氧气驱动布地奈德混悬液及硫酸特布他林混悬液雾化吸入治疗毛细支气管炎56例

目的 探讨氧气驱动布地奈德混悬液及硫酸特布他林混悬液雾化吸入治疗毛细支气管炎的疗效.方法 将2004年2月一2006年2月临床确诊的毛细支气管炎患儿112例随机分为观察组和对照组.二组患儿均常规给予抗病毒、吸氧、止咳、镇静等综合治疗,观察组给予布地奈德混悬液和硫酸特布他林混悬液雾化吸入,对照组给予利巴韦林加α-糜蛋白酶、地塞米松雾化吸入.比较二组治疗后的临床症状、肺部体征持续时间、病情治愈好转率.结果 观察组患儿咳嗽喘憋缓解、心率恢复、缩短哮鸣音湿啰音持续时间及住院天数均明显少于对照组(Pa<0.01).观察组治愈率(92.86%)与对照组(66.10%)比较有显著性差异(X2=12.31P<0.01).结论 在综合治疗基础上加用氧气驱动布地奈德混悬液和硫酸特布他林混悬液雾化吸入治疗毛细支气管炎有协同作用,可缩短病程,提高治愈率,可作为佐治毛细支气管炎的主要药物之一.     

布地奈德对毛细支气管炎后哮喘的预防作用

目的 探讨吸入布地奈德对毛细支气管炎后哮喘的预防作用.方法 选取2001年6月～2004年12月诊断为毛细支气管炎的220例患儿,分组观察在临床症状控制后,吸入和不吸入布地奈德,随访两年后哮喘的患病率.结果 治疗组110例中,发生哮喘3例,占2.7%(3/110),对照组110例中,发生哮喘24例,占21.8%(24/110),差异有显著性(P＜0.01).结论 吸入布地奈德能有效降低毛细支气管炎后哮喘患病率.     

雾化吸入糖皮质激素联合特布他林及异丙托溴铵治疗毛细支气管炎的疗效及预后

目的观察糖皮质激素联合异丙托溴铵、特布他林雾化吸入治疗毛细支气管炎的疗效,探讨不同疗程吸入糖皮质激素对毛细支气管炎预后的影响。方法将108例收治住院的毛细支气管炎患儿随机分为3组,均采用综合治疗。治疗1组予布地奈德混悬液联合特布他林、异丙托溴铵三联雾化吸入治疗7d,继续丙酸氟替卡松雾化吸入治疗至12周;治疗2组予布地奈德混悬液联合特布他林溶液二联雾化吸入治疗7d;对照组单用特布他林溶液雾化吸入治疗7d。观察3组患儿临床症状消失时间、住院天数,并进行临床疗效评定及追踪停药1a为喘息性疾病患病人数及患病率。结果治疗1组和治疗2组在咳嗽、喘憋症状缓解、肺部哮鸣音消失时间及缩短住院天数方面均优于对照组(Pa<0.05),治疗1组在临床缓解率方面较治疗2组更具优势(P<0.05)。治疗1组在停药1a喘息性疾病患病率明显降低,与对照组比较差异有统计学意义(P<0.05),治疗2组在停药1a喘息性疾病患病率与对照组比较稍低,但无显著性差异(P>0.05)。结论糖皮质激素联合特布他林二联雾化吸入治疗毛细支气管炎疗效肯定,糖皮质激素联合特布他林、异丙托溴铵三联雾化吸入治疗毛细支气管炎,对急性期症状的缓解优势更为明显,毛细支气管炎患儿吸入性糖皮质激素早期干预治疗至12周,可降低发展为支气管哮喘的几率。     

