November 2013 to December 2015. Eighty children and 80 healthy controls were divided into asthmatic bronchopneumonia group (positive Asthma Predictive Index group) and asthmatic bronchopneumonia group (negative Asthma Predictive Index group) according to the Asthma Predictive index. The children were admitted to the hospital immediately after the first tidal breathing pulmonary function test in the acute phase and the acute phase, and were relieved 15 minutes before discharge. Result 1. Pulmonary function of asthmatic bronchopneumonia (positive Asthma Predictive Index group) and asthmatic bronchopneumonia (negative Asthma Predictive Index group) in acute stage were compared. TPTEF/TE, VPEF/VE were lower than those in the control group, but there was no significant difference in the decrease of TPTEF/TE and VPEF/VE between the two groups in the acute phase. There was no significant difference in the lung function between the remission asthmatic bronchopneumonia (positive Asthma Predictive Index group) and the acute phase (P 0.05). TPTEF/TE and VPEF/VE were significantly higher than those in the acute phase (P 0.05), but still lower than those in the normal control group. TPTEF/TE and VPEF/VE in the negative asthma predictive index group were not different from those in the control group on the 14th day after discharge, but TPTEF/TE and VPEF/VE in the positive asthma predictive index group were still lower than those in the control group. TPTEF/TE and VPEF/VE in the positive group were not restored to normal. 2. Pulmonary function indexes TPTEF/TE and VPEF/VE in the asthmatic bronchopneumonia (positive Asthma Predictive Index group) were significantly improved after aerosol inhalation compared with those before inhalation. The difference was statistically significant (P 0.05). Pulmonary function indexes TPTEF/TE in the asthmatic bronchopneumonia (negative Asthma Predictive Index group) after aerosol inhalation. VPEF / VE showed no significant improvement compared with the control group (P 0.05). The positive rate of bronchial relaxation test in asthmatic bronchopneumonia (positive Asthma Predictive Index group) was 73%, and that in asthmatic bronchopneumonia (negative Asthma Predictive Index group) was 21%. The clinical symptoms were relieved, but TPTEF / TE, VPEF / VE did not return to normal. Small airway obstruction still existed. 2. Tidal breathing velocity - volume loop (TBFV loop) of asthmatic bronchopneumonia showed different changes before and after treatment in acute and remission stages. The severity of asthmatic bronchopneumonia was negatively correlated with TPTEF / TE, VPEF / VE. TPTEF / TE, VPEF / VE could reflect the degree of small airway obstruction, evaluate the severity and changes of the disease, and provide objective evidence for clinical diagnosis and treatment of the disease. 4, asthma. Compared with asthmatic pneumonia (positive Asthma Predictive Index group) and asthmatic bronchopneumonia (negative Asthma Predictive Index group), asthmatic bronchopneumonia (positive Asthma Predictive Index group) has slower lung function recovery than asthmatic bronchopneumonia (negative Asthma Predictive Index group). Pulmonary function damage persists and needs early active intervention. The positive rate of bronchial diastolic test in the asthmatic bronchopneumonia group (positive Asthma Predictive Index group) was significantly higher than that in the asthmatic bronchopneumonia group (negative Asthma Predictive Index group), indicating that the degree of airway reversibility in the asthmatic bronchopneumonia group (positive Asthma Predictive Index group) was higher and could reflect the airway of the two groups. Pathophysiological characteristics provide an important basis for rational selection of treatment options.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R725.6
本文编号：2193193
[Abstract]:Objective Tidal breathing pulmonary function test is not required to follow the instructions of the traditional examination, just calm and spontaneous breathing, non-invasive, especially suitable for the determination of infant pulmonary function, in infant respiratory diseases have a wide range of prospects, tidal breathing lung function parameters and tidal breath flow VO loop (tidal breath flow vo) The changes of lume curve and TBFV loop can reflect the nature and degree of pulmonary function impairment in infants. It can indirectly assess the severity of the disease and evaluate the efficacy of drugs or treatments. The purpose of this study was to investigate the characteristics of tidal breathing and pulmonary function during the treatment of asthmatic bronchopneumonia and to explore the application of tidal breathing and pulmonary function test in infants with asthmatic bronchopneumonia. The application value of asthmatic bronchopneumonia in infants and young children is to provide parameters for accurate diagnosis and reasonable treatment of asthmatic bronchopneumonia.The first part is to select 100 infants hospitalized with asthmatic bronchopneumonia in the Department of pediatrics, XX Hospital of Anhui Medical University from November 2013 to December 2015, and 80 healthy controls. In the pneumonia group, tidal pulmonary function was tested at the acute stage and remission stage before discharge, tidal respiratory function parameters, tidal breathing velocity-volume loop (TBFV loop) were observed at the acute and remission stages of asthmatic bronchopneumonia, and the severity of clinical symptoms was scored half an hour before tidal respiratory function test. Asthmatic bronchopneumonia was divided into mild, moderate, severe, mild, moderate, and severe children with major tidal breathing lung function parameters and clinical symptom severity score and admission tidal breathing lung function parameters of the correlation. results 1, asthmatic bronchopneumonia acute observation group of children RR (respiratory rate, expiratory) Inspiration frequency was higher than control group (P 0.05), TI / TE (inspiratory time / expirator y time, inspiratory / expirator y time), TV / kg (tidal volume / kg, tidal volume per kg body weight), TPTEF / TE (time to tidal peak expirator y flow / expirator y time, peak time ratio), VPEF / VE (expirator y volume at tidal