在婴幼儿乙酰胆碱激发试验中应用增容快速胸腹压力技术(RVRTC)进行反复肺功能检测的可行性报告
2008/04/30
为了评估婴幼儿乙酰胆碱激发试验中通过增容快速胸腹压力技术(RVRTC)检测肺功能的可行性，Loland等人对402名1个月大的健康婴幼儿做反复乙酰胆碱（从0.037到16.674µmol四倍剂量）激发试验，并应用RVRTC法测量肺功能。其中99%的婴幼儿成功测量了肺功能基线值，79%的婴幼儿通过FEV0.5得到了激发剂量（PD），另有87%的婴幼儿通过经皮氧分压成功测出激发剂量。临床试验中及出院后都没有观察到严重的不良反应。在适量的乙酰胆碱作用下，大多婴幼儿的激发剂量都能确定。21%的婴幼儿FEV0.5值在试验中下降超过40%，1%的婴幼儿出现短暂的自限的低氧（血氧< 80%），19%婴幼儿出现心动过缓（心率< 90次/分）。出院后，父母们最常观察到的是孩子们在睡眠(95%)、饮食(57%)和行为方式(58%)等方面的改变。将父母对该试验的可接受性按1到10评分，平均评分为8，13%的父母评分 5。操作者完成该试验需用3小时，而实际肺功能检测的时间仅占一半。
由此看出，这项单中心的综合性试验在无症状婴幼儿中实施是安全的，具有可行性。
由此看出，这项单中心的综合性试验在无症状婴幼儿中实施是安全的，具有可行性。
（于娜 中国医科大学附属第一医院呼吸内科 110001 摘译）
(Chest. 2008; 133:115-122)
Feasibility of Repetitive Lung Function Measurements by Raised Volume Rapid Thoracoabdominal Compression During Methacholine Challenge in Young Infants
Background: The aim of the study was to evaluate the feasibility of lung function measurements by the raised volume rapid thoracoabdominal compression (RVRTC) technique during bronchial methacholine challenge in young infants.
Method: Four hundred two healthy infants were tested at 1 month of age with RVRTC during repeated methacholine challenges with quadrupling doses from 0.037 to 16.674 µmol.
Results: Measurement of baseline lung function was successful in 99% and the provocative dose (PD) was achieved in 79% of infants by forced expiratory volume in 0.5 s (FEV0.5). Additionally, the PD was successfully measured in 87% by transcutaneous oxygen pressure. No serious adverse events were observed during testing or after discharge from the clinic. The methacholine dose range was appropriate as PD could be determined in the majority of infants. FEV0.5 values in 21% of infants dropped > 40% during the test. Short-lasting, self-limiting episodes of hypoxemia of < 80% occurred in 1% of infants and bradycardia < 90 beats/min in 19% of infants. The most common observations by parents were changes in the patterns of sleeping (95%), eating (57%), and behavior (58%) of the infant after hospital discharge. The mean acceptability rating among parents was 8 on a scale from 1 to 10, with 13% rating 5. It took one operator 3 h to complete the test, with the actual lung function testing accounting for half the time.
Conclusion: This very comprehensive experience with standardized measurements of lung function by RVRTC during methacholine challenge in young infants in a single center leads us to conclude that the test is feasible and safe to perform in asymptomatic young infants.
Key Words: bronchial provocation tests • feasibility studies • infant • method acceptability • respiratory function tests • safety
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