婴幼儿喘息与病毒感染的关系研究

目的 探索婴幼儿喘息与呼吸道病毒感染的关系.方法 选择初次喘息患儿78例,反复喘息患儿72例,留取末梢血进行4种常见呼吸道病毒检测.结果 2组患儿病毒总检出率为61.33%,各组患儿病毒检测阳性率差异有显著性(P<0.01),但均以呼吸道合胞病毒(RSV)为主,其它病毒阳性率很低.结论 RSV是诱发婴幼儿喘息和喘息反复发作的主要病原.     

婴幼儿喘息性疾病的病毒病原学研究

目的 了解婴幼儿喘息性疾病常见呼吸道病毒感染的病原学情况.方法 采集318例婴幼儿喘息性疾病住院患儿的鼻咽部分泌物标本,采用逆转录-聚合酶链反应(RT-PCR)进行呼吸道合胞病毒(RSV),流感病毒A、B型(INFA、B),副流感病毒Ⅰ、Ⅱ、Ⅲ型(PIY Ⅰ、Ⅱ、Ⅲ),腺病毒(ADV),鼻病毒(RV),偏肺病毒(hMPV)检测.结果 318例婴幼儿喘息性疾病中检出呼吸道病毒阳性258例,阳性率为81.1％.检出6种呼吸道病毒、其阳性率分别为RSV 36.2％,hMPV21.7％,RV 14.5％,INF-B 1.3％,PIV-Ⅲ3.1％,ADV 5.3％.4至6月份病毒阳性检出率最高(92.7％),1至3月份病毒阳性检出率最低(51.3％).1岁以前主要是RSV和hMPV感染,1～3岁主要是RSV和RV感染.毛细支气管炎及喘息性支气管炎主要是RSV、hMPV感染,婴幼儿哮喘主要是hMPV、RV感染.结论 合胞病毒是婴幼儿喘息性疾病的首位病毒病原体,其次是hMPV、RV.喘息患儿病毒检出阳性率呈季节性分布,且随年龄增长呈下降趋势.     

孟鲁司特辅助治疗病毒感染婴幼儿喘息45例

目的观察孟鲁司特治疗病毒感染婴幼儿喘息的临床疗效。方法选择2011年1月至2012年6月住院就诊的病毒感染喘息婴幼儿90例,随机分为两组,各45例。对照组予以常规治疗,观察组在对照组基础上加用孟鲁司特治疗,观察两组治疗后的疗效。结果观察组的总有效率为93.33%,明显优于对照组的75.56%(χ2=9.025,P=0.029<0.05)。观察组的咳嗽消失时间及罗音消失时间明显短于对照组(t=3.940,5.341,P=0.000<0.01)。观察组的吸氧、激素及雾化使用情况明显少于对照组(χ2=4.486,4.731,4.444,P=0.034,0.030,0.035<0.05)。两组患者住院时间长短比较差异无统计学意义。两组治疗后仅PaO2与治疗前相比,差异具有统计学意义(t=5.670,14.420,P=0.000,0.000<0.01)。观察组治疗后PaO2与对照组相比,差异有统计学意义(t=6.799,P=0.000<0.01)。结论孟鲁司特治疗病毒感染婴幼儿喘息具有较好的临床疗效,且能更快地改善患儿的临床症状,且不良反应少,值得临床推广。     

婴幼儿首次喘息发作后潮气呼吸肺功能持续变化与持续性喘息的关系

摘要：目的：观察婴幼儿喘息潮气功能的变化与该患儿发展为持续性喘息的关系。方法：对2005.1至2006.1月因第一次喘息发作在我院住院的患儿肺潮气功能进行观察。同时对观察病例进行长期随访。随访期5年。结果：婴幼儿喘息的第一次潮气功能的异常及严重程度与是否发展为持续性喘息无明显相关性。但潮气功能的持续性异常，特别是持续性重度阻塞性变化和今后发展为持续性喘息存在明显正相关。结论：婴幼儿第一次喘息发作后，持续性肺潮气功能异常。对判断婴幼儿喘息的是否发展为持续性喘息具有一定的临床意义。     

