潮气呼吸肺功能在晚期早产儿肺功能监测中的应用

目的探讨潮气呼吸肺功能在晚期早产儿肺功能监测中的应用。方法动态监测晚期早产儿的潮气呼吸肺功能,并与足月儿比较,说明潮气呼吸肺功能在晚期早产儿肺功能监测中的可行性及有效性。结果晚期早产儿生后吸呼比、达峰时间比和达峰容积比,数值较足月儿明显减低,差异有显著的统计学意义(P0.01);晚期早产儿生后7天时的达峰时间比和达峰容积比1天时或前2天升高,差异有统计学意义(P0.05)。结论对于晚期早产儿,潮气呼吸肺功能是一个可行及有效的监测方法,适合大样本、长时间和动态监测。     

潮气呼吸肺功能测定鉴别诊断小儿慢性咳嗽的价值

目的探讨通过潮气呼吸肺功能鉴别诊断小儿慢性咳嗽的方法和临床价值。方法选取2016年1月至2017年1月我院收治的慢性咳嗽非哮喘患儿与咳嗽变异性患儿分别60例,对其进行潮气呼吸肺功能测定,观察两组患者的检查区别。结果两组患儿在潮气量、呼吸频率及呼气时间的比较结果上无显著差异,P0.05,无统计学意义。吸气时间、呼吸比、达峰时间及达峰容积的比较较高上有显著差异,P0.05,有统计学意义。结论潮气呼吸肺功能测定可有效鉴别慢性咳嗽的非哮喘和咳嗽变异性哮喘,可在临床进行推广应用。     

桂西地区婴幼儿喘息性疾病潮气呼吸肺功能变化的研究

目的研究桂西地区婴幼儿喘息性疾病潮气呼吸肺功能的特点,探讨潮气呼吸肺功能测定对婴幼儿喘息性疾病的临床应用价值。方法对来自广西西部的百色、河池两地区80例3岁以下婴幼儿喘息性疾病患儿进行潮气呼吸肺功能测定,并与同期同地区60例非喘息性呼吸道疾病婴幼儿进行比较,对比两组儿童肺功能指标的变化。结果观察组患儿肺功能性质以阻塞性改变为主(占85%),与对照组比较,阻塞越严重,TBFV环呼气下降支斜率越大,甚至出现向内凹陷。观察组患儿达峰时间比(TPTEF/TE)、达峰容积比(VPTEF/VE)、每千克体重潮气量(TV/kg)、吸呼比(Ti/Te)、呼出75%潮气量时呼气流速(TEF75%)低于对照组(P0.05);呼吸频率(RR)、潮气呼气峰流速(PTEF)、潮气量时呼气流速(TEF25%)高于对照组(P0.05);50%潮气量时呼气流速(TEF50%)与对照组差异无统计学意义(P0.05)。对其中20例患儿予平喘治疗后呼吸频率有一定减低,达峰时间比(TPTEF/TE)、达峰容积比(VPTEF/VE)高于治疗前(P0.05)。结论桂西地区婴幼儿喘息性疾病肺功能损害以阻塞性通气障碍为主。潮气呼吸肺功能测定对婴幼儿喘息性疾病病情评估、治疗以及预后判断均有重要的临床价值。     

婴幼儿哮喘患儿潮气呼吸肺功能改变的特征

目的观察婴幼儿哮喘患儿在发作期与缓解期的潮气呼吸流速——容量曲线测定结果。方法选择婴幼儿哮喘患儿40例，于镇静后进行潮气呼吸流速容量曲线测定（TBFV）。主要参数有：每公斤潮气量（VT／kg）、呼吸频率（RR）、吸气时间（Ti）、呼气时间（Te）、吸呼比（Ti／Te）、达峰时间比（TPTEF／TE）、达峰容积比（VPEF／VE），并对30例哮喘患儿经正规吸入治疗1～3月的缓解期进行复查。观察其改善情况。同时对40例无呼吸道疾病的婴幼儿进行肺功能检测，作为正常对照。结果哮喘组的潮气量与正常对照组无显著差异，其他各指标差异均有显著性（P〈0．01）。哮喘组经1～3月治疗后，复查TPEF／TE，VPEF／VE显著上升，但与对照组仍有显著差异，未能恢复正常水平。结论潮气呼吸肺功能测定能反映出婴幼儿哮喘的病理生理特点，可成为呼吸系统疾病诊断的重要补充。     