毛细支气管炎患儿肺功能特点及应用吸入性糖皮质激素的疗效

目的探讨毛细支气管炎患儿肺功能特点及吸入性布地奈德（普米克令舒）、丙酸氟替卡松（辅舒酮）治疗毛细支气管炎的疗效。方法毛细支气管炎患儿100例分为观察组、对照组。2组均采用综合治疗,观察组加用普米克令舒/辅舒酮吸入。测定治疗前、出院时、出院后3个月二组患儿潮气呼吸肺功能;观察其急性期症状缓解情况;回访出院后3个月及1a后健康情况。30例同龄健康儿童的肺功能为健康对照组。结果1.观察组在改善临床症状、减少住院天数上优于对照组（Pa〈0.05）。2.观察组出院后3个月,咳嗽、气喘发作次数较对照组减少（Pa〈0.05）。3.出院时观察组潮气量（TV/kg）的增加、呼吸频率（RR）的下降优于对照组（Pa〈0.05）;观察组25%潮气量时的潮气呼气流速（TEF25%）、达峰时间比（TPEF/TE）、达峰容积比（VPEF/VE）较入院时上升（Pa〈0.05）,3个月后恢复正常,与健康对照组比较无明显差异（P〉0.05）。对照组出院时TEF25%、TPEF/TE、VPEF/VE与入院时无明显改变（Pa〉0.05）,3个月后仍未恢复正常。4.随访1a,观察组发展为支气管哮喘的几率低于对照组（P〈0.05）。5.毛细支气管炎急性期临床评分与TPEF/TE、VPEF/VE呈负相关,临床评分数值越高,病情越重,TPEF/TE、VPEF/VE值越低。结论1.毛细支气管炎患儿用吸入性糖皮质激素早期干预治疗,对急性期症状的缓解、降低发展为支气管哮喘的几率有较好疗效。2.TPEF/TE及VPEF/VE可判断毛细支气管炎呼吸道阻塞严重程度。     

吸入高渗盐水及肾上腺素对治疗急性中重度毛细支气管炎患儿疗效的研究

目的 通过观察毛细支气管炎患儿的临床症状缓解情况及住院天数,评价高渗盐水雾化吸入及其与肾上腺素联合应用治疗毛细支气管炎的临床疗效及应用价值.方法 选取2012年8月至2013年5月于中国医科大学附属盛京医院小儿呼吸内科住院的2岁以下急性毛细支气管炎患儿154例,根据入院时呼吸困难评分分为两大组,即中度毛细支气管炎组和重度毛细支气管炎组,每大组根据治疗药物不同采用随机数字表法随机分为3个治疗组.3组的治疗方案分别为吸入普米克令舒+可必特(治疗组1)、吸入高渗盐水(治疗组2)、吸入高渗盐水+肾上腺素(治疗组3).在治疗前及治疗后4d分别测定临床症状评分及呼吸频率,计算呼吸困难分差,记录咳嗽、气促及喘息情况明显缓解天数,并记录住院天数.平行比较两大组间治疗前后临床症状改善水平,对比分析不同治疗方案对毛细支气管炎患儿的影响.结果 中度毛细支气管炎组中,各治疗组治疗前后在住院天数及临床症状改善程度方面差异均无统计学意义(P均＞0.05).重度毛细支气管炎组中,治疗组2和治疗组3在治疗4d后,呼吸困难分差、住院天数及治疗后咳嗽、气促、喘鸣等临床症状持续天数较治疗组1有明显差异,差异均有统计学意义(P均＜0.05);治疗组3在治疗4d后,呼吸困难分差较治疗组2有明显升高,差异有统计学意义(P＜0.05),而两组间住院天数及治疗后咳嗽、气促、喘鸣等临床症状持续天数无明显差异(P均＞0.05).结论 各治疗方案对于中度毛细支气管炎患儿的临床疗效无明显差异;对于重度毛细支气管炎患儿,高渗盐水联合肾上腺素雾化吸入治疗疗效明显优于普米克令舒联合可必特吸入及高渗盐水单一治疗,住院天数缩短,评分改善值明显增高.     