婴幼儿喘息性肺炎的护理

喘息性肺炎是儿童婴幼儿期常见的一种严重疾病，必须抓紧时间治疗和护理，不能延误，我科自1990-2000年共收住喘息性肺炎60例，在环境、饮食、治疗、心理教育方面给了精心护理，并予以相应的出院指导，均在1～3周治愈或缓解出院，效果较满意，仅1例合并先天性心脏病而死亡。     

婴幼儿喘息性肺炎与血清总IgE的相关性研究

目的探讨婴幼儿喘息性肺炎血清总IgE的水平变化及临床意义。方法采用电化发光法检测112例喘息性肺炎及54例支气管肺炎患者血清总IgE的水平，并进行相关性分析。结果喘息性肺炎患者血清总IgE的水平明显高于支气管肺炎患者，差异有统计学意义（P〈0．05）。反复发作喘息性肺炎患者血清总IgE的水平明显高于一次发作喘息性肺炎患者，差畀有统计学意义（P〈0．05）。结论血清总IgE的水平与婴幼儿喘息性肺炎有相关性，对耍幼儿喘息性肺炎的预后判断有一定的意义。     

孟鲁司特和布地奈德治疗病毒感染婴幼儿喘息的临床观察

目的探讨孟鲁司特、布地奈德治疗病毒感染婴幼儿喘息的临床疗效及预后。方法将54例病毒感染的喘息患儿分为观察组与对照组,两组给以常规综合治疗,对照组26例加用地塞米松0．2mg／kg静脉点滴,治疗组28例在常规综合治疗基础上口服孟鲁司特钠4mg／次,每日顿服,疗程3个月,布地奈德混悬液0．5mg／次,雾化吸入,每日2次,疗程5～7d,观察两组临床症状、体征恢复情况及患儿住院天数,对所有病例随访3个月,观察患儿再次发生喘息的情况。结果治疗组咳嗽、喘息、哮鸣音消失时间、患儿住院天数与对照组比较差异有统计学意义,随访3个月,治疗纽患儿喘息发生率低于对照组。结论病毒感染的婴幼儿喘息应用孟鲁司特、布地奈德联合治疗疗效确切,能够降低喘息的复发率。     

人类偏肺病毒感染与小儿喘息性疾病关系探讨

目的了解小儿喘息性疾病人类偏肺病毒（hMPV）感染情况，探讨二者之间关系。方法对124例小儿喘息性疾病患儿鼻咽分泌物分别作7种常见呼吸道病毒[呼吸道合胞病毒（RSV）、流感病毒A、B型、副流感病毒1、2、3型、腺病毒]免疫荧光检测和hMPV逆转录巢式聚合酶链反应（RT-nPCR）特异性基因检测。结果共检测到各种病毒阳性70例，其中7种常见呼吸道病毒阳性53例（42．7％），分别是RSV39例，流感病毒6例，腺病毒5例，副流感病毒3例；RT-nPCR检测hMPV阳性17例（13．7％），hMPV合并RSV感染2例；RSV和hMPV感染患儿在年龄、性别、临床症状上无统计学意义（P〉0．05）。结论RSV仍是小儿喘息性疾病中最多见病原体，hMPV可能是其发病的又一重要病原体，二者临床特征相似。     

易坦静治疗婴幼儿喘息性疾病疗效观察

目的观察易坦静口服辅助治疗婴幼儿喘息性疾病的疗效。方法将96例喘息性疾病的患儿随机分为2组,治疗组口服易坦静,对照组口服急支糖浆。对两组的临床控制率、主要症状、体征持续时间及住院天数进行比较。结果治疗组疗效明显优于对照组(P<0.01)。结论易坦静治疗喘息性疾病有协同作用,可提高治愈率、缩短病程,可作为治疗喘息性疾病的推荐药物。     