婴幼儿潮气呼吸肺功能的临床应用研究

目的研究潮气呼吸肺功能检查在婴幼儿常见的呼吸系统疾病诊断的临床价值。方法选择年龄2个月-3岁我院同期住院婴幼儿支气管肺炎48例、支气管哮喘37例、毛细支气管炎26例,完成潮气呼吸肺功能舒张试验,并对吸入支气管扩张剂前后的主要肺功能参数进行比较。结果吸入支气管扩张剂前哮喘组、毛支组分别与肺炎组比较达峰时间比TPTEF/Te和达峰容积比VPEF/Ve均有统计学差异(P 0. 05)。吸入支气管扩张剂后肺炎组、哮喘组、毛支组TPTEF/Te和VPEF/Ve均有所改善,且差异有统计学意义(P 0. 05)。结论通过潮气呼吸肺功能测定支气管肺炎、支气管哮喘、毛细支气管炎患儿均有不同程度的气道阻塞,给予支气管扩张剂后气道阻塞程度均有所改善。     

潮气呼吸肺功能检测对婴幼儿喘息性疾病的诊断价值

目的探讨潮气呼吸肺功能检测对婴幼儿喘息性疾病的诊断价值。方法收集2012年1月—2014年1月在我院住院的支气管哮喘患儿40例(哮喘组)、毛细支气管炎患儿40例(毛细组)及门诊体检健康婴幼儿40例(对照组)。均于平静呼吸状态下监测潮气呼吸肺功能,指标包括:单位质量内潮气量(Vt)、呼气时间(Te)、吸气时间(Ti)、呼吸频率(RR)、达到峰流速时间(TPTEF)、达到呼气峰流速时所呼吸气体体积(VPTEF)以及呼吸容积(Ve),计算呼吸比(Ti/Te)、达峰时间比(TPTEF/Te)以及达峰容积比(VPTEF/Ve)。哮喘组和毛细组患儿完成测试后,均给予0.5%沙丁胺醇雾化吸入治疗,3个月后进行复测。结果治疗前哮喘组和毛细组患儿RR高于对照组,Te、Ti、TPTEF/Te及VPTEF/Ve低于对照组(P0.05)。吸入沙丁胺醇后,哮喘组Vt、VPTEF/Ve及TPTEF/Te高于治疗前,毛细组RR、TPTEF/Te低于治疗前(P0.05)。结论潮气呼吸肺功能检测能够间接反映婴幼儿喘息性疾病的病理生理特征,为临床诊断提供参考。     

喘息对支气管肺炎患儿潮气呼吸肺功能的影响

目的观察喘息对支气管肺炎患儿潮气呼吸肺功能的影响。方法对54例支气管肺炎患儿分为观察组喘息组25例和对照组非喘息组29例,在肺炎急性期及恢复期分别测定潮气呼吸流速容量(TBFV)环图形及参数呼吸频率(RR)、每公斤体重潮气量(VT/kg)、达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)、吸呼比(Ti/Te)、呼出和吸入50%潮气容积时的呼气流速与吸气流速之比(TEF50/TIF50),进行分析。结果 1.观察组急性期TBFV环图形分析及相关参数较对照组无统计学意义。2.观察组恢复期TBFV图形分析正常17例、阻塞性改变8例,较对照组正常26例、阻塞性改变3例,经χ2检验P0.05,有统计学意义。观察组恢复期达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)较对照组低,经t检验有统计学意义(P0.05)。结论观察组气道阻塞性病变恢复较对照组慢,喘息可影响支气管肺炎患儿气道阻塞性功能障碍的恢复。     

