顺尔宁联合吸入糖皮质激素治疗小儿哮喘

近2年来我院应用顺尔宁联合吸入糖皮质激素治疗小儿哮喘,探寻小儿哮喘的最佳治疗方法,达到控制小儿哮喘的发展,以防发展为成人哮喘.     

温阳法治疗小儿哮喘研究进展

目的:探讨温阳法治疗小儿哮喘的研究进展。方法:查阅近年国内有关文献并进行综述。结果:温阳法对小儿哮喘的发作期、缓解期均有较好的治疗效果。结论:温阳法在小儿哮喘治疗中占有重要地位,是小儿哮喘临床治疗中不可忽视的一治疗大法。     

小儿哮喘缓解期中医药防治现状及展望

哮喘是儿童期常见的呼吸道慢性疾病之一,其临床主要表现为反复发作性喘息、呼吸困难、胸闷或咳嗽。具有反复发作、迁延难愈的特点。随着中医对小儿哮喘发病机理认识的不断深入,中医中药在防治小儿哮喘方面逐渐凸显出其独特的优势,尤其在小儿哮喘的缓解期的防治方面已取得了可喜的成果,为探索更新、更有效的根治小儿哮喘的方法奠定了坚实的基础。本文综述了近10年来中医药防治小儿哮喘缓解期的临床资料,并对目前中医药防治小儿哮喘方面所存在的问题进行了分析和展望。     

免疫调节剂治疗小儿哮喘临床应用进展

哮喘是小儿常见的呼吸系统过敏疾病慢性呼吸系统疾病。病理学主要表现为气道高反应及慢性炎症性病变。小儿哮喘的确切病因及发病机制目前仍不十分清楚。现有研究认为,各种原因导致的小儿时期的气道高敏反应是主要原因。小儿哮喘现阶段以缓解气道痉挛,减少发作频率,改善患儿免疫水平为主要治疗原则。近年来,免疫调节剂在小儿哮喘治疗中逐渐受到重视,因此,本文对近年来免疫调节剂治疗小儿哮喘临床应用进展做一综述,以期为临床小儿哮喘的免疫治疗提供一定的参考。     

中医外治法配合中医药治疗儿童哮喘缓解期研究进展

综合分析近10年来有关小儿哮喘的中医外治法的研究文献,发现中医外治法在小儿哮喘缓解期调理脏腑整体功能等方面积累了丰富的经验,取得了较大的成绩。应充分发挥中医优势,为治疗小儿哮喘提供更好的治疗方法。     

小儿哮喘缓解期肺脾气虚证候血清蛋白组学分析

目的 :应用蛋白组学技术分析小儿哮喘缓解期患者血清蛋白,构建小儿哮喘缓解期肺脾气虚证候的辨证模型。方法 :采用弱阳离子磁珠结合表面加强激光解析电离飞行时间质谱技术对94例哮喘缓解期患儿和80例健康儿童的血清作蛋白组学检测,筛选小儿哮喘缓解期肺脾气虚证候的差异性蛋白峰,应用Biomarker Patterns软件建立小儿哮喘缓解期肺脾气虚证候的辨证模型。结果 :50例小儿哮喘缓解期肺脾气虚证患者和80例健康儿童血清作蛋白组学比较,有30个差异蛋白峰(P0.05,倍数≥1.5),筛选4832.60、5917.16、6122.09、33314.46 m/z 4个差异蛋白峰构建的小儿哮喘缓解期肺脾气虚证候辨证模型,灵敏度为87.50%,特异度为90.00%;盲法检验灵敏度为85.70%,特异度为86.70%。小儿哮喘缓解期肺脾气虚证患者和小儿哮喘缓解期脾肾阳虚、肺肾阴虚证患者血清作蛋白组学比较,有22个差异蛋白峰(P0.01)。结论 :采用WCX磁珠结合SELDI-TOF-MS技术可以检测小儿哮喘缓解期肺脾气虚证候的特异性血清蛋白峰,并建立灵敏度和特异度较高的小儿哮喘缓解期肺脾气虚证候的辨证模型。     

近10年中医治疗小儿哮喘研究进展

综合分析近10年有关小儿哮喘的中医治疗研究文献,发现中医药治疗小儿哮喘和调理小儿脏腑功能等方面都积累了很丰富的经验,取得了一定的成果。中医药价格便宜,且副作用小,应充分利用其优势,为治疗小儿哮喘提供更好的治疗方法。     

