中国实用儿科杂志

中国实用儿科杂志

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儿童肺功能检查和呼出气一氧化氮测定应用现状调查分析

  

  1. 1.中国医科大学附属盛京医院小儿呼吸内科， 辽宁 沈阳  110004； 2.大连医科大学附属大连市儿童医院呼吸科， 辽宁  大连  116012； 3.吉林大学第一医院小儿呼吸一科， 吉林  长春  130021； 4.哈尔滨市儿童医院呼吸一科， 黑龙江  哈尔滨  150010； 5.内蒙古自治区人民医院儿科， 内蒙古  呼和浩特  010017； 6.大庆油田总医院儿科， 黑龙江  大庆  163001
  • 出版日期:2021-03-06 发布日期:2021-04-08

A questionnaire survey on current situation of pulmonary function testing and determination of fractional exhaled nitric oxide in children

  1. *Department of Pediatrics，Shengjing Hospital of China Medical University，Shenyang  110004，China
  • Online:2021-03-06 Published:2021-04-08

摘要： 目的　对儿童肺功能检查（pulmonary function testing，PFT）和呼出气一氧化氮（fractional exhaled nitric oxide， FeNO）测定的应用现状进行调查。方法　2019年9月23日至11月23日， 通过问卷对辽宁省、 吉林省、 黑龙江省和内蒙古自治区已经开展或有意愿开展儿童PFT或FeNO测定的161家医院进行调查，并汇总分析资料。结果　（1）参与调查的161家医院中有40.99%开展了儿童PFT， 与未开展者相比三级医院所占比例更高、 儿科病床数更多、 儿童哮喘标准化门诊的比例更高， 差异均具有统计学意义（P＜0.05）。与已开展儿童PFT的医院相比， 尚未开展的医院认为设备昂贵（19.70% vs. 72.63%）和报告判读困难（15.15% vs. 54.74%）， 差异具有统计学意义（P＜0.001）。（2）儿童PFT的基本方法是常规通气法（100.00%）， 支气管舒张试验（80.30%）开展也较为广泛， 婴幼儿肺功能（45.45%）和脉冲振荡法（36.36%）开展也越来越多， 而肺弥散功能（10.61%）、 体积描记法（7.58%）和支气管激发试验（4.55%）则开展相对较少。常规通气法、 脉冲振荡法和潮气呼吸法， 每种检查方法在2016年、2017年和2018年检查例数之间的比较差异均无统计学意义（P＞0.05）。（3）24.22%（39/161）医院开展了儿童FeNO测定， 其中以三级医院为主（87.18%）。常见的测定方法包括联机一口气法（89.74%）、 离线潮气呼吸法（74.36%）和联机鼻呼气法（43.59%）， 2016—2018年每年采用不同检测方法检测病例数量之间比较， 差异均无统计学意义（P＞0.05）。结论　辽宁省、 吉林省、 黑龙江省和内蒙古自治区的儿童PFT发展仍不平衡， 应加强在基层医院的推广和普及。已开展PFT的医院应积极探索肺弥散功能和体积描记法在儿科的应用。开展支气管舒张试验时，要注意PFT方法和支气管舒张剂的选择。儿童FeNO测定应以联机一口气法为主， 离线潮气呼吸法和联机鼻呼气法仍需进一步探索。

关键词: 儿童, 肺功能检查, 呼出气一氧化氮, 问卷调查

Abstract: Objective　To investigate the current situation of pulmonary function testing（PFT） and determination of fractional exhaled nitric oxide（FeNO） in children. Methods　An electronic questionnaire survey was performed in 161 hospitals in Liaoning，Jilin，Heilongjiang，and Inner Mongolia Autonomous Region that had conducted or were willing to conduct PFT or FeNO determination in children from September 23 to November 23，2019. Results　（1）A total of 161 hospitals participated in the survey，and PFT for children had been conducted in 40.99% of the responders. Compared with hospitals that had not conducted PFT for children，there was significantly higher proportion of tertiary hospitals，more pediatric beds，and  higher proportion of standardized pediatric asthma outpatient（P＜0.05） in these hospitals. Compared with hospitals that had conducted PFT for children，those who had not yet done so thought that the equipment were expensive（19.70% vs. 72.63%） and it was difficult to make interpretation of the report（15.15% vs. 54.74%）（P＜0.001）.（2）Spirometry was the most common testing（100%），followed by bronchodilation test（80.30%），infant pulmonary function testing（45.45%） and impulse oscillometry（36.36%）. Diffuse capacity，plethysmography and bronchial provocation test had been conducted relatively less（10.61%，7.58% and 4.55%，respectively）. There was no significant difference in the number of examinations for the spirometry，impulse oscillometry，or infant pulmonary function testing in 2016，2017，and 2018（P＞ 0.05）. （3）About 24.22%（39/161） of the hospitals had conducted FeNO determination for children，most of which were tertiary hospitals（87.18%）. The most common method conducted was online single-breath measurement（89.74%），followed by offline tidal breath measurement（74.36%） and online nasal breath measurement（43.59%）. There was no significant difference in the number of measurements for each method in 2016，2017，and 2018 or for each year among the three methods（P＞ 0.05）. Conclusion 　The application of　PFT for children in Liaoning，Jilin，Heilongjiang and Inner Mongolia is not popular，especially in the primary hospitals. The hospitals which have conducted PFT should manage to conduct diffuse capacity and plethysmography for children. When conducting a bronchodilation test，the PFT method and the choice of bronchodilators should be paid attention to. Online single-breath measurement should be the main FeNO measurement for children，while the offline tidal-breath and the online nasal-breath measurements need to be further explored.

Key words: child, pulmonary function testing, fractional exhaled nitric oxide, questionnaire survey