van Aalderen W M, Postma D S, Koëter G H, Knol K
Department of Pediatrics, University Hospital, Groningen, The Netherlands.
Acta Paediatr Scand. 1988 Mar;77(2):269-74. doi: 10.1111/j.1651-2227.1988.tb10641.x.
We investigated in well controlled asthmatic children whether it is possible to predict by measuring daytime forced expiratory volume in one second, the decline in nocturnal peak expiratory flow rate values after withdrawal of maintenance medication. Forced expiratory volume in one second and peak expiratory flow rate were measured in the outpatient clinic, on the last day with medication. Peak expiratory flow rates were then measured every four hours on days 4, 5 and 6 without medication. Seventeen children showed an amplitude in circadian peak expiratory flow rate values of more than 20% (group I) and nine children showed an amplitude of 20% or less on the three study days (group II). Mean values +/- SEM were 34.7 +/- 2.1% and 10.5 +/- 1.5%, respectively. Forced expiratory volume in one second values were comparable in both groups. Daytime peak expiratory flow rate values before and after withdrawal, remained on the same level in both groups. In group I peak expiratory flow rate values of 24.00 and 08.00 hours on day 6 were significantly lower (p less than 0.05) than on day 4. The results indicate that history and daytime pulmonary function measurements alone, are insufficient to assess the clinical situation and suggest that a decrease in early morning peak expiratory flow rate value (08.00 hours) is an early sign of deterioration of the disease state, after reduction of medication.
我们对病情得到良好控制的哮喘儿童进行了研究，探讨通过测量日间一秒用力呼气量，是否有可能预测在停用维持药物后夜间呼气峰值流速值的下降情况。在门诊，于使用药物的最后一天测量一秒用力呼气量和呼气峰值流速。然后在停药后的第4、5和6天，每4小时测量一次呼气峰值流速。17名儿童的昼夜呼气峰值流速值振幅超过20%（第一组），9名儿童在三个研究日的振幅为20%或更低（第二组）。平均值±标准误分别为34.7±2.1%和10.5±1.5%。两组的一秒用力呼气量值相当。两组在停药前后的日间呼气峰值流速值均保持在同一水平。在第一组中，第6天24:00和08:00时的呼气峰值流速值显著低于第4天（p<0.05）。结果表明，仅根据病史和日间肺功能测量不足以评估临床状况，并提示在减少药物用量后，清晨呼气峰值流速值（08:00时）下降是疾病状态恶化的早期迹象。
