171例使用乙酰甲胆碱进行激发试验结果回顾性分析

发布时间：2018-06-05 04:02

本文选题：激发试验 + 乙酰甲胆碱　；参考：《中国实用内科杂志》2014年S1期

【摘要】：目的探讨并分析目前临床支气管激发试验阳性率过低的问题,思考提高阳性率的方法。方法回顾性分析我院2014年1月至2014年5月共171例门诊怀疑支气管哮喘的患者进行支气管激发试验。我院采用的仪器是Jaeger肺功能仪,以乙酰甲胆碱作为激发原,采用机器配置的雾化吸入方式进行药物吸入,药物浓度分别为0.9%NaCL(0.072mg),MCH4mg/mL(0.0512mg),4mg/mL(0.07mg),32mg/mL(0.5095mg),32mg/mL(0.5095mg),32mg/mL(0.5089mg),32mg/mL(0.852mg)。激发试验后舒张试验采用乙丙托溴铵气雾剂4PUFFS,15分钟后行舒张试验。结果 171例患者中支气管激发试验阴性者共131例,支气管激发试验阳性者共40例,阳性率为23.4%。结论引起支气管阳性率过低的原因很多,现归纳以下4点,(1)患者的选择,严格选择高度怀疑支气管哮喘的患者。(2)诊断标准的敏感性,目前国内多采用FEV1%下降率大于等于20%为阳性,但目前国外的一些研究证实反映气道反应性的较敏感指标为sGaw,在FEV1下降20%的时候sGaw已下降50%以上,故采用sGaw来判断阳性可提高哮喘患者的检出率。(3)激发原的选择,目前临床上所用的激发原有很多种,不同的哮喘患者可能对不同的激发原敏感,这也是造成有些哮喘患者激发试验为阴性的原因,故针对不同的患者选择不同的激发原为以后研究的重点,可以提高哮喘的检出率。(4)支气管激发试验后加做支气管舒张试验,可以排除由于各种原因引起的激发试验阴性的患者的检出率。如果激发试验是阴性,而后加做舒张试验是阳性也能做出哮喘的诊断。
[Abstract]:Objective to discuss and analyze the problem of low positive rate of bronchial provocation test in clinic at present, and to think about ways to improve the positive rate. Methods from January 2014 to May 2014, 171 patients with suspected bronchial asthma in our hospital were analyzed retrospectively. The instrument used in our hospital was Jaeger pulmonary function instrument. Methacholine was used as the stimulator, and the drug was inhaled by atomized inhalation with machine configuration. The drug concentration was 0.9NaCL0.072 mg / mL 0.0512 mg / mL 0.07 mg / mL 0.5095 mg / mL ~ 0.50 mg / mL ~ (2) ~ 0.5089 mg / mL ~ (-1) ~ 0.5089 mg / mL ~ (-1) ~ 0.852mL ~ (-1) ~ 0.852mL ~ (-1). The relaxation test was performed 15 minutes after excitation test with ethylprotopril ammonium bromide aerosol (4 PUFFS). Results among 171 cases, 131 cases were negative in bronchial provocation test and 40 cases were positive in bronchial provocation test, the positive rate was 23.443%. Conclusion there are many reasons for the low bronchial positive rate. The following 4 points are summarized: 1) the sensitivity of the diagnostic criteria for the highly suspected bronchial asthma patients should be strictly selected. At present, FEV1% decrease rate is more than 20% positive in our country, but some foreign studies have confirmed that the more sensitive index to reflect airway reactivity is sGaw.When FEV1 decreases by 20%, sGaw has dropped by more than 50%. Therefore, using sGaw to judge the positive rate can improve the detection rate of asthma patients. It is possible that different asthma patients may be sensitive to different stimuli. This is also the reason why some asthmatic patients are negative in provocation test. Therefore, choosing different stimuli for different patients is the focus of future research, which can improve the detection rate of asthma. 4) bronchial dilatation test is added after bronchial provocation test. The detection rate of patients with negative excitation tests caused by various causes can be excluded. Asthma can be diagnosed if the test is negative, and then the diastolic test is positive.
【作者单位】：浙江大学附属邵逸夫医院呼吸治疗科;
【分类号】：R562.25

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