Hadjikoumi Irene, Hassan Akbar, Milner Anthony D
Paediatric Department, Guy's and St. Thomas' Hospital, Guy's, King's, St. Thomas' School of Medicine, King's College, London, UK.
Pediatr Pulmonol. 2003 Dec;36(6):495-501. doi: 10.1002/ppul.10384.
The interrupter technique (Rint) is a noninvasive method for assessing respiratory resistance. The aims of this study were to assess whether upper airway support affects the measurement of Rint, if inspiratory or expiratory Rint were most reproducible, and which method of assessing Rint correlated best with spirometry results and was the most sensitive for identifying bronchodilator response. Twenty-four asthmatic children with a mean age of 10.3 years (range, 7-16 years) were included in the study. Rint measurements were obtained in inspiration and expiration with cheeks supported and unsupported. Spirometry was then performed. Rint and spirometry measurements were repeated after the inhalation of 600 mcg of salbutamol. The mean Rint supported inspiratory (0.708 KPa/l/sec) and expiratory (0.729 KPa/l/sec) values were significantly higher than the unsupported values (inspiratory, 0.622 KPa/l/sec; expiratory, 0.584 KPa/l/sec), P < 0.05 and P < 0.001, respectively. The reproducibility of Rint was not different whether cheeks were supported or not, or whether the measurements were carried out during inspiration or expiration. Cheek support improved the correlation with all the lung function results, both in inspiratory and expiratory measurements. The best correlations, however, were found for the inspiratory supported Rint results. The most sensitive method to ascertain bronchodilator response (BD) was the inspiratory supported Rint measurement, as 83.3% of children were identified as having a positive response to bronchodilator therapy as defined by a reduction of twice the coefficient of variation of the measurement. In conclusion, cheek support increases Rint but does not impact on reproducibility, though it improves the correlation with spirometric indices. Rint with cheek support on inspiration correlates best with spirometric indices and appears to be the most sensitive measure of response to bronchodilators.
间断阻断技术（Rint）是一种评估呼吸阻力的非侵入性方法。本研究的目的是评估上气道支持是否会影响Rint的测量，吸气或呼气时的Rint测量结果哪一个最具可重复性，以及哪种评估Rint的方法与肺功能测定结果相关性最佳且对识别支气管扩张剂反应最敏感。24名平均年龄为10.3岁（范围7 - 16岁）的哮喘儿童被纳入研究。在脸颊得到支撑和未得到支撑的情况下分别进行吸气和呼气时的Rint测量。然后进行肺功能测定。吸入600微克沙丁胺醇后重复进行Rint和肺功能测定。脸颊得到支撑时吸气（0.708千帕/升/秒）和呼气（0.729千帕/升/秒）的平均Rint值显著高于未得到支撑时的值（吸气，0.622千帕/升/秒；呼气，0.584千帕/升/秒），P值分别<0.05和<0.001。无论脸颊是否得到支撑，也无论测量是在吸气还是呼气时进行，Rint的可重复性并无差异。脸颊支撑改善了与所有肺功能结果的相关性，无论是吸气还是呼气测量。然而，对于吸气时得到支撑的Rint结果，相关性最佳。确定支气管扩张剂反应（BD）最敏感的方法是吸气时得到支撑的Rint测量，因为按照测量变异系数降低两倍来定义，83.3%的儿童被确定为对支气管扩张剂治疗有阳性反应。总之，脸颊支撑会增加Rint，但不影响可重复性，尽管它改善了与肺功能指标的相关性。吸气时脸颊得到支撑的Rint与肺功能指标相关性最佳，似乎是对支气管扩张剂反应最敏感的测量方法。
