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中国循证儿科杂志

中国循证儿科杂志 ›› 2022, Vol. 17 ›› Issue (6): 438-442.DOI: 10.3969/j.issn.1673-5501.2022.06.006

• 论著 • 上一篇    下一篇

体积描记法检测婴幼儿肺功能质量改进研究

万成宙1,蒋高立1,黄剑峰,王立波   

  1. 复旦大学附属儿科医院呼吸科 上海，201102；1 共同第一作者
  • 收稿日期:2022-11-14 修回日期:2022-12-23 出版日期:2022-12-25 发布日期:2022-12-25
  • 通讯作者: 黄剑峰;王立波

Analysis of the effect on the pulmonary function test using the baby body plethysmography by improving the quality of operational protocol

WAN Chengzhou1, JIANG Gaoli1, HUANG Jianfeng, WANG Libo#br#   

  1. Children's Hospital of Fudan University, Department of Respiratory, Shanghai 201102, China;1 Co-first author
  • Received:2022-11-14 Revised:2022-12-23 Online:2022-12-25 Published:2022-12-25
  • Contact: HUANG Jianfeng;WANG Libo

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摘要： 背景 婴幼儿体积描记法（体描）是检测功能残气量和气道阻力的金标准，是婴幼儿呼吸生理评估的重要方法 。 目的 探讨改进体描肺功能检测（PFT）的操作技能对提升体描PFT成功率的影响。 设计 质量改进研究。 方法 采用德国耶格公司生产的婴幼儿体描仪进行PFT，测量11个潮气呼吸参数和6个体描参数。改进前婴幼儿体描流程和方法依据美国胸科协会和欧洲呼吸协会颁布的婴幼儿体描测试仪器和操作方法指南，改进后是在此基础上，加大镇静药物（口服水合氯醛）剂量，操作前肢体抚触或足底按摩5 min，15度仰卧位斜坡枕头放置等。纳入2017年1月至2019年1月在肺功能室行体描PFT的连续病例，排除急性下呼吸道感染（ALRI）所致的重症肺炎患儿，以2018年1月1日划分为改进前和改进后。分为新生儿肺炎组和ALRI组，ALRI组分为喘息和非喘息亚组。 主要结局指标 潮气呼吸成功率、体描成功率、镇静失败率。 结果 新生儿肺炎组120例，ALRI组477例。镇静后未能入睡31例，新生儿肺炎组3例，ALRI组28例，喘息和非喘息亚组各14例。早醒未完成体描PFT的23例，新生儿肺炎组6例，均发生在体描参数检测中；ALRI组17例，喘息亚组5例，非喘息亚组12例。总体人群改进后较改进前潮气成功率、体描成功率提升，镇静失败率下降，差异有统计学意义。新生儿肺炎组潮气呼吸成功率和体描成功率改进后虽有所提高，镇静失败率有所下降，但较改进前差异无统计学意义。非喘息亚组和喘息亚组潮气呼吸成功率、体描成功率改进后较改进前均提高，镇静失败率均下降，差异均有统计学意义。 结论 改进婴幼儿体描PFT流程和方法可显著提升潮气呼吸成功率和体描成功率，降低镇静失败率。

关键词: 体积描记法, 质量改进, 肺功能, 婴儿, 新生儿

Abstract: Background Baby body plethysmography is the gold standard for testing the functional residual volume and airway resistance, making it important for the evaluation of infant respiratory physiology. Objective To explore the influence of improving the operation skills of pulmonary function test (PFT) in plethysmography on the success rate of PFT. Design Quality improvement study. Methods PFTs were performed using the Jaeger MasterScreen BabyBody device (Erich Jaeger GmbH, v4.65, Würzburg, Germany) to examine tidal breathing flow volume loop (TBFVL) and plethysmographic functional residual capacity (FRCP). Before the improvement, the protocol of PFT were in accordance with the recommendations published by the American Thoracic Society (ATS) and the European Respiratory Society (ERS). On the basis of the previous protocol, improvement was described as increasing the dosage of sedatives (oral chloral hydrate) , touching or massaging the baby for 5 minutes before the test, and placing a slope pillow with 15 degree supine position. Continuous cases of PFT in pulmonary function room from January 2017 to January 2019 were included, and children with severe pneumonia caused by acute lower respiratory tract infection (ALRI) were excluded. The date of January 1, 2018 was set as the timing to differentiate before and after improvement. They were divided into neonatal pneumonia group and ALRI group. ALRI group was divided into the wheeze and non-wheezing subgroups. Main outcome measures The success rate of TBFVL and FRCP, and the failure rate of sedation. Results Totally 120 cases of neonatal pneumonia and 477 cases of ALRI were included. There were 31 cases failing to fall asleep after sedation, 3 cases with neonatal pneumonia and 28 cases with ALRI for both 14 cases in the wheezing and non-wheezing subgroups. Among 23 cases in the early awakening group who did not finish the PFT, there were 6 cases with neonatal pneumonia and 17 cases with ALRI for 5 cases in the wheezing and 12 cases in the non-wheezing subgroup. Although the success rate of TBFVL and FRCP had been improved with decreased rate of sedation failure in the neonatal pneumonia group, there was no significant difference compared with that before the improvement on PFT protocol. The success rate of TBFVL and FRCP had been improved with decreased rate of sedation failure in the non- wheezing and the wheezing subgroups after improvement on PFT protocol with statistical significance. Conclusion Improving the quality of PFT protocol of Baby body plethysmography can significantly increase the success rate of FRCP and TBFVL and reduce the failure rate of sedation.

Key words: Plethysmography, Improving the quality, Pulmonary, Infants, Neonates