血液透析串联血液灌流对维持性血液透析患者微炎症及血管内皮功能的影响

Objective To investigate the effect of hemodialysis with hemo-perfusion on microinflammatory and vascular endothelial function of chronic hemodialysis patients. Methods Twenty hemodialysis patients were divided into two groups, 10 patients received hemodialysis therapy for four times (as control group), and 15 patients received hemodialysis with hemoperfusion(HD+HP) therapy for four times. The level of TNF-α and sVCAM-1 were detected before therapy and after therapy for four times. Results The level of TNF-α and sVCAM-1 in chronic hemodialysis patients were higher than that of control group; The level of TNF-α were positive correlated with the level of sVCAM-1 (r=0.674, P<0.05) before therapy; The level of TNF-α and sVCAM-1 in hemo-perfusion group patients decreased after therapy for 4 times. There was statistically difference between before and after therapy (P<0. 05); while in control group, both of them showed no statistically different (P>0.05). Conclusions Microinflammatory possibly lead to vascular endothelial function damage in chronic hemodialysis patients.Hemodialysis with hemo-perfusion could effectively reduce microinflammation and alleviate vascular endothelial function damage in chronic hemodialysis patients.     

血液透析串联血液灌流对维持性血液透析患者微炎症及血管内皮功能的影响

Objective To investigate the effect of hemodialysis with hemo-perfusion on microinflammatory and vascular endothelial function of chronic hemodialysis patients. Methods Twenty hemodialysis patients were divided into two groups, 10 patients received hemodialysis therapy for four times (as control group), and 15 patients received hemodialysis with hemoperfusion(HD+HP) therapy for four times. The level of TNF-α and sVCAM-1 were detected before therapy and after therapy for four times. Results The level of TNF-α and sVCAM-1 in chronic hemodialysis patients were higher than that of control group; The level of TNF-α were positive correlated with the level of sVCAM-1 (r=0.674, P<0.05) before therapy; The level of TNF-α and sVCAM-1 in hemo-perfusion group patients decreased after therapy for 4 times. There was statistically difference between before and after therapy (P<0. 05); while in control group, both of them showed no statistically different (P>0.05). Conclusions Microinflammatory possibly lead to vascular endothelial function damage in chronic hemodialysis patients.Hemodialysis with hemo-perfusion could effectively reduce microinflammation and alleviate vascular endothelial function damage in chronic hemodialysis patients.     

血液透析串联血液灌流对维持性血液透析患者微炎症及血管内皮功能的影响

Objective To investigate the effect of hemodialysis with hemo-perfusion on microinflammatory and vascular endothelial function of chronic hemodialysis patients. Methods Twenty hemodialysis patients were divided into two groups, 10 patients received hemodialysis therapy for four times (as control group), and 15 patients received hemodialysis with hemoperfusion(HD+HP) therapy for four times. The level of TNF-α and sVCAM-1 were detected before therapy and after therapy for four times. Results The level of TNF-α and sVCAM-1 in chronic hemodialysis patients were higher than that of control group; The level of TNF-α were positive correlated with the level of sVCAM-1 (r=0.674, P<0.05) before therapy; The level of TNF-α and sVCAM-1 in hemo-perfusion group patients decreased after therapy for 4 times. There was statistically difference between before and after therapy (P<0. 05); while in control group, both of them showed no statistically different (P>0.05). Conclusions Microinflammatory possibly lead to vascular endothelial function damage in chronic hemodialysis patients.Hemodialysis with hemo-perfusion could effectively reduce microinflammation and alleviate vascular endothelial function damage in chronic hemodialysis patients.     