peak expirator y flow / expirator y time, peak volume at peak expirator y time, peak volume at peak expirator y flow / expirator y time). Compared with the control group, TEF 25% (the 25% tidal volume during expiratory flow, 25% tidal volume during expiratory flow), TEF 50% (the 50% tidal volume during expiratory flow, 50% tidal volume during expiratory flow) were lower than the control group (P 0.05); PTEF (tidal peak expiratory flow), TEF 75% (the 75% tidal volume during expiratory flow, Respiratory flow rate at 75% tidal volume was higher than that in control group, but there was no significant difference (P 0.05). RR in acute phase was higher than that in remission phase (P 0.05), TI/TE, TV/kg, TPTEF/TE, VPEF/VE, TEF 25%, TEF 50% were lower than that in remission phase (P 0.05); PTEF and TEF 75% were higher than that in remission phase, but there was no significant difference (P 0.05). TEF 50% was lower than that of the control group (P 0.05). There was no significant difference in the other indexes (P 0.05). In the acute phase of asthmatic bronchopneumonia, the maximum expiratory velocity decreased, the peak of expiratory flow moved forward, the expiratory time prolonged, the slope of descending branch increased, even to the axis of volume depression, and the figure was short. In obese patients, after active treatment, the slope of the descending branch of the expiratory system was lower than that at admission, the peak of the curve was obviously backward, the TFV ring became wider, and the descending branch of the expiratory system was far away from the volume axis.3 Mild, moderate, and severe tidal breathing pulmonary function differences were found: acute stage score for mild, moderate and severe patients compared with the control group, moderate and mild changes in comparison with statistical significance, but no significant difference between moderate and severe. Asthmatic bronchopneumonia clinical symptom severity score and hospitalization tidal breathing Spearman rank correlation analysis showed that clinical score was negatively correlated with TPTEF / TE and VPEF / VE, while clinical score was not correlated with VT / kg, RR, TI / TE, PTEF, TEF 75%, TEF 50%, TEF 25%. Methods The second part was selected from the children hospitalized with asthmatic bronchopneumonia in XX Hospital of Anhui Medical University from November 2013 to December 2015. Eighty children and 80 healthy controls were divided into asthmatic bronchopneumonia group (positive Asthma Predictive Index group) and asthmatic bronchopneumonia group (negative Asthma Predictive Index group) according to the Asthma Predictive index. The children were admitted to the hospital immediately after the first tidal breathing pulmonary function test in the acute phase and the acute phase, and were relieved 15 minutes before discharge. Result 1. Pulmonary function of asthmatic bronchopneumonia (positive Asthma Predictive Index group) and asthmatic bronchopneumonia (negative Asthma Predictive Index group) in acute stage were compared. TPTEF/TE, VPEF/VE were lower than those in the control group, but there was no significant difference in the decrease of TPTEF/TE and VPEF/VE between the two groups in the acute phase. There was no significant difference in the lung function between the remission asthmatic bronchopneumonia (positive Asthma Predictive Index group) and the acute phase (P 0.05). TPTEF/TE and VPEF/VE were significantly higher than those in the acute phase (P 0.05), but still lower than those in the normal control group. TPTEF/TE and VPEF/VE in the negative asthma predictive index group were not different from those in the control group on the 14th day after discharge, but TPTEF/TE and VPEF/VE in the positive asthma predictive index group were still lower than those in the control group. TPTEF/TE and VPEF/VE in the positive group were not restored to normal. 2. Pulmonary function indexes TPTEF/TE and VPEF/VE in the asthmatic bronchopneumonia (positive Asthma Predictive Index group) were significantly improved after aerosol inhalation compared with those before inhalation. The difference was statistically significant (P 0.05). Pulmonary function indexes TPTEF/TE in the asthmatic bronchopneumonia (negative Asthma Predictive Index group) after aerosol inhalation. VPEF / VE showed no significant improvement compared with the control group (P 0.05). The positive rate of bronchial relaxation test in asthmatic bronchopneumonia (positive Asthma Predictive Index group) was 73%, and that in asthmatic bronchopneumonia (negative Asthma Predictive Index group) was 21%. The clinical symptoms were relieved, but TPTEF / TE, VPEF / VE did not return to normal. Small airway obstruction still existed. 2. Tidal breathing velocity - volume loop (TBFV loop) of asthmatic bronchopneumonia showed different changes before and after treatment in acute and remission stages. The severity of asthmatic bronchopneumonia was negatively correlated with TPTEF / TE, VPEF / VE. TPTEF / TE, VPEF / VE could reflect the degree of small airway obstruction, evaluate the severity and changes of the disease, and provide objective evidence for clinical diagnosis and treatment of the disease. 4, asthma. Compared with asthmatic pneumonia (positive Asthma Predictive Index group) and asthmatic bronchopneumonia (negative Asthma Predictive Index group), asthmatic bronchopneumonia (positive Asthma Predictive Index group) has slower lung function recovery than asthmatic bronchopneumonia (negative Asthma Predictive Index group). Pulmonary function damage persists and needs early active intervention. The positive rate of bronchial diastolic test in the asthmatic bronchopneumonia group (positive Asthma Predictive Index group) was significantly higher than that in the asthmatic bronchopneumonia group (negative Asthma Predictive Index group), indicating that the degree of airway reversibility in the asthmatic bronchopneumonia group (positive Asthma Predictive Index group) was higher and could reflect the airway of the two groups. Pathophysiological characteristics provide an important basis for rational selection of treatment options.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R725.6
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