Hülskamp Georg, Pillow J Jane, Dinger Jürgen, Stocks Janet
Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health and Great Ormond Street Hospital for Children National Health Service (NHS) Trust, London, UK.
Pediatr Pulmonol. 2006 Jan;41(1):1-22. doi: 10.1002/ppul.20318.
This is the second paper in a review series that will summarize available data and discuss the potential role of lung function testing in infants and young children with acute neonatal respiratory disorders and chronic lung disease of infancy. The current paper addresses the expansive subject of measurements of lung volume using plethysmography and gas dilution/washout techniques. Following orientation of the reader to the subject area, we focus our comments on areas of inquiry proposed in the introductory paper to this series. The quality of the published literature is reviewed critically, and recommendations are provided to guide future investigation in this field. Measurements of lung volume are important both for assessing growth and development of lungs in health and disease, and for interpreting volume-dependent lung function parameters such as respiratory compliance, resistance, forced expiratory flows, and indices of gas-mixing efficiency. Acute neonatal lung disease is characterized by severely reduced functional residual capacity (FRC), with treatments aimed at securing optimal lung recruitment. While FRC may remain reduced in established chronic lung disease of infancy, more commonly it becomes normalized or even elevated due to hyperinflation, with or without gas-trapping, secondary to airway obstruction. Ideally, accurate and reliable bedside measurements of FRC would be feasible from birth, throughout all phases of postnatal care (including assisted ventilation), and during subsequent long-term follow-up. Although lung volume measurements in extremely preterm infants were described in a research environment, resolution of several issues is required before such investigations can be translated into routine clinical monitoring.
这是一篇综述系列文章中的第二篇，该系列将总结现有数据，并讨论肺功能测试在患有急性新生儿呼吸系统疾病和婴儿慢性肺病的婴幼儿中的潜在作用。本文探讨了使用体积描记法和气体稀释/冲洗技术测量肺容积这一广泛主题。在引导读者了解该主题领域之后，我们将评论集中在本系列 introductory paper 中提出的探究领域。对已发表文献的质量进行了批判性审查，并提供了建议以指导该领域的未来研究。肺容积测量对于评估健康和疾病状态下肺的生长发育，以及解释诸如呼吸顺应性、阻力、用力呼气流量和气体混合效率指标等与容积相关的肺功能参数都很重要。急性新生儿肺病的特征是功能残气量（FRC）严重降低，治疗旨在确保最佳的肺复张。虽然在已确诊的婴儿慢性肺病中 FRC 可能仍然降低，但更常见的情况是由于气道阻塞继发的过度充气（无论有无气体潴留），FRC 会恢复正常甚至升高。理想情况下，从出生开始，在产后护理的所有阶段（包括辅助通气）以及随后的长期随访期间，都应能够在床边进行准确可靠的 FRC 测量。尽管在研究环境中描述了极早产儿的肺容积测量，但在将此类研究转化为常规临床监测之前，还需要解决几个问题。