血液透析串联血液灌流对维持性血液透析患者微炎症及血管内皮功能的影响

Objective To investigate the effect of hemodialysis with hemo-perfusion on microinflammatory and vascular endothelial function of chronic hemodialysis patients. Methods Twenty hemodialysis patients were divided into two groups, 10 patients received hemodialysis therapy for four times (as control group), and 15 patients received hemodialysis with hemoperfusion(HD+HP) therapy for four times. The level of TNF-α and sVCAM-1 were detected before therapy and after therapy for four times. Results The level of TNF-α and sVCAM-1 in chronic hemodialysis patients were higher than that of control group; The level of TNF-α were positive correlated with the level of sVCAM-1 (r=0.674, P<0.05) before therapy; The level of TNF-α and sVCAM-1 in hemo-perfusion group patients decreased after therapy for 4 times. There was statistically difference between before and after therapy (P<0. 05); while in control group, both of them showed no statistically different (P>0.05). Conclusions Microinflammatory possibly lead to vascular endothelial function damage in chronic hemodialysis patients.Hemodialysis with hemo-perfusion could effectively reduce microinflammation and alleviate vascular endothelial function damage in chronic hemodialysis patients.     

血液透析串联血液灌流对维持性血液透析患者微炎症及血管内皮功能的影响

Objective To investigate the effect of hemodialysis with hemo-perfusion on microinflammatory and vascular endothelial function of chronic hemodialysis patients. Methods Twenty hemodialysis patients were divided into two groups, 10 patients received hemodialysis therapy for four times (as control group), and 15 patients received hemodialysis with hemoperfusion(HD+HP) therapy for four times. The level of TNF-α and sVCAM-1 were detected before therapy and after therapy for four times. Results The level of TNF-α and sVCAM-1 in chronic hemodialysis patients were higher than that of control group; The level of TNF-α were positive correlated with the level of sVCAM-1 (r=0.674, P<0.05) before therapy; The level of TNF-α and sVCAM-1 in hemo-perfusion group patients decreased after therapy for 4 times. There was statistically difference between before and after therapy (P<0. 05); while in control group, both of them showed no statistically different (P>0.05). Conclusions Microinflammatory possibly lead to vascular endothelial function damage in chronic hemodialysis patients.Hemodialysis with hemo-perfusion could effectively reduce microinflammation and alleviate vascular endothelial function damage in chronic hemodialysis patients.     

血液透析串联血液灌流对维持性血液透析患者微炎症及血管内皮功能的影响

Objective To investigate the effect of hemodialysis with hemo-perfusion on microinflammatory and vascular endothelial function of chronic hemodialysis patients. Methods Twenty hemodialysis patients were divided into two groups, 10 patients received hemodialysis therapy for four times (as control group), and 15 patients received hemodialysis with hemoperfusion(HD+HP) therapy for four times. The level of TNF-α and sVCAM-1 were detected before therapy and after therapy for four times. Results The level of TNF-α and sVCAM-1 in chronic hemodialysis patients were higher than that of control group; The level of TNF-α were positive correlated with the level of sVCAM-1 (r=0.674, P<0.05) before therapy; The level of TNF-α and sVCAM-1 in hemo-perfusion group patients decreased after therapy for 4 times. There was statistically difference between before and after therapy (P<0. 05); while in control group, both of them showed no statistically different (P>0.05). Conclusions Microinflammatory possibly lead to vascular endothelial function damage in chronic hemodialysis patients.Hemodialysis with hemo-perfusion could effectively reduce microinflammation and alleviate vascular endothelial function damage in chronic hemodialysis patients.     

血液透析串联血液灌流对维持性血液透析患者微炎症及血管内皮功能的影响

Objective To investigate the effect of hemodialysis with hemo-perfusion on microinflammatory and vascular endothelial function of chronic hemodialysis patients. Methods Twenty hemodialysis patients were divided into two groups, 10 patients received hemodialysis therapy for four times (as control group), and 15 patients received hemodialysis with hemoperfusion(HD+HP) therapy for four times. The level of TNF-α and sVCAM-1 were detected before therapy and after therapy for four times. Results The level of TNF-α and sVCAM-1 in chronic hemodialysis patients were higher than that of control group; The level of TNF-α were positive correlated with the level of sVCAM-1 (r=0.674, P<0.05) before therapy; The level of TNF-α and sVCAM-1 in hemo-perfusion group patients decreased after therapy for 4 times. There was statistically difference between before and after therapy (P<0. 05); while in control group, both of them showed no statistically different (P>0.05). Conclusions Microinflammatory possibly lead to vascular endothelial function damage in chronic hemodialysis patients.Hemodialysis with hemo-perfusion could effectively reduce microinflammation and alleviate vascular endothelial function damage in chronic hemodialysis patients.     

