Aebischer C Casaulta
Pädiatrische Pneumologie, Medizinische Universitäts-Kinderklinik, Inselspital, Bern.
Praxis (Bern 1994). 2002 Mar 20;91(12):503-7. doi: 10.1024/0369-8394.91.12.503.
In the majority of patients with respiratory disease, the most important diagnostic information can be obtained just by taking a thorough medical history and appraising the general clinical status. Lung function is a valuable tool in routine practice for assessing the general status at the beginning of treatment, for evaluating the clinical course and for documenting the response to therapy. The parameters measured by spirometry are read as volume (liter) or volume per unit of time (flow). If a spirometer is used in pediatrics, its measurements should be linear, within the range of the flow rates achieved by children. Spirometry does not provide information about the respiratory status in the resting state. If pulmonary overinflation or restriction is suspected (for example in patients with cystic fibrosis), a whole-body plethysmograph must be performed in addition to spirometry. Because their cooperation is required, children under the age of 5-6 cannot be given spirometric examinations. The younger the subject, the more important it is that the examiner has experience in dealing with children as well as experience in interpreting lung function readings. By far, not all children have the physical or pulmonary development required to understand how to exhale deeply or forcibly enough. As soon as they start breathing consciously, they will tend to breath flatter and quicker. Therefore, it is worth while for the examining physician to perform the breathing maneuver several times himself in front of the child to show them how it is done and have them practice before the measurement. It is imperative that a curve of the dynamics of the resulting time/flow volume be made available. The curve configuration enables diagnosis and allows assessment of the patient's cooperation. The readings are then used for quantifying analysis.
在大多数呼吸系统疾病患者中,仅通过全面的病史采集和评估一般临床状况,就能获得最重要的诊断信息。肺功能是日常实践中的一项重要工具,可用于在治疗开始时评估总体状况、评估临床病程以及记录治疗反应。通过肺活量测定法测量的参数以体积(升)或单位时间的体积(流量)来读取。如果在儿科使用肺活量计,其测量结果应呈线性,且在儿童所能达到的流速范围内。肺活量测定法无法提供静息状态下的呼吸状况信息。如果怀疑存在肺过度充气或受限情况(例如囊性纤维化患者),除了肺活量测定法外,还必须进行全身体积描记法检查。由于需要儿童配合,5 - 6岁以下的儿童无法进行肺活量测定检查。受试者年龄越小,检查者具备处理儿童的经验以及解读肺功能读数的经验就越重要。到目前为止,并非所有儿童都具备理解如何充分深呼气或用力呼气所需的身体或肺部发育水平。一旦他们开始有意识地呼吸,就往往会呼吸更浅更快。因此,检查医生值得在孩子面前亲自进行几次呼吸动作示范,向他们展示如何做,并让他们在测量前练习。必须提供所得时间/流量体积动态曲线。曲线形态有助于诊断并能评估患者的配合情况。然后将读数用于定量分析。