哮喘急性发作患者的肺功能测定结果
2007/03/12
急性发作期哮喘患者急诊就诊时通常有呼吸困难症状，情绪焦虑，且常常有咳嗽症状，急诊室环境较杂乱，因而不易达到肺功能测定标准，相关报道也较少。Robert A.Silverman等选取了20个急诊室进行了一项多中心临床研究，对在急诊环境下，在急性发作期哮喘病人是否可以获得良好的肺功能结果进行了探讨。该研究选取了到达急诊时、30min、1h、2h、4h以及出院后随访6个时间点进行FEV1测定。肺功能测定标准为：测定2次以上、用力呼气时间≥2s、达峰流速时间＜120ms、反推容积＜5%FVC，可重复性标准为可接受的两次最高FEV1变异率＜10%，与常用的美国胸科协会肺功能测定标准略有不同。
结果表明，在620名患者中（12～65岁），在刚到达急诊时测定的肺功能，＞90%的患者可达到测定标准，74%的患者达到可重复性标准，肺功能测定质量随测定时间点的后移而逐渐改善。到1h时，90%的患者达到测定标准和可重复性标准。重度患者（FEV1<25%预计值）开始时不易达到测定标准，但随时间推移其测定质量也逐渐提高。
作者认为在对操作人员进行良好培训后，对于大多数急性发作期成人哮喘患者，即使在到达急诊的1h内也可以获得符合标准的肺功能结果。
（赵海涛 沈阳军区总医院呼吸内科 110016 摘译）
(CHEST，2007，131：164-171)FEV1 Performance Among Patients With Acute Asthma*
Results From a Multicenter Clinical Trial
Robert A. Silverman, MD; Edith Flaster, MS; Paul L. Enright, MD and Steven G. Simonson, MD, FCCP
Abstract
Objective: To determine the ability of patients seen for acute asthma exacerbations in the emergency department (ED) to perform good-quality FEV1 measurements.
Methods: Investigators from 20 EDs were trained to perform spirometry testing as part of a clinical trial that included standardized equipment with special software-directed prompts. Spirometry was done on ED arrival and 30 min, 1 h, 2 h, and 4 h later, and during follow-up outpatient visits.
Measurements: Study performance criteria differed from American Thoracic Society (ATS) guidelines because of the population acuity and severity of illness as follows: ability to obtain acceptable FEV1 measures (defined as two or more efforts with forced expiratory times 2 s and time to peak flow < 120 ms or back-extrapolated volume < 5% of the FVC) and reproducibility criteria (two highest acceptable FEV1 values within 10% of each other).
Results: Of the 620 patients (age range, 12 to 65 years), > 90% met study acceptability criteria on ED arrival and 74% met study reproducibility criteria. Mean initial FEV1 was 38% of predicted. Spirometry quality improved over time; by 1 h, 90% of patients met study acceptability and reproducibility criteria. Patients with severe airway obstruction (FEV1 < 25% of predicted) were initially less likely to meet quality goals, but this improved with time. The site was also an independent predictor of quality.
Conclusion: When staff are well trained and prompt feedback regarding adequacy of efforts is given, modified ATS performance goals for FEV1 tests can be met from most acutely ill adolescent and adult asthmatics, even within the first hour of evaluation and treatment for an asthma exacerbation.
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赤潮毒素（短裸甲藻毒素）气溶胶与哮喘
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持续性哮喘患者运动期间主诉呼吸困难症状的变化
