Gorelick Marc H, Stevens Molly W, Schultz Theresa, Scribano Philip V
Section of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA.
Pediatr Emerg Care. 2004 Jan;20(1):22-6. doi: 10.1097/01.pec.0000106239.72265.16.
To determine the frequency with which children >or=6 years with acute asthma can perform peak expiratory flow rate measurements (PEFR) in an emergency department (ED).
DESIGN/METHODS: Data were obtained from a prospective cohort study of children with acute asthma. All children (age 2-18 years old) treated in an urban pediatric ED for an acute exacerbation during randomly selected days over a 12-month period were prospectively evaluated. According to treatment protocols, PEFR was to be measured in all children age 6 years and older before therapy and after each treatment with inhaled bronchodilators. Registered respiratory therapists obtained PEFR and evaluated whether patients were able to perform the maneuver adequately.
Four hundred and fifty-six children, 6 to 18 years old (median 10 years), were enrolled; 291 (64%) had PEFR measured at least once. Of those in whom PEFR was attempted at least once, only 190 (65%) were able to perform adequately. At the start of therapy, 54% (142/262) were able to perform PEFR. Of the 120 who were unable to perform initially, 76 had another attempt at the end of the ED treatment, and 55 (72%) were still unable to perform. A total of 149 patients had attempts at PEFR both at the start and end of treatment, of these, only 71 (48%) provided valid information on both attempts. Patients unable to perform PEFR were younger (mean +/- SD = 8.7 +/- 2.8 years) than those who were able to perform successfully (11.2 +/- 3.2 years) and those with no attempts (10.0 +/- 3.4 years). Children admitted to the hospital were more likely to be unable to perform PEFR (58/126 = 46%) than those discharged from the ED (43/330 = 13%, P < 0.0001).
Adequate PEFR measurements are difficult to obtain in children with acute asthma. Treatment and research protocols cannot rely exclusively on PEFR for evaluation of severity.
确定6岁及以上急性哮喘患儿在急诊科（ED）进行呼气峰值流速（PEFR）测量的频率。
设计/方法：数据来自一项关于急性哮喘患儿的前瞻性队列研究。对在12个月期间随机选定的日子里因急性加重在城市儿科急诊科接受治疗的所有儿童（年龄2 - 18岁）进行前瞻性评估。根据治疗方案，所有6岁及以上儿童在治疗前以及每次吸入支气管扩张剂治疗后均应测量PEFR。注册呼吸治疗师获取PEFR并评估患者是否能够充分完成该操作。
纳入了456名6至18岁（中位数10岁）的儿童；291名（64%）至少进行了一次PEFR测量。在那些至少尝试进行一次PEFR测量的儿童中，只有190名（65%）能够充分完成该操作。在治疗开始时，54%（142/262）的儿童能够进行PEFR测量。在最初无法进行测量的120名儿童中，76名在急诊科治疗结束时再次尝试，其中55名（72%）仍然无法完成。共有149名患者在治疗开始和结束时都尝试进行PEFR测量，其中只有71名（48%）在两次尝试中均提供了有效信息。无法进行PEFR测量的患者比能够成功完成测量的患者（平均±标准差 = 11.2 ± 3.2岁）以及未尝试测量的患者（10.0 ± 3.4岁）年龄更小（平均±标准差 = 8.7 ± 2.8岁）。入住医院的儿童比从急诊科出院的儿童更有可能无法进行PEFR测量（58/126 = 46% 对比 43/330 = 13%，P < 0.0001）。
在急性哮喘患儿中很难获得充分的PEFR测量结果。治疗和研究方案不能仅仅依赖PEFR来评估病情严重程度。
