Madsen F, Ulrik C S, Dirksen A, Hansen K K, Nielsen N H, Frølund L, Viskum K, Kok-Jensen A
Department of Pulmonary Medicine, Rigshospitalet, Copenhagen, Denmark.
Respir Med. 1996 Mar;90(3):131-8. doi: 10.1016/s0954-6111(96)90154-7.
The launching of cheap, pocket-sized spirometers, with data storage capability, has made patient-administered sequential spirometry (PASS) an attractive method of monitoring ventilatory capacity. At present, little information is available on the quality of PASS, compared to laboratory spirometry. The aim of this study was to investigate whether patients could perform PASS without loss of reliability and reproducibility as compared with traditional laboratory spirometry. Ten healthy volunteers performed spirometry for 1 month and 10 emphysematous patients with alpha 1-antitrypsin deficiency (type PiZ) performed spirometry twice daily for up to 2 yr. To fulfil Good Clinical Practice criteria on full data documentation, a traditional direct recording spirometer, the Vitalograph R-model, was used. A decompression device was used for calibration and a 3.8% annual drift in volume registration was noted. This drift was largest for the first year. After training, all patients were able to perform unsupervised spirometry, producing technically correct forced expiratory curves. Reproducibility of FEV1 and FVC obtained by PASS was found to be as good as for laboratory spirometry. After adjustment for the diurnal variation, the residual variation of FEV1 was 2.5% (range 1.6-4.2%) for healthy volunteers and 5.6% (range 4.2-7.7%) for emphysematous patients. Forced vital capacity showed the same pattern. In conclusion, PASS is possible in highly motivated individuals without loss of reliability and reproducibility when compared to laboratory spirometry.
具备数据存储功能的廉价袖珍肺活量计的推出，使患者自行进行的连续肺活量测定（PASS）成为一种颇具吸引力的通气功能监测方法。目前，与实验室肺活量测定相比，关于PASS质量的信息较少。本研究的目的是调查与传统实验室肺活量测定相比，患者进行PASS时是否会丧失可靠性和可重复性。10名健康志愿者进行了1个月的肺活量测定，10名α1抗胰蛋白酶缺乏症（PiZ型）的肺气肿患者每天进行两次肺活量测定，持续长达2年。为符合完整数据记录的良好临床实践标准，使用了传统的直接记录式肺活量计Vitalograph R型。使用减压装置进行校准，发现体积记录存在3.8%的年度漂移。第一年这种漂移最大。经过培训后，所有患者都能够在无人监督的情况下进行肺活量测定，生成技术上正确的用力呼气曲线。发现PASS获得的FEV1和FVC的可重复性与实验室肺活量测定一样好。在对昼夜变化进行调整后，健康志愿者FEV1的残余变化为2.5%（范围1.6 - 4.2%），肺气肿患者为5.6%（范围4.2 - 7.7%）。用力肺活量呈现相同模式。总之，对于积极性高的个体，与实验室肺活量测定相比，进行PASS是可行的，且不会丧失可靠性和可重复性。
