支氣管哮喘病之最大呼氣流量容積曲線之研究

Evaluation of Maximal Expiratory Flow-Volume Curve in Bronchial Asthma

沈建業(C. Y. Shen) ； 謝遠清(Y. C. Hsieh) ； 汪大衛(D. Wang)

《Journal of Medical Sciences》 4卷1期 (1981/07) Pp. 1133-1141

摘要

本研究利用30位健康成年人與47位支氣管哮喘之患者，觀察其最大呼氣流量容積曲線變化之情形。使用美製Model 5000 Pul. Lab.以及Collin's 13.5L.肺量計，根據Gaensler及Wright使用每分鐘最大志願通氣量數值變化，以為呼吸道阻塞程度之分類標準。根據此項測定結果發現，患支氣管性哮喘病人之最大呼氣流量容積曲線圖形，在不同肺容積下之呼氣流量均較正常人為低，當阻塞愈嚴重時其PFR，FEF50，FEF75，VC，FEV1%，MEFR，MMF值亦愈低，且最大呼氣流量容積曲線圖形，隨病情嚴重程度而有顯著之改變。如所週知，迄今為止，所有肺功能檢查均非特定性者，但如前述各項檢查，則已為舉世公認測定呼吸道阻力正常與否方法之一。而支氣管性氣喘病與慢性氣管炎相似，其主要生理病理變化之一，即在於呼吸道阻力之增加，因以表現許多臨床症狀與肺功能之異常。故測定上述各種肺功能檢查，特別是測定最大呼氣流量容積曲線圖形之改變，即可確定其人之呼吸道阻力是否增加及其病變部位，係在胸腔外或胸腔內之氣管，如再佐以臨床病史，物理檢查，以及X光照片，與其他檢驗室檢查之綜合判斷，即可推測此項呼吸道阻力之增加，是否由支氣管性哮喘所引起，抑或由其他慢性阻塞性肺病，如慢性氣管炎等引起而加以鑑別。同時並可藉此進一步鑑定其嚴重程度，站在臨床觀點而言，如用於兵役體驗，則更可鑑定其體位等級，以為徵兵選擇之標準。

並列摘要

The changes of maximal expiratory flow-volume curve (MEFVC) were evaluated in 30 healthy adults and 47 patients with clinical diagnosis of bronchial asthma. The MEFVC and the ventilatory function tests were performed by the Model 5000 Pul. Lab. and the Collin's 13.5 respirometer. The value of MVV which was recommended by Gaensler and Wright was used as the criterion for classificaiton of obstructive ventilatory impairment. It was found that the maximal expiratory airflow at different lung volumes in asthematic patients were markedly decreased compare to that in normal subjects. The values of PFR, FEF50, FEF75, and VC as well as MEFR and MMF were also significantly changed as the airway obstruction became more severe in patients with bronchial asthma, especially the MEFVC pattern. So far as we know all pulmonary function tests are nonspecific. However, the above mentioned tests are recognized by the public as a group of tests for the determination of airway obstruction whether normal or not. Bronchial asthma, similar to the chronic bronchitis, has a common pathophysiological change in increasing the obstruction of the airway, so as to produce many clinical symptoms and abnormal pulmonary function tests. When the pulmonary function test is determined, especially the determination of MEFVC pattern, together with clinical history, physical examination, and chest X-ray, as well as other laboratory tests, we may ascertain and differentiate whether his increase in airway obstruction is due to bronchial asthma or other chronic obstructive pulmonary disease such as chronic bronchitis, and then classify his degree of severity or impairment. Furthermore, at the clinical point of view, we may also use this test to classify the status of health and the standard of fitness for a military-service man.