沐舒坦雾化吸入佐治毛细支气管炎的疗效观察

目的评价沐舒坦雾化吸入佐治毛细支气管炎的疗效。方法对120例毛细支气管炎患儿采用随机分组,沐舒坦雾化组63例和对照组57例,观察治疗前后临床症状体征和胸部X线检查的变化。结果沐舒坦雾化组在临床症状和体征缓解方面优于对照组(P<0.01);总有效率高于对照组(P<0.05);治疗前后胸部X线检查两组无显著性差异(P>0.05)。结论沐舒坦雾化吸入佐治毛细支气管炎安全、有效,无明显副作用。     

布地奈德联合特布他林雾化吸入治疗毛细支气管炎

目的 观察布地奈德联合特布他林空气压缩泵雾化吸入治疗毛细支气管炎的疗效.方法 将80例毛细支气管炎患儿随机分为观察组和对照组,二组均予常规治疗.观察组加用布地奈德、特布他林空气压缩泵雾化吸入治疗.记录治疗5 d后喘息、哮鸣音有无减轻或消失及治疗后症状、体征消失的时间.并对治疗5 d后二组疗效进行比较.结果 治疗5 d后观察组显效率和有效率分别为50.0%和92.5%,明显高于对照组的25.0%和62.5%(Pa <0.001).观察组呼吸困难、咳嗽、喘息、哮鸣音、痰鸣青等消失时间与对照组比较均有显著性差异(P1 <0.05).结论 布地奈德联合特布他林空气压缩泵雾化吸入治疗毛细支气管炎能够迅速改善症状,缩短病程.     

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为探讨预防呼吸道合胞病毒(RSV)毛细支气管炎后反复喘息及哮喘的方法,本文于1999-11—2002-03对收治的217例RSV毛细支气管炎患儿在急性期症状控制后继续给予不同疗程的辅舒酮吸入治疗,并与73例同期病例做比较,随访2年,观察预防效果,现报告如下。一般资料:研究对象均为符合毛细支气管炎诊断标准[1]的住院患儿。纳入标准:(1)初次发病;(2)固相酶联免疫吸附实验(MACELISA)检测提示血清特异性RSV-IgM阳性;(3)除外先天性心脏病、结核感染及支气管异物等疾病。剔除标准:(1)未坚持随访;(2)未按规定的疗程用药。符合纳入条件的共217例,其中男…     

布地奈德和沙丁胺醇联合吸入治疗儿童哮喘急性发作的疗效观察

目的 观察布地奈德和沙丁胺醇混悬液治疗儿童哮喘急性发作的疗效.方法 通过随机分组65例患儿,两组患儿均采用综合性治疗,对照组30例给予沙丁胺醇溶液吸入治疗,治疗组在对照组基础上.加用布地奈德溶液吸入治疗;观察用药前后患儿症状体征(呼吸困难、咳嗽、喘息、哮鸣音)改善情况及治疗前后峰流速(PEF)的变化.结果 治疗组总有效率为97.1%,对照组为80.0%,两组比较差异有显著性(P<0.05).结论 对哮喘急性发作息儿,布地奈德和沙丁胺醇联合吸入可尽快缓解呼吸困难、喘息症状,效果明显优于单纯吸入沙丁胺醇溶液,疗效显著.     

氧驱动雾化吸入治疗毛细支气管炎喘憋发作临床观察

目的　寻找一种快捷、高效的治疗毛细支气管炎(简称毛支炎)喘憋发作的方法。方法将190例毛细支气管炎患儿分治疗组(120例),对照组(70例)。治疗组按随机分配原则分别氧驱动雾化吸入Ⅰ,Ⅱ,Ⅲ号各40例.对照组予静滴氨茶碱及糖皮质激素(氢化考的松琥珀酸钠),各组均予毛细支气管炎相应常规治疗。结果　对照组与治疗组各组相比较,治疗组各组显效率优于对照组(P<0.01),症状缓解时间治疗组各组均优于对照组(P<0.01),而治疗组中又以雾化Ⅱ号(喘乐宁0.25ml加普米克令舒1ml加溴化异丙托品0.5ml加生理盐水2ml)作用尤为显著。结论6L/min氧驱动雾化吸入短效β-受体激动剂加抗胆碱能药及糖皮质激素为治疗毛细气管炎喘憋发作的最佳方法。     

