Gershel J C, Goldman H S, Stein R E, Shelov S P, Ziprkowski M
N Engl J Med. 1983 Aug 11;309(6):336-9. doi: 10.1056/NEJM198308113090603.
To assess the value of routine chest radiography during acute first attacks of asthma, we studied 371 consecutive children over one year of age who presented with an initial episode of wheezing. Three hundred fifty children (94.3 per cent) had radiographic findings that were compatible with uncomplicated asthma and were considered negative. Twenty-one (5.7 per cent) had positive findings: atelectasis and pneumonia were noted in seven, segmental atelectasis in six, pneumonia in five, multiple areas of subsegmental atelectasis in two, and pneumomediastinum in one. The patients with positive films were more likely to have a respiratory rate above 60 or a pulse rate above 160 (P less than 0.001), localized rales or localized decreased breath sounds before treatment (P less than 0.01), and localized rales (P less than 0.005) and localized wheezing (P less than 0.02) after treatment; also, these patients were admitted to the hospital more often (P less than 0.001). Ninety-five per cent (20 of 21) of the children with positive films could be identified before treatment on the basis of a combination of tachypnea, tachycardia, fever, and localized rales or localized decreased breath sounds. Most first-time wheezers will not have positive radiographs; careful clinical evaluation should reveal which patients will have abnormal radiographs and will therefore benefit from the procedure.
为评估常规胸部X线检查在哮喘急性首次发作时的价值，我们对371名年龄超过1岁、首次出现喘息发作的连续患儿进行了研究。350名患儿（94.3%）的X线检查结果与单纯性哮喘相符，被视为阴性。21名患儿（5.7%）有阳性结果：7名患儿出现肺不张和肺炎，6名患儿出现节段性肺不张，5名患儿出现肺炎，2名患儿出现多个亚段性肺不张区域，1名患儿出现纵隔气肿。胸片阳性的患者更有可能呼吸频率超过60次/分或脉搏率超过160次/分（P<0.001），治疗前有局限性啰音或局限性呼吸音减弱（P<0.01），治疗后有局限性啰音（P<0.005）和局限性哮鸣音（P<0.02）；此外，这些患者住院的频率更高（P<0.001）。95%（21名中的20名）胸片阳性的患儿在治疗前可根据呼吸急促、心动过速、发热以及局限性啰音或局限性呼吸音减弱的组合进行识别。大多数首次喘息患儿的胸片不会呈阳性；仔细的临床评估应能揭示哪些患者的胸片会异常，从而将从该检查中获益。