潮气呼吸测定分析毛细支气管炎婴儿通气功能

目的　了解毛细支气管炎患儿通气功能状况、通气功能障碍类型及气道阻塞程度。方法　采用德国耶格公司的MasterScreen肺功能测定仪,测定74例毛细支气管炎患儿急性期潮气呼吸功能,分析潮气呼吸流速容量(TBFV)环、每千克体重潮气量(VT/kg)、呼吸频率(RR)、吸呼比(Ti/Te)、达峰时间比(TPF %TE)、达峰容积比(VPF %VE) ,确定通气功能状况、通气功能障碍类型及气道阻塞程度。结果　每千克体重潮气量下降,呼吸频率加快,达峰时间比和达峰容积比下降。TBFV环呈阻塞性改变40例(54 .1 % )、限制性改变6例(8.1 % ) )、混合性改变2 3例(31 .1 % )、正常5例(6 .8% )。轻度阻塞1 5例(2 3 .8% ) ,中度阻塞2 5例(39.7% ) ,重度阻塞2 1例(33.3 % ) ,极重度阻塞2例(3 .2 % )。结论　毛细支气管炎患儿存在明显通气功能异常,主要为阻塞性和混合性通气功能障碍。气道以中重度阻塞为主。     

非紫绀型先天性心脏病儿童术前潮气呼吸肺功能研究

目的:探讨非紫绀型先天性心脏病儿童术前潮气呼吸肺功能相关参数改变及其影响因素。方法:选择非紫绀型先天性心脏病儿童107例为研究对象,健康体检儿童48例为对照组,分别进行潮气呼吸肺功能检查。先天性心脏病儿童介入术中测定肺动脉平均压,并分别采集上腔静脉、肺动脉及主动脉(或左心房)血检测血氧饱和度及血红蛋白;按肺动脉平均压分为非肺高压组65例和肺高压组42例,并计算血流动力学指标。将3组儿童肺功能进行比较,对先天性心脏病儿童血流动力学指标与肺功能参数进行相关性分析。结果:从对照组、非肺高压组到肺高压组,每分钟通气量(MV)、潮气呼气峰流速(PTEF)、潮气峰流速/潮气量(PF/VE)水平逐渐增高,达峰时间(TPTEF)、达峰时间比(TPTEF/TE)、达峰容积(VPTEF)和达峰容积比(VPEF/VE)水平则逐渐降低,差异有统计学意义(P0.05)。肺动脉平均压与PF/VE、RR、Ti/Te呈正相关(r=0.31、0.25、0.257,P0.05),与TPTEF、Te呈负相关(r=-0.26、-0.283,P0.05);肺血管阻力与PF/VE、RR、Ti/Te呈正相关(r=0.306、0.247、0.218,P0.05),与MV、Ti、Te呈负相关(r=-0.205、-0.207、-0.264,P0.05)。结论:非紫绀型先天性心脏病儿童存在阻塞性通气功能障碍,随着肺动脉平均压力及肺血管阻力的升高,可合并限制性通气功能障碍。     

采用环抱式体位行早产儿肺功能检查的效果观察

目的探讨环抱式体位在提高早产儿肺功能检查成功率中的效果。方法应用德国Jaeger Master Screen肺功能仪对90例早产儿进行潮气呼吸肺功能检测,对实验组(采用环抱式体位)和对照组(采用传统平卧位)进行平行对比,分析两组肺功能检查所用的时间及二次重复检查率。结果两组患儿肺功能检查所用时间比较,实验组明显短于对照组(P0.05),二次重复检查率实验组明显低于对照组(P0.05)。结论环抱式体位能提高早产儿肺功能检查的顺利性和检查结果的可靠性、客观性。     