肥胖对哮喘预测指数阳性喘息婴幼儿治疗效果的影响

目的 探讨肥胖对哮喘预测指数（API）阳性喘息婴幼儿治疗效果的影响。方法 选取API 阳性的喘息婴幼儿208 例,按Kaup 指数分为肥胖组（93 例）和非肥胖组（115 例）。在急性喘息发作期给予综合治疗,缓解期给予吸入性糖皮质激素（ICS）布地奈德混悬液压缩泵雾化吸入治疗。根据临床控制情况调整ICS治疗用量,共治疗6 个月。治疗后2 周随访1 次,之后每月随访1 次。结果 治疗后2 周、1 个月肥胖组的临床症状缓解率分别为35.5% 及75.3%,低于非肥胖组的53.0% 和87.8%（P P 结论 肥胖可抑制API 阳性喘息婴幼儿对ICS 治疗的反应。     

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??Objective To observe the efficacy of aerosol inhalation of recombinant human interferon alpha 2b in treatment of bronchiolitis and its effects on the pulmonary function restoration and recurrent wheezing. Methods A total of 100 outpatient infants diagnosed with bronchiolitis between January 2015 and April 2015 ??74 males??26 females??were divided into 2 groups??61 cases in group A and 39 cases in group B. In addition to the conventional therapy??group A had aerosol inhalation of recombinant human interferon alpha 2b for 5-7 days. Group B??as the control group??only had the conventional therapy. Then the curative effect after 7 days of treatment??time for clinical symptoms and signs to disappear??the tidal breathing pulmonary function about 2 months later and the incidence of recurrent wheezing of both group 6 months later were compared. Results The curative effect??time for clinical symptoms and signs to disappear and tidal breathing pulmonary function ??TPTEF/TE??VPEF/VE?? of group A were significantly improved when compared with group B ??P??0.05????but the incidence of recurrent wheezing between group A and B had no significant difference??P??0.05??. Conclusion Aerosol inhalation of recombinant human interferon alpha 2b in treatment of bronchiolitis has good curative effect. This treatment can help clinical symptoms and signs to disappear early??help the early restoration of small airway obstruction??and mildly reduce the rate of recurrent wheezing.     

Randomised controlled trial of budesonide for the prevention of post-bronchiolitis wheezing.

BACKGROUND: Previous studies suggest that recurrent episodes of coughing and wheezing occur in up to 75% of infants after acute viral bronchiolitis. AIM: To assess the efficacy of budesonide given by means of a metered dose inhaler, spacer, and face mask in reducing the incidence of coughing and wheezing episodes up to 12 months after acute viral bronchiolitis. METHODS: Children under the age of 12 months admitted to hospital with acute viral bronchiolitis were randomised to receive either budesonide or placebo (200 microg or one puff twice daily) for the next eight weeks. Parents kept a diary card record of all episodes of coughing and wheezing over the next 12 months. RESULTS: Full follow up data were collected for 49 infants. There were no significant differences between the two study groups for the number of infants with symptom episodes up to six months after hospital discharge. At 12 months, 21 infants in the budesonide group had symptom episodes compared with 12 of 24 in the placebo group. The median number of symptom episodes was 2 (range, 0-13) in those who received budesonide and 1 (range, 0-11) in those who received placebo. Because there is no pharmacological explanation for these results, they are likely to be caused by a type 1 error, possibly exacerbated by there being more boys in the treatment group. CONCLUSION: Routine administration of budesonide by means of a metered dose inhaler, spacer, and face mask system immediately after acute viral bronchiolitis cannot be recommended.     

Randomised controlled trial of budesonide for the prevention of post-bronchiolitis wheezing

BACKGROUND—Previous studies suggest that recurrent episodes of coughing and wheezing occur in up to 75% of infants after acute viral bronchiolitis.AIM—To assess the efficacy of budesonide given by means of a metered dose inhaler, spacer, and face mask in reducing the incidence of coughing and wheezing episodes up to 12 months after acute viral bronchiolitis.METHODS—Children under the age of 12 months admitted to hospital with acute viral bronchiolitis were randomised to receive either budesonide or placebo (200 µg or one puff twice daily) for the next eight weeks. Parents kept a diary card record of all episodes of coughing and wheezing over the next 12months.RESULTS—Full follow up data were collected for 49 infants. There were no significant differences between the two study groups for the number of infants with symptom episodes up to six months after hospital discharge. At 12 months, 21 infants in the budesonide group had symptom episodes compared with 12 of 24 in the placebo group. The median number of symptom episodes was 2 (range, 0-13) in those who received budesonide and 1 (range, 0-11) in those who received placebo. Because there is no pharmacological explanation for these results, they are likely to be caused by a type 1 error, possibly exacerbated by there being more boys in the treatment group.CONCLUSION—Routine administration of budesonide by means of a metered dose inhaler, spacer, and face mask system immediately after acute viral bronchiolitis cannot be recommended.     