用体质理论指导小儿哮喘的防治

小儿哮喘的防治尤其是根治较为棘手。将中医的体质理论与临床小儿哮喘的防治结合起来,运用中医体质理论, 从调整患儿素体着手去探索根治哮喘的有效途径,不仅能填补体质理论对具体疾病防治的研究空白,还能提高中医药对小儿哮喘的防治水平。      

平喘合剂治疗小儿哮喘的临床观察

目的 探讨平喘合剂在治疗小儿哮喘的临床疗效。方法 选择小儿哮喘患者200例，随机分为中药治疗组、中成药组和西药组。观察平喘合剂对小儿哮喘的治疗效果，并与痰喘丸组和博利康尼组作对照。结果 平喘合剂对小儿哮喘证候疗效、平喘起效时间及完全平喘时间方面均明显优于痰喘丸组和博利康尼组。结论 平喘合剂治疗小儿哮喘有良好的治疗效果。     

小儿哮喘的护理

目的通过对小儿哮喘发作及缓解期的护理,可防止病情恶化,使病情好转,达到治疗的目的。方法针对不同儿童哮喘病人的特点,作出相应的护理。结果各类小儿哮喘病人病情好转。结论各类小儿哮喘病人,治疗及时得当、有效控制感染、仔细观察、耐心护理可防止病情恶化。     

1860 例畲族儿童支气管哮喘流行病学调查分析

目的了解畲族儿童支气管哮喘流行现状、分布特征及影响因素,为今后畲族儿童支气管哮喘诊治工作提供科学依据。方法根据全国儿童哮喘协作组制定的统一方案,采取整群抽样的方法,对宁德市1860名0～14岁畲族儿童进行哮喘流行病学调查。结果宁德市1860名0-14岁畲族儿童哮喘患病率为3．17％,发病季节以冬（25．4％）、春季（28．8％）为主,哮喘发作与性别（男、女患病率分别为3．45％和2．81％）、呼吸道感染（81．4％）及遗传因素（39．0％）等有关。结论支气管哮喘是儿童最常见的呼吸系统慢性疾病之一,是环境因素和遗传因素共同作用诱导的复杂疾病,对畲族哮喘患儿及其家长进行有关哮喘基础知识的普及和教育是提高哮喘诊治水平的重要措施。     

Asthma morbidity in Australia: an epidemiological study.

OBJECTIVE: To examine the prevalence and management of asthma in adults and children in a population sample in eastern Australia. SETTING: A random sample of children from 33 primary schools in Sydney, Melbourne, Brisbane, and the Upper Hunter Valley (New South Wales), and their parents. DESIGN: A cross-sectional analytic survey of 8753 primary school children aged between 5 and 12 years, and their parents (n = 13,945 adults). Asthma prevalence and management practices were determined by parental responses to a questionnaire, and spirometry was performed in children with "probable asthma". RESULTS: Of 8753 children whose parents responded, the prevalence of current wheeze was 19.5% and diagnosed asthma was 17.1%. Of the children with "probable asthma", 30% had their lung function measured in the previous year, and 6% possessed both a peak flow meter and an action plan for their asthma. Undertreatment was likely, as preventive asthma medications (inhaled corticosteroids or sodium cromoglycate) were used regularly by only 25.5% of these children and by 44.3% of children who had asthma symptoms more than twice per week. Children with the diagnosis of asthma reported higher rates of preventive medication use and ventilatory function measurement than children with frequent symptoms without the diagnosis. In the 13,945 adults, the reported prevalence of asthma was 7%, of whom 39% were using preventive medications, 34% had their ventilatory function assessed in the previous year, and 7% had both a peak flow meter and an asthma action plan. CONCLUSIONS: The study illustrated the gap between the current level of asthma management in the community and the standards set by the Thoracic Society of Australia and New Zealand. Undertreatment and suboptimal management of asthma remain important problems in Australia.     