Influence of breathing frequency and tidal volume on cardiac output

The aim of our experiment was to investigate the influence of increasing either breathing frequency or tidal volume on cardiac output (Q), in normocapnia. We measured Q with a CO2 rebreathing method in 6 men and 6 women in the sitting and the supine position, imposing different breathing patterns: in one set of experiments tidal volume was kept constant at 1 L while breathing frequency was randomly changed between 20, 30 and 40 breaths/min; in another breathing frequency was kept constant at 30 breaths/min while tidal volume was randomly altered between 1, 1.5 and 2 L. Switching from open circuit breathing to rebreathing (for measurement of Q) required no change in breathing pattern. From the beginning, CO2 was added to the inspired gas to maintain end-tidal FCO2 at 0.054, so as to obtain steady state conditions throughout the measurements. Q rose significantly when tidal volume was increased (938 ml/L rise in tidal volume when sitting, and 743 ml/L when supine). Breathing frequency had an insignificant effect (213 ml/10 breaths frequency increase when sitting and 142 ml/10 breaths when supine). The greater influence of ventilation on Q when sitting than when supine is best explained by the fact that in the latter position venous return is already high. There are no demonstrable differences in this effect between males and females.     

Pulmonary mechanics and gas exchange: Effect of lateral positioning during recovery from respiratory distress syndrome

Sixteen stable intubated premature infants without a clinically significant patent ductus arteriosus were studied during recovery from respiratory distress syndrome in order to determine the effects of left and right lateral, as compared to supine, positioning. Pulmonary mechanics were measured for spontaneous breaths 5 and 15 minutes after positioning, and arterial blood gases 15 minutes after positioning. Infants were randomized to 1 of 2 position sequences: (1) supine, left, supine, right or (2) supine, right, supine, left. No significant differences were detected between positions for dynamic compliance, tidal volume/kg, and total, inspiratory and expiratory pulmonary resistance. Likewise, no significant differences in Pa_O2 or Pa_CO2, were detected between the positions. The sequence of positions did not affect the pulmonary mechanics of spontaneous breaths or arterial blood gases. This suggest that short-term lateral positioning as well as supine positioning can be utilized without deleterious effects on pulmonary mechanics and gas exchange in neonates recovering from respiratory distress syndrome. © 1993 Wiley-Liss, Inc.     

Effect of a Soft Boston Orthosis on pulmonary mechanics in severe cerebral palsy.

Spinal braces such as the Soft Boston Orthosis (SBO) help stabilize scoliosis and improve sitting, positioning, and head control in individuals with cerebral palsy. However, their impact on pulmonary mechanics in this population has not been studied. We examined the effect of a Soft Boston Orthosis on the pulmonary mechanics and gas exchange in 12 children and young adults (5-23 years of age) with severe cerebral palsy. Pulmonary resistance, compliance, tidal volume, minute ventilation, work of breathing, oxygen saturation, and end-tidal CO2 tension were measured with the subjects seated both with and without the orthosis and in the supine position without the orthosis. There were no significant differences in the measured parameters when comparing subjects with and without their orthoses in the sitting or in the supine position. As would be expected in individuals with severe cerebral palsy, pulmonary resistance was increased (7.33 cm H2O/L/s) and compliance was decreased (0.12 L/cm H2O) compared to reported normal values. Work of breathing was greatest in the sitting position without the orthosis (1.2 dynes/cm), suggesting that the improved positioning achieved with the orthosis may decrease the work of breathing. We conclude that the application of a Soft Boston Orthosis does not impact negatively on pulmonary mechanics and gas exchange in young people with severe cerebral palsy.     

睡眠对慢性阻塞性肺疾病患者上气道阻力的影响

目的 探讨睡眠对慢性阻塞性肺疾病(COPD)患者上气道阻力及呼吸动力学的影响.方法 选择19例COPD急性加重期住院患者,治疗后病情稳定,通过食道-胃囊管法,检测气道开口压、食道压和胃内压,层流速仪测呼吸流速和容量改变.同步监测多导睡眠图,采集患者在清醒、睡眠仰卧及侧卧位呼吸动力学的变化.结果 睡眠时吸气峰流速、平均吸...     