Inhaled corticosteroids during and after respiratory syncytial virus-bronchiolitis may decrease subsequent asthma

Respiratory syncytial virus (RSV) bronchiolitis in infancy can lead to bronchial hyper-reactivity or recurrent obstructive bronchitis. The aim of the present study was to determine whether the type of treatment has an influence on respiratory status after RSV bronchiolitis. The study involved 117 infants (mean age 2.6 months), who needed hospital treatment because of RSV bronchiolitis. The patients were divided randomly into three groups. All received the same symptomatic treatment. Group I children received symptomatic treatment only, group II children were treated for 7 days with inhaled budesonide, 500 µg three times per day, administered via a nebulizer. Group III children received nebulized budesonide, 500 µg twice per day for two months. Follow-up consisted of out-patient check-ups 2 and 6 months after the infection, and telephone contact two years after the infection. Statistically significant differences were seen between the groups. In group I 37% of the children had asthma, in group II 18%, and in group III 12%. According to the present study it seems that inhaled corticosteroid treatment during and after the acute phase of infant RSV bronchiolitis may have a beneficial effect on subsequent bronchial wheezing tendency.     

雾化吸入布地奈德治疗毛细支气管炎的临床多中心研究

目的　明确雾化吸入布地奈德对轻、 中度毛细支气管炎的治疗效果。方法　采用多中心、 随机、 对照临床试验方法,于2017年9月至2019年6月对来自国内18个儿科呼吸中心的209例毛细支气管炎婴幼儿患者进行本研究。将209例患儿随机分为3组,分别为对照组、 布地奈德治疗1组（0.5 mg/次）、 布地奈德治疗2组（1.0 mg/次）。各组患儿月龄、 性别、 病程、 入院时白细胞计数、 C反应蛋白（C-reaction protein,CRP）、 病情严重程度等基本资料差异均无统计学意义（P＞0.05）。分组治疗后,从喘息、 咳嗽、 哮鸣音、 水泡音、 三凹征等方面按照严重程度进行评分。结果　在治疗开始第1天,每2 h进行1次评分; 第2天,每4 h进行1次评分; 第3～7天,每6 h进行1次评分,3组患儿在以上各个时间点的病情评分差异均无统计学意义（P＞0.05）。结论　雾化吸入布地奈德并不能显著降低轻、 中度毛细支气管炎患儿的临床症状评分。     

Bronchiolitis in young infants: is it a risk factor for recurrent wheezing in childhood?

Background

Acute bronchiolitis in infancy is considered a risk factor for recurrent wheezing episodes in childhood. The present study assessed prevalence, clinical manifestations and risk factors for recurrent wheezing events during the first 3 years of life and persistent wheezing events beyond this age in children hospitalized as young infants with acute bronchiolitis.

Methods

Two groups of children aged 6 years were included. The study group comprised 150 children with a history of hospitalization for bronchiolitis, with the first event at <6 months of age. The control group comprised 66 age- and sex-matched children with no history of bronchiolitis before 6 months of age. Children in both groups had been followed until 6 years of age by their pediatricians; data were obtained retrospectively by reviewing ambulatory records during children’s visits in pediatricians’ clinics. The data included epidemiological parameters, prevalence, age at onset, number of and treatments given for episodes of wheezing events prior to 6 years of age, pathogens detected, and severity of acute bronchiolitis in the study group.

Results

Overall, 58% and 27% of children in the study and control groups, respectively (P=0.001) had recurrent wheezing episodes prior to the age of 3 years. Children in the study group had earlier onset of recurrent wheezing, had more episodes of wheezing, and required more bronchodilator and systemic steroids treatments compared to the control group.