儿童哮喘与幽门螺杆菌感染的相关性研究

目的通过对比分析哮喘患儿与健康儿童幽门螺旋杆菌（Hp）14C感染率以及血浆中白细胞介素-1b（IL-1b）含量的关系,分析探究Hp感染对儿童哮喘的作用机理,找出更佳防治儿童哮喘的对策方法。方法采用分层抽样法随机抽取2010年8月~2012年8月在我院住院治疗的50例哮喘患儿（哮喘组）、50例非哮喘Hp感染患儿（Hp感染正常组）、50例哮喘且Hp感染患儿（Hp感染＋哮喘组）和50例健康儿童（正常组）为受试对象。利用14C尿素呼气检测仪检测Hp感染阳性率,ELISA试剂盒检测血浆中白细胞介素-1b（IL-1b）含量。结果 1哮喘儿童的14C尿素呼气检测阳性率为34.0%（哮喘组）和50.0%（Hp感染＋哮喘组）,明显大于健康对照儿童的4.0%（P〈0.05）,且哮喘和Hp感染正线性相关（R=0.30,P〈0.05）;2Hp菌株感染后的儿童14C尿素呼气检测阳性率明显高于未感染儿童（P〈0.05）,且哮喘和Hp阳性感染概率呈现正线性关系（R=0.47,P〈0.05）。3四组患儿IL-1b都满足正态分布,其中哮喘儿童的IL-1b浓度为（3.68±0.12）ng/m L,低于健康对照儿童的（0.61±0.04）ng/m L,组间对比具有统计学意义（P〈0.05）;Hp感染＋哮喘组儿童IL-1b浓度为（4.77±0.09）ng/m L,明显高于哮喘组儿童的（3.68±0.12）ng/m L,组间对比差异明显（P〈0.05）。结论哮喘儿童与无哮喘儿童幽门螺旋杆菌（Hp）感染率和血浆中白细胞介素-1b（IL-1b）含量有显著差异,这为哮喘患儿诊断提供了监测依据,在儿童哮喘疾病的治疗过程中有较大的应用价值。     

社区儿童哮喘发病相关因素调查及综合干预评价

目的探讨社区儿童哮喘发病的相关因素,评价社区综合干预在儿童哮喘防治中的作用。方法对社区中2837名0～14岁儿童进行哮喘筛查,共筛查出65例哮喘患儿,采用自编问卷调查表进行回顾性调查,并将65例哮喘儿童随机分为干预组35例,对照组30例,对照组给予常规治疗,干预组在常规治疗的基础上给予社区综合干预措施,即健康教育、规范化管理及跟踪随访,随访期限为1年,比较两组哮喘发作频率及程度。结果该社区中儿童哮喘的发病率为2.3%,以春季最多见,占47.7%(31例);哮喘患儿首次出现喘息的年龄<3岁者占72.3%(47例);诱发因素以呼吸道感染最多见,占65.2%(38例);家族中有哮喘及其他过敏史者分别为23.0%(15例)和16.9%(11例),患儿有湿疹和/或过敏性鼻炎等过敏史者占29.2%(19例)。经社区综合干预后,哮喘的发作次数、发作程度均明显改善。结论哮喘发病与发病年龄、季节、家族史及个人过敏史等多种因素密切相关;应改善儿童的居住环境,积极防治儿童早期呼吸道感染,早期诊断和社区综合干预是儿童哮喘防治的有效措施。     

哮喘儿童血清变应原特异性IgE分布特征

目的观察临床诊断为哮喘的儿童血清变应原特异性IgE(sIgE)的分布特征。方法应用UniCAP100系统的荧光酶联免疫方法,对临床确诊的324例哮喘儿童和60例无特应性疾病史的对照组儿童进行吸入性变应原筛查(Phadiatop)和食物变应原筛查(fx5E),比较2组筛查阳性率的差异,并分析哮喘组各年龄段的筛查阳性率。对其中94例Phadiatop阳性哮喘儿童选择性测定8种(类)吸入性变应原血清sIgE,包括户尘螨、粉尘螨、屋尘、混合真菌、混合树木花粉、混合草花粉、猫毛发皮屑、狗毛发皮屑,分析各种(类)吸入性变应原阳性检出率。结果324例哮喘组儿童Phadiatop、fx5E阳性率分别为55.2%和45.1%,均显著高于对照组相应阳性率20.0%和23.3%。单纯Phadiatop阳性的哮喘儿童平均年龄(7.47±3.27)岁,显著高于单纯fx5E阳性哮喘儿童的平均年龄(3.80±2.04)岁。哮喘儿童Phadiatop阳性的高峰年龄段分别在7岁(总阳性率86.4%)和10岁(总阳性率83.3%)。fx5E阳性的高峰年龄段为3岁(总阳性率63.2%)。94例哮喘儿童血清sIgE阳性检出率分别为:户尘螨62.7%、粉尘螨61.7%、屋尘58.5%、混合真菌43.6%、混合树木花粉27.7%、混合草花粉26.6%、猫毛发皮屑47.6%、狗毛发皮屑36.0%。结论临床诊断为哮喘的儿童,近75%对吸入性变应原和(或)食物变应原过敏;婴幼儿期哮喘儿童以食物性变应原过敏多见,4岁以上哮喘儿童对吸入性变应原过敏逐渐增加。在吸入性变应原中,尘螨、屋尘和真菌是引起儿童哮喘主要的变应原。     