Effect of posture on ventilation and breathing pattern during room air breathing at rest

We measured minute ventilation (VE), tidal volume (VT), mean inspiratory flow (VT/TI), and occlusion pressure (P.1) in 10 resting subjects breathing room air, in sitting, supine, right and left lateral positions, and compared them with corresponding data on static lung compliance [Cst(l)], dynamic lung compliance [Cdyn(l)], and pulmonary flow resistance [R(l)]. Highest values for VT, VE, VT/TI, P.1, and effective inspiratory impedance [P.1/(VT/Ti)] were observed in the supine posture. Values for P.1 and P.1/(VT/TI in lateral decubitus were intermediate to those obtained when seated and supine. While the increases in P.1 and P.1/(VT/TI) in recumbent postures were qualitatively similar to the decrease in Cdyn(l) and increase in R(l), there was no significant correlation between them, probably reflecting the complex relationship between P.1/(VT/TI) and lung compliance and resistance, as the former, in addition to lung mechanics, also depends on the shape of the inspiratory driving pressure wave, the active inspiratory impedance, the mechanics of the chest wall, and the duration of inspiration.     

Effects of supine and lateral positions on cardiac output and intracardiac pressures: an experimental study

Hemodynamic measurements in human subjects and in experimental animals are generally made in the supine position; not much attention is paid to potential beneficial or harmful effects of right or left lateral positions on cardiac output or other hemodynamic variables. To evaluate the potential influence of such positional changes on cardiac performance, we measured cardiac output and left and right ventricular pressures (with micromanometer catheters) in anesthetized experimental animals (eight dogs and nine pigs) in the supine, right lateral, and left lateral positions. Cardiac output increased from supine to left lateral (mean +/- SD, 2.6 +/- 0.9 to 3.1 +/- 1.0 liters/min; p less than .001) and from supine to right lateral positions (2.6 +/- 0.9 to 3.1 +/- 1.1 liters/min; p less than .001). There was an associated decrease in arteriovenous oxygen saturation difference from supine to left lateral position (31 +/- 8% to 24 +/- 4%; p less than .001) and from supine to right lateral position (32 +/- 9% to 25 +/- 6%; p less than .001). Left ventricular systolic and end-diastolic pressures increased from supine to left lateral (128 +/- 17/9 +/- 2 to 147 +/- 19/16 +/- 4 mm Hg; both p less than .001) and from supine to right lateral positions (128 +/- 19/9 +/- 2 to 141 +/- 16/16 +/- 7 mm Hg; p less than .01 and p less than .001, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of positional changes on inferior vena caval size and dynamics and correlations with right-sided cardiac pressure

Effects of supine and lateral positions on the size and shape of the inferior vena cava (IVC) were studied in 30 normal persons and in 53 patients with cardiac disease undergoing right-sided cardiac catheterization. In normal subjects, mean values for both IVC diameter and area decreased significantly (p less than 0.01) from the right lateral (22 +/- 3 mm and 3.9 +/- 0.6 cm2, respectively) to the supine position (15 +/- 5 mm; 1.8 +/- 0.9 cm2) to the left lateral position (7 +/- 3 mm; 0.8 +/- 0.4 cm2). IVC shape was round in the right lateral, oval in the supine, and slit-like in left lateral position. In the 53 patients, significant differences in IVC diameter and area were also detected in all 3 positions. However, when separated into 2 groups according to right atrial pressure, patients with normal pressure (8 mm Hg or less) had diameter and area values equivalent to those of normal subjects, whereas patients with elevated right atrial pressure (more than 8 mm Hg) had supine and left lateral IVC diameters and areas that were larger than normal, and approximately equivalent: diameters--23 +/- 3 mm (right), 18 +/- 5 mm (supine) and 17 +/- 7 mm (left); areas--4.1 +/- 0.8 cm2 (right), 3.3 +/- 1.2 cm2 (supine) and 3.1 +/- 1.3 cm2 (left). IVC diameters and areas in all 3 positions correlated with mean right atrial pressure, measured subsequently in the supine position, but the left lateral position provided the strongest correlations (r = 0.85, IVC diameter vs right atrial pressure; r = 0.89, IVC area vs right atrial pressure).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of disease activity and position on autonomic nervous modulation in patients with systemic lupus erythematosus