Conclusion

Hospitalization within the first six months of life for acute bronchiolitis is an independent risk factor for recurrent wheezing episodes during the first 3 years of life.

     

影响3%高渗盐水雾化吸入治疗毛细支气管炎患儿疗效的多因素分析

目的探讨3%高渗盐水雾化吸入治疗毛细支气管炎的有效性及影响其疗效的因素。方法回顾性分析2009年6月至2012年12月住院患儿中首要诊断为毛细支气管炎且已完善鼻咽抽吸物16种常见呼吸道病毒检测的病例资料。以治疗2天后临床严重程度评分下降百分比和住院时间作为终点指标评价3%高渗盐水雾化吸入治疗的有效性,并进一步寻找影响其疗效的因素。结果 3%高渗盐水雾化吸入治疗组患儿2天后严重程度评分平均下降42.86%(11.11%~66.67%),显著高于未使用高渗盐水治疗组的平均下降率26.79%(0%~50.00%),差异有统计学意义(P=0.006);两组患儿住院时间差异无统计学意义(P=0.26)。多重线性回归分析显示,年龄3个月、母乳喂养、呼吸道合胞病毒(RSV)感染及肺部听诊可闻及广泛哮鸣音的患儿疗效更好,该多重线性回归分析模型具有统计学意义(R2=0.58,P0.001)。结论3%高渗盐水雾化吸入治疗2天后可降低毛细支气管炎患儿严重程度评分,推荐用于3个月、母乳喂养、RSV感染、肺部闻及广泛哮鸣音的毛细支气管炎住院患儿,疗程为2~3天。     

T淋巴细胞亚群及过敏原与婴幼儿肺炎支原体感染伴喘息的关系

目的 分析肺炎支原体 （MP）感染伴喘息婴幼儿的T淋巴细胞亚群表达及过敏原筛查情况。方法 流式细胞仪检测354例MP感染伴喘息婴幼儿 （MP喘息组）、336例MP感染不伴喘息婴幼儿 （MP非喘息组）、277例反复喘息患儿 （反复喘息组）的外周血T淋巴细胞亚群表达,同时进行过敏原检测。结果 MP喘息组和反复喘息组的CD3+及CD3+CD8+淋巴细胞百分比均低于MP非喘息组 （P < 0.05）;MP喘息组和MP非喘息组的CD3+CD4+淋巴细胞百分比均高于反复喘息组 （P < 0.05）;MP喘息组和反复喘息组的CD3-CD19+及CD19+CD23+淋巴细胞百分比均明显高于MP非喘息组 （P < 0.05）,以反复喘息组最高 （P < 0.05）。食入性过敏原检测总阳性率 （30.3%）高于吸入性过敏原 （14.7%）,P < 0.05;反复喘息组、MP喘息组的食入性和吸入性过敏原阳性率均高于MP非喘息组,以反复喘息组最高 （P < 0.05）。结论 T淋巴细胞亚群紊乱、过敏体质在MP感染伴喘息的婴幼儿发病起着重要作用。     

Relation between serum IL‐4, IL‐13 and IFN‐γ levels and recurrence of wheezing episodes in infants with acute bronchiolitis

Lower respiratory tract infections are the most important factors among various causes which trigger wheezing in the first year of life. The factors associated with episodic wheezing in children with acute bronchiolitis are still subjects of research. Infections, environmental factors, immunologic mechanisms are sorted as etiologic risk factors of episodic wheezing. We aimed to investigate the relationship between serum interleukin (IL)‐4, IL‐13 and γ‐interferon (IFN‐γ) levels and recurrence of wheezing episodes in infants with acute bronchiolitis. One hundred twenty infants between 3 and 36 months with acute bronchiolitis enrolled in the study. Personal histories, clinical and laboratory data of infants were recorded. The patients were followed for a year. Venous blood samples were obtained to determine serum IL‐4, IL‐13, and IFN‐γ levels during acute bronchiolitis episode. The number of wheezing episodes was significantly higher in infants with a positive family history of allergy. A statistically significant correlation was determined between serum IL‐13 levels of infants and number of wheezing episodes. High serum IL‐13 levels and a positive history of allergy may have important roles in the recurrence of acute bronchiolitis.