中国实用儿科杂志

中国实用儿科杂志

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学龄前儿童用力肺活量测定的质量控制分析

张清玲1，郑劲平2，袁本通1，何桦2，王健1，安嘉颖2，张敏1，罗定芬2，陈桂莲1   

  1. 1.深圳市第二人民医院 呼吸内科，广东深圳 518026；2.广州医学院附属第一医院 广州呼吸疾病研究所，广东广州510120
  • 收稿日期:2005-11-20 修回日期:2006-01-12 出版日期:2006-04-06 发布日期:2006-04-06

Quality control for spirometry in preschool children.

Zhang Qingling*,Zheng Jinping,Yuan Bentong,et al.   

  1. *Respiratory Department，Shenzhen 2nd People’s Hospital,Shenzhen 518026，China
  • Received:2005-11-20 Revised:2006-01-12 Online:2006-04-06 Published:2006-04-06

摘要： 目的探讨学龄前儿童用力肺活量测定的质量控制标准。 方法2004年4~9月，对深圳地区3~7岁正常儿童343例(男184例，女159例),采用意大利COSMED公司生产的COSMED流量传感仪,参考美国胸科协会可接受曲线标准，通过测定用力肺活量(FVC)、05s用力呼气容积(FEV05)、075s用力呼气容积(FEV075)、1s用力呼气容积(FEV1)以及05ｓ用力呼气容积占用力肺活量比值(FEV05/FVC)、075ｓ用力呼气容积占用力肺活量比值(FEV075/FVC)、1ｓ用力呼气容积占用力肺活量比值(FEV1/FVC)、外推容量(VBE)、外推容量占用力肺活量比值(VBE/FVC)、呼气时间(FET100%)及最佳2次的FVC、FEV075、FEV05、FEV1变异等指标，分析学龄前儿童用力肺活量测定的质量控制标准。 结果279名(813%)儿童能够成功完成测试。平均VBE为(4271±1361)mL，95百分位数为64mL，最大为72mL；VBE/FVC为(393±134)%，95百分位数为636%，最大为926%；52例(186%)VBE/FVC>5%；年龄越小的儿童其VBE/FVC越高；VBE/FVC与身高呈负相关(P<005)。儿童平均呼气时间为(161±052)s，5百分位数为09s，18例(65%)呼气时间<1s。儿童最佳2次的FVC、FEV1、FEV075、FEV05变异均<02L；约631%儿童最佳2次的FEV075的变异<5%；约662%最佳2次的FEV1变异<5%，各变异<01L的百分比为90%~93%。 结论建议对于中国学龄前儿童用力肺活量的质控标准为：曲线起始以VBE为标准，VBE/FVC<65%或VBE<65mL,取最大值；曲线终止以呼气时间≥09s，且呼气相时间容积曲线显示呼气容量出现平台，持续时间≥1s为标准；FEV05及FEV075需在报告中报告；曲线的重复性标准为最佳2次FVC及FEV075的变异<10%或<01L(取最大值)。

关键词: 肺通气, 肺活量, 学龄前儿童, 质控标准

Abstract: AbstractObjectiveTo probe into the criteria of quality control for spirometry in preschool children. MethodsA survey in 343 healthy preschool children(184 boys,159girls) aged 3 to 7 years old was carried out in Shenzhen in 2004.Eleven flow volume tests parameters \[forced vital capacity(FVC),forced expiratory volume at o.5 second(FEV0.5),forced expiratory volume at 0.75 second(FEV0.75),forced expiratory volume at one second(FEV1),extrapolated volume(VBE),extrapolated volume to FVC ratio(VBE/FVC),the difference between the two highest values of FVC or FEV0.5,FEV0.75,FEV1 and forced expiratory time(FET 100%)］ were measured by using COSMED spirometry of Italian. ResultsThe average extrapolated volume(VBE) was 42.71±13.61 mL， 95Percentile value being 64mL；the average VBE/FVC was (393±134)%，95Percentile value being 636% in this group.Fiftytwo of 279 children (18.6%) were not able to produce a VBE/FVC value less than 5%.The younger children tended to have higher VBE/FVC values.There was significant relationship between VBE/FVC and height (P< 0.05).The average forced expiratory time(FET) was 1.61±0.52sec，5Percentile value being 09sec,and 18 of 279 (6.5%) children produced a FET less than 1 second.Forced expiratory volume in 0.50 and 0.75 sec(FEV0.5,FEV0.75) were thus measured in preschool children.All children presented their two best efforts(FVC、FEV0.75、FEV0.5、FEV1 FVC ) no more than 0.2L.About 63.1%of the tested children presented their two best efforts(FEV0.75) no more than 5%.About 66.2% of the tested children presented their two best efforts( FEV1) no more than 5%.More than 90% of the tested children presented their two best efforts(FVC、FEV0.75、FEV0.5、FEV1 FVC ) no more than 0.1L. ConclusionStart of test can be quantitatively assessed as in adults,but results greater than 65 mL for VBE or 6.5% for VBE/ FVC should be indications for visual reinspection of the flow volume trace,rather than automatic exclusion.Expiratory time should not be less than 0.9s and expiration continues until there is a clear plateau on the volume time trace,and there should be no volume change for 1 second.In all preschool children both FEV0.75 and FEV0.5 should be reported in addition to FEV1.Repeatability can be assessed as for adults,but criteria of 100 mL and 10% of best effort for FVC and FEVt may be more appropriate than the criteria applied to adults

Key words: Quality control criteria , Spirometry, Preschool children