Brenner B E, Abraham E, Simon R R
Am J Med. 1983 Jun;74(6):1005-9. doi: 10.1016/0002-9343(83)90802-1.
Presence of pulsus paradoxus, PCO2, sternocleidomastoid retraction, and flow rates have been used at the bedside to assess the severity of acute asthma. In our study of 49 adult patients, pulse rate, respiratory rate and pulsus paradoxus were shown to be significantly higher in patients assuming the upright position on admission to the emergency center; arterial pH, PO2, and peak expiratory flow rate were significantly lower in the upright patients. All upright patients had sternocleidomastoid retraction. Peak expiratory flow rate was 73.3 +/- 5 liters per minute in diaphoretic patients, 134 +/- 21 liters per minute in non-diaphoretic, upright patients, and 225 +/- 7.5 liters per minute in recumbent patients (p less than 0.02). No recumbent patient had a peak expiratory flow rate of less than 150 liters per minute or a PCO2 of greater than 44 mm Hg. The index of Fischl, signifying a need for admission to the hospital if greater than 4, was 4 or higher in 70 percent of upright patients and in 88 percent of diaphoretic patients. Only 7 percent of recumbent patients had Fischi indexes of greater than 4.
奇脉、二氧化碳分压（PCO2）、胸锁乳突肌回缩和流速已被用于床边评估急性哮喘的严重程度。在我们对49名成年患者的研究中，显示急诊中心入院时采取直立位的患者，其脉搏率、呼吸频率和奇脉显著更高；直立位患者的动脉pH值、氧分压（PO2）和呼气峰值流速显著更低。所有直立位患者均有胸锁乳突肌回缩。出汗患者的呼气峰值流速为每分钟73.3±5升，无汗直立位患者为每分钟134±21升，卧位患者为每分钟225±7.5升（p<0.02）。没有卧位患者的呼气峰值流速低于每分钟150升或PCO2高于44毫米汞柱。菲施尔指数大于4表示需要住院治疗，70%的直立位患者和88%的出汗患者该指数为4或更高。只有7%的卧位患者菲施尔指数大于4。