血液透析串联血液灌流对维持性血液透析患者微炎症及血管内皮功能的影响

Objective To investigate the effect of hemodialysis with hemo-perfusion on microinflammatory and vascular endothelial function of chronic hemodialysis patients. Methods Twenty hemodialysis patients were divided into two groups, 10 patients received hemodialysis therapy for four times (as control group), and 15 patients received hemodialysis with hemoperfusion(HD+HP) therapy for four times. The level of TNF-α and sVCAM-1 were detected before therapy and after therapy for four times. Results The level of TNF-α and sVCAM-1 in chronic hemodialysis patients were higher than that of control group; The level of TNF-α were positive correlated with the level of sVCAM-1 (r=0.674, P<0.05) before therapy; The level of TNF-α and sVCAM-1 in hemo-perfusion group patients decreased after therapy for 4 times. There was statistically difference between before and after therapy (P<0. 05); while in control group, both of them showed no statistically different (P>0.05). Conclusions Microinflammatory possibly lead to vascular endothelial function damage in chronic hemodialysis patients.Hemodialysis with hemo-perfusion could effectively reduce microinflammation and alleviate vascular endothelial function damage in chronic hemodialysis patients.     

血液透析串联血液灌流对维持性血液透析患者微炎症及血管内皮功能的影响

目的探讨血液透析串联血液灌流对维持性血液透析患者促炎因子及血管内皮功能的影响。方法我院透析中心血液透析患者25例。10例行单纯血液透析治疗,15例血液透析串联血液灌流治疗,选择10例健康人作为正常对照。观察与单纯血液透析相比,串连灌流治疗前、连续4次强化治疗后促炎因子TNF—a及VCAM一1的改变。结果维持性血液透析患者血中TNF—a、sVCAM-1的水平明显高于正常人。治疗前MHD患者血TNF—a与sVCAM-1水平呈显著正相关关系（r=0．674,P〈0．05）。患者血液透析串联血液灌流连续4次治疗后血中TNF—a、VCAM-1水平均明显下降。而单纯血液透析治疗组,TNF—a、sVCAM-1无明显改变。结论血液透析患者体内炎症状态可能导致了血管内皮功能损伤。血液透析串联血液灌流改善了患者体内微炎症状态并减轻血管内皮功能损伤。     

血管舒张功能评价长期血液灌流串联血液透析对患者血管内皮功能的价值

目的 探讨血流介导的血管舒张功能（FMD）对长期血液灌流串联血液透析患者血管内皮功能的评价作用。方法 以2013年3月至2016年1月上海市松江区中心医院诊治的73例维持性血液透析患者为研究对象,其中单纯血液透析（HD）33例（HD组）,血液灌流串联血液透析（HP+HD）治疗40例（HP+HD组）,选择同期健康体检40例正常人群为对照组,比较各组肱动脉FMD、硝酸甘油介导的血管舒张功能（NMD）及微炎症相关指标。结果 与对照组比较,HD组、HP+HD组透析前肱动脉FMD均低,血清hs-CRP、TNF-α水平均升高,差异均有统计学意义（P<0.05）。与透析前比较,HD组透析后肱动脉FMD下降［（7.10±1.52）% vs （4.75±1.65）%］（P<0.05）,而HP+HD组则上升［（7.08±1.60）% vs （8.40±1.53）%］;HP+HD组透析后肱动脉FMD大于HD组,血清hs-CRP、TNF-α水平均低于HD组,差异均有统计学意义（P<0.05）。3组肱动脉NMD比较差异无统计学意义（P>0.05）。结论 长期血液透析患者多存在血管内皮功能异常,单纯血液透析加重患者血管内皮功能损害,而血液灌流串联血液透析能有效改善机体微炎症状态及减轻血管内皮功能损害。