Page 71 - 2022-32-中国全科医学

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1.The First Affiliated Hospital of Guangzhou Medical University/National Clinical Research Center of Respiratory Disease/National
Respiratory Medical Center，State Key Laboratory of Respiratory Disease/Guangzhou Institute of Respiratory Health，Guangzhou
510120，China
2.Department of Pediatrics，the First Affiliated Hospital of Guangzhou Medical University，Guangzhou 510120，China
*
Corresponding author：ZHENG Jinping，Professor；E-mail：jpzhenggy@163.com
【Abstract】 Background Measurement of lung function during tidal breathing is an important method in the
diagnosis，management and severity assessment for infants with respiratory diseases. Nasal obstruction is a common comorbidity
of respiratory tract infections，and severe nasal obstructionmay affect the results of pulmonary function test. Objective To assess
the association of nasal obstruction with pulmonary function and airway resistance during tidal breathing，and to evaluate the effect
of normal saline nasal drops on relieving nasal congestion and improving pulmonary function in infants with wheezing. Methods
A total of 55 children with wheezing were included，including wheezing with nasal congestion in 25 cases and wheezing without
nasal congestion in 30 cases. Fifty-five infants with wheezing as the chief symptom who were treated in the First Affiliated Hospital
of Guangzhou Medical University were retrospectively selected from June 2015 to May 2016. They received the measurement of
pulmonary function during tidal breathing，respiratory resistance using the respiratory resistance tester with single-breath method
and body plethysmography. Nasal obstruction was assessed，and those with three points were excluded，the remaining infants
with 0 and 1-2 points were assigned to wheezing without nasal obstruction group（n=30），wheezing with nasal obstruction group
（n=25），respectively. Baseline lung functions were compared between wheezing with nasal obstruction group before nasal
obstruction treatment and without nasal obstruction group. And pulmonary functions of wheezing with nasal obstruction group
were compared before and after nasal obstruction treatment. Results Wheezing infants with nasal obstruction had higher specific
effective airway resistance（sReff） and effective airway resistance（Reff）than those without （P<0.05）. The ratio of the
proportion of time to reach peak tidal expiratory flow to total expiratory time（TPTEF/TE）〔（24.58±6.15）% vs. （21.12±4.16）%〕
and the ratio of the volume until peak expiratory flow to the total expiratory volume （VPEF/VE） 〔（26.38±5.19）% vs.
（22.98±3.75）%〕 improved significantly in wheezing infants with nasal obstruction after nasal obstruction was relieved by
treatment compared to the baseline（P<0.05）. The respiratory resistance （RrsSO），sReff and Reff decreased significantly in
wheezing infants with nasal obstruction after nasal obstruction was relieved compared to the baseline （P<0.05）. Conclusion
Nasal obstruction could increase the airway resistance（sReff and Reff） in wheezing infants. Pre-test nasal secretion clearance is
one criterion in quality control of pulmonary function tests. Nasal obstruction caused by secretions could be effectively relieved by
liquefying the secretions with a few drops of normal saline. The tidal breathing parameters（TPTEF/TE and VPEF/VE ratios） and
airway resistance parameters（RrsSO，sReff and Reff）were improved after nasal obstruction was relieved.
【Key words】 Nasal obstruction；Respiratory insufficiency；Tidal breathing function test；Plethysmography；Airway
resistance；Nasal drops

鼻塞是婴幼儿常见的体征，肺功能检查过程中常能 响镇静效果的方法，是鼻塞患儿完成肺功能检查的关键。
发现。由于婴幼儿鼻腔发育尚未成熟，鼻腔、后鼻道相 本研究采用 0.9% 氯化钠溶液滴鼻、鼻腔分泌物清理及
对较窄，鼻黏膜血管丰富，感染或受冷空气刺激后易出 改变体位法以减轻鼻塞，通过体积描记法肺功能检查评
现流鼻涕、鼻塞 ［1］ 。研究表明使用麻黄碱滴鼻剂可有 估此种鼻塞缓解方法的有效性，为肺功能检查过程中的
效解除鼻塞，改善潮气呼吸功能 ［2］ 。但麻黄碱为拟肾 鼻塞处理提供实践依据。
上腺素，可直接激动血管平滑肌的 α、β 受体，使皮肤、 1 对象与方法
黏膜及内脏血管收缩，具有一过性轻微烧灼感、干燥感、 1.1 研究对象 回顾性分析 2015 年 6 月—2016 年 5
心率增快等不良反应 ［3］ 。研究发现 0.9% 氯化钠溶液鼻 月在广州医科大学附属第一医院就诊的以喘息为主诉
腔冲洗可有效清除鼻腔分泌物及炎性因子 ［4-5］ ，减轻患 的婴幼儿的临床资料，年龄 5 月龄 ~36 月龄，身长
儿流涕、鼻塞症状，无不良反应 ［6］ 。鼻腔冲洗法是患 <90 cm，平卧位时可置于体描箱内并关闭仓门。排除有
儿取仰卧位，医护人员在患儿的一侧鼻孔缓慢注入 0.9% 鼻中隔偏曲、鼻息肉，腺样体肥大、鼻黏膜水肿等引起
氯化钠溶液，另一侧鼻孔持续用负压进行吸引，直至无 上呼吸道阻塞疾病病史的患儿。本研究通过广州医科大
分泌物吸出 ［7］ 。这种操作方法易引起患儿哭闹、挣扎， 学附属第一医院科研项目审查伦理委员会审批（批号：
不利于对其进行镇静前睡眠剥夺，对于需要进行肺功能 医科伦审 2015 第 35 号）。受试者家长阅读并签署知情
检查的鼻塞患儿并不适用，因此，有效缓解鼻塞且不影 同意书。