호흡기 증상을 호소하는 소아에서 기침과 천명음의 객관적 평가를 위한 기침-홀터 모니터링의 유용성
Validity of Cough-Holter Monitoring for the Objective Assessment of Cough and Wheezing in Children with Respiratory Symptoms
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목적:임상에서 기침, 천명에 대한 평가는 환자나 보호자가 호소하는 주관적인 증상과 의사의 신체 진찰을 통해 주로 이루어지고 있다. 하지만 이러한 방법들은 일회성이며 주관적인 측면이 있어 기침이나 천명음의 양적인 평가나 지속적인 모니터링에 제한점이 많다. 이에 본 연구에서는 기침-홀터 모니터에서 측정된 기침, 천명음의 빈도 및 강도와 호소하는 증상 및 청진 결과의 일치도를 평가하여 이에 따른 임상적 이용 가치를 알아보고자 하였다. 방법:기침이나 천명음을 주소로 2011년 2월 1일부터 2011년 10월 31일까지 고려대학교 안암병원 소아청소년과 호흡기 알레르기 클리닉을 방문하여 입원한 59명을 대상으로 시행하였다. 대상 환아들은 야간에 약 12시간 동안 기침-홀터 모니터를 사용하여 기침과 천명음의 빈도 및 강도를 분석하였으며, 측정된 결과와 보호자에 의해 설문 작성된 VAS score, 소아청소년과 의사의 청진 상 wheezing score 사이의 연관성을 분석하였다. 결과:전체 대상군에서 기침-홀터는 VAS score와 기침의 빈도, 강도에서 유의한 양의 상관 관계를 보였고, wheezing score도 천명음의 빈도와 강도에서 유의한 양의 상관 관계를 보였다. 천명군과 비천명군 모두에서 기침-홀터는 기침 강도와 유의한 양의 상관 관계를 보였으나, 천명군에서 wheezing score와 천명음의 빈도 및 강도는 모두 유의한 상관 관계가 없었다. 결론:본 연구에서 기침-홀터로 측정한 기침, 천명음은 환자 또는 보호자가 호소하는 기침 증상 및 소아청소년과 의사의 청진을 통한 주관적 평가 결과와 유의하게 일치하는 경향을 보였다. 기침-홀터는 임상에서 급, 만성 호흡기 증상을 호소하는 소아를 평가하는 객관적 평가 도구의 하나로서 유용하게 사용할 수 있을 것으로 판단된다.
Abstract
Purpose:Cough and wheezing are the most common respiratory symptoms in children. Recently, the cough-holter monitoring has been used to estimate the frequency and intensity of cough and wheezing, objectively. In this study, we aimed to evaluate the validity of cough-holter monitoring for the objective assessment of cough and wheezing in the hospitalized children with respiratory symptoms. Methods:Cough-holter monitoring was performed in 59 children who suffered from cough and/or wheezing. We obtained the information on the frequency and intensity of cough and wheezing from the parents, a pediatrician, and cough-holter monitoring. Visual Analogue Scale (VAS) scores were taken by parents, and the pediatrician estimated the wheezing score by using a stethoscope. We assessed a relationship between the VAS scores, wheezing score, and cough-holter monitoring data. Results:The frequencies and intensities of cough correlated positively with the VAS scores (r=0.301, P=0.032; and r=0.540, P=0.001, respectively) and the frequencies and intensities of wheezing also correlated positively with the Wheezing scores. (r=0.335, P=0.011; and r=0.457, P=0.001, respectively) The wheezing intensity did not correlate with the Wheezing score in wheezing children. (r=0.321, P=0.089)Conclusion:Cough-holter monitoring correlated positively with the VAS scores and the wheezing scores. Cough-holter monitoring appears to be a useful objective assessment tool for the children who have suffered from cough and/or wheezing.
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