Patients with systemic lupus erythematosus (SLE) are known to have lower heart rate variability and impaired vagal modulation, and right lateral position has been shown to lead to a higher vagal modulation than supine position in healthy subjects and patients with cardiovascular diseases. This study evaluated the effect of disease activity and different recumbent positions on cardiac autonomic nervous modulation by heart rate variability analysis in patients with SLE. Thirty-five female patients with SLE and 33 female controls were enrolled in this study. Electrocardiogram was recorded during supine, left lateral, and right lateral positions for 15 min. Both time and frequency domains heart rate variability measures were calculated. The normalized high-frequency power was used as the index of vagal activity, and the low-/high-frequency power ratio as the index of sympathovagal balance. We found that patients with SLE had lower indices of time domain heart rate variability measures and lower low-frequency power, high-frequency power, and normalized high-frequency power than control subjects. SLE patients with lower serum albumin had lower normalized high-frequency power and higher low-/high-frequency power ratio. In patients with SLE, right lateral position could lead to higher high-frequency power, normalized high-frequency power, and lower low-/high-frequency power ratio than supine position. In addition, the lower the normalized high-frequency power in supine position the patient had, the greater the increase in normalized high-frequency power when the position of the patient was changed from supine to right lateral. Thus, serum albumin level might be used as a potential disease severity index of SLE, and right lateral position can lead to higher vagal modulation and lower sympathetic modulation, renin–angiotensin–aldosterone modulation, and vagal withdrawal than supine position in patients with SLE. Right lateral position can be used as an efficient and physiological vagal enhancer in SLE patients with depressed vagal modulation.     

Pulmonary gas trapping increases in asthmatic children and adolescents in the supine position

This study aimed to see if gas trapping or ventilation inhomogeneity during tidal breathing increases in young asthmatic subjects when recumbent over a period of 1 hr. Ten asthmatic children and teenagers and 12 control subjects performed tidal breathing multiple-breath N(2)-washout in the sitting position and immediately, 30 min, and 60 min after assuming the supine position. The asthma group also performed the same lung function tests on another day, but then remained in the sitting position throughout. When assuming the supine position, both groups showed significant falls in vital capacity (4-8%) and in functional residual capacity (FRC) (>20%). Gas trapping increased significantly after 30 and 60 min in the supine position only in the asthma group, but other indices of ventilation inhomogeneity did not change with body position. When in the supine position, the trapped gas volume was on average 10% of FRC in the asthma group, which was twice as much as when sitting and three times higher than in supine control subjects. It is concluded that assuming the supine position leads to increased gas trapping in young asthmatics but not in healthy subjects; this could be one of several mechanisms that contribute to nocturnal worsening of asthma.     

全肺切除术后保护性通气体会

目的探讨行一侧全肺切除术后患者的呼吸支持。方法分析56例一侧全肺切除术后患者呼吸机的应用,20例采用传统呼吸参数设置潮气量(vt):8～12 ml/kg;36例患者采用新呼吸参数设置潮气量(vt):左侧全肺切除潮气量(vt)设置:6～8 ml/kg,右侧全肺切除潮气量(vt)设置:5～7 ml/kg。结果20例采用传统呼吸参数设置潮气量患者中,发生气胸6例,支气管胸膜瘘3例,死亡2例;36例患者采用新呼吸参数设置潮气量患者中:发生气胸2例,支气管胸膜瘘1例,无死亡。结论全肺切除术后采取保护性通气可减少术后并发症的发生率,帮助患者稳定度过围术期。