高渗盐水诱导痰法在运动诱发型支气管痉挛患者中的安全性评估
2007/06/27
目前关于稳定型哮喘患者诱导痰(SI)的安全性评价已有较详尽的论述，但对如何评价运动诱发型支气管痉挛(EIB)的化痰安全性还未确定。为了研究诱导痰时 EIB的严重程度与支气管痉挛发生的关系，明确运动后诱导痰是否会增加诱导痰期间的恶性支气管痉挛的发生风险。Chris Carlsten等人对32名轻中度哮喘患者 (基础值FEV1占预计值的86±9% [平均值±标准差])和EIB患者(运动后FEV1下降15～63%)进行研究,先将沙丁胺醇溶于3%的盐水的对患者进行预处理, 然后隔天运动后30分后用沙丁胺醇盐水进行诱导痰试验。结果在未运动和运动30分钟后进行诱导痰试验期间,最大呼气流速(PEFR)均明显下降,但两者之间PEFR下降无明显差别。诱导痰期间PEFR下降的最佳预计值为预处理的FEV1,然而EIB的严重程度与SI期间支气管痉挛无相关性。因此得出：对运动诱发后支气管痉挛的哮喘患者进行运动后诱导痰试验是安全的，且诱导痰前EIB的严重程度并不是诱导痰期间支气管痉挛发生的重要决定因素。
（于娜 沈阳中国医科大学附属一院呼吸科 110001 摘译）
( Chest.2007;131:1339-1344)
Key Words: asthma·bronchial hyperresponsiveness·exercise·exercise-induced bronchoconstriction·safety·sputum induction
Safety of Sputum Induction With Hypertonic Saline Solution in Exercise-Induced Bronchoconstriction
Chris Carlsten, MD, MPH; Moira L. Aitken, MD, FCCP and Teal S. Hallstrand, MD, MPH
* From the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle WA.
Abstract 摘要
Background: The safety of sputum induction (SI) is well described in stable asthma, but the safety of SI in exercise-induced bronchoconstriction (EIB) has not been established.
Objectives: Our goals were to examine the relationship between the severity of EIB and bronchoconstriction during SI, and to determine if SI conducted after exercise challenge increases the risk of excess bronchoconstriction during SI.
Methods: SI was conducted in 32 patients with mild-to-moderate asthma (baseline FEV1, 86±9% of predicted [mean±SD]) with EIB (15 to 63% reduction in FEV1 following exercise challenge) following pretreatment with albuterol using 3% saline solution and repeated on a separate day 30-min after exercise challenge.
Results: There was a reduction in peak expiratory flow rate (PEFR) during SI without exercise (mean maximum reduction vs baseline, 4.0% at 10 min; 95% confidence interval [CI], 1.0 to 7.1; p=0.02) and during SI 30 min following exercise (mean maximum reduction vs baseline, 5.2% at 8 min; 95% CI, 1.0 to 7.5; p≤0.01); however, there was no difference between the PEFR reductions during SI without or following exercise challenge. The best predictor of reduction in PEFR during SI was the preprocedure FEV1, while the severity of EIB was not associated with bronchoconstriction during SI.
Conclusions: We conclude that SI can be performed safely following exercise challenge in asthmatics with EIB, and that the severity of EIB prior to SI is not a major determinant of bronchoconstriction during SI.
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持续性鼻炎的诊断分类及其与呼出一氧化氮和哮喘的关系*
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不同严重程度哮喘患者呼出一氧化氮的差流分析（Differential Flow Analysis）