佛山地区哮喘儿童过敏变应原状况的研究

目的了解佛山地区儿童哮喘过敏原分布状况。方法采用皮肤点刺过敏原测试。结果佛山地区哮喘患儿过敏原尘螨阳性率为85．0％,室尘为49．0％,蟑螂为48．0％;而正常儿童过敏原阳性率尘螨为 14．0％,室尘13．0％,蟑螂为7．0％,两者经统计学处理,差异显著(P<0．05)。结论佛山地区哮喘儿童过敏原以尘螨居首位,室尘次之,蟑螂第三。     

Recent trends in the prevalence and severity of childhood asthma.

OBJECTIVE--To examine changes in the prevalence and distribution of childhood asthma and its relationship with various measures of children's health and functioning between 1981 and 1988. It was hypothesized that there would be an increase in the prevalence of asthma, especially among black children, and that available measures would suggest a deterioration in the health and functioning of children with asthma over this period. DESIGN--Analyses of data from the Child Health Supplements to the National Health Interview Survey. SETTING AND SAMPLE--Nationally representative random sample of 15,224 children aged 0 to 17 years in 1981 and 17,110 in 1988. MAIN OUTCOME MEASURES--Changes in (1) the prevalence and distribution of asthma, and (2) among children with asthma, the percentage of children hospitalized, days spent in bed, school days lost in the year prior to survey, and parent ratings and reports of children's overall health status and behavior problems. RESULTS--The estimated prevalence of childhood asthma increased from 3.1% in 1981 to 4.3% in 1988 (P < .0001), with similar increases for children, adolescents, and both sexes. Increases occurred among white children (2.7% to 4.1%; P < .0001) but not black children (5.3% vs 5.1%; not significant). Among those with asthma in 1988 compared with 1981, there was better overall health status (11% vs 24% fair/poor; P < .0001) and fewer with 30 or more days spent in bed in the last year (3.9% vs 7.2%; P < .04). We also observed trends toward a lower rate of hospitalization in the last year (10% vs 14%; P = .07), fewer school days missed (2% vs 6% with > 30 days; P = .08), and a lower rate of extreme behavior problem scores (13% vs 18%; P = .09) in 1988 compared with 1981. Reductions were similar among both black and white children. CONCLUSIONS--These results indicate that the estimated prevalence of asthma among children in the United States increased by almost 40%, and that although the increase occurred exclusively among white children, the prevalence of asthma still remains higher in black children than in white children. There was no support for increasing asthma severity and functional impact among either black or white children with asthma in 1988 compared with 1981. These findings provide no evidence to support the beliefs that asthma prevalence is increasing largely among black children or that the severity of asthma among most children in the United States is increasing.     

玉溪市0～14岁儿童哮喘流行病学调查

目的了解玉溪市0～14岁儿童哮喘的流行现状、分布特征及影响因素.方法采取整群抽样的方法,随机选取玉溪市城区0～14岁儿童16 717例进行调查.结果玉溪市0～14岁儿童哮喘患病率为1.13%,其中男、女性别之比为109：77,发病季节以秋、春季为主,以性别、呼吸道感染、过敏及遗传因素与哮喘发作有关.儿童哮喘治疗为吸入激素58.1%,支气管舒张剂45.7%,全身激素37.6%,抗白三烯药18.3%,脱敏治疗5.9%.结论玉溪市城区0～14岁儿童哮喘患病率为1.13%.其原因与性别、呼吸道感染、过敏及遗传因素等多种因素有关.对哮喘患儿及其家长进行有关哮喘基础知识的普及和教育是提高哮喘的诊治水平的重要措施.     

Adequacy of management and severity of asthma in children attending a summer camp

To assess the adequacy of therapy in asthma, 46 children with asthma attending a summer camp were asked to complete a questionnaire about their symptoms and the treatment that they had received. Each child's height, weight, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were measured. According to defined criteria of symptom severity the children were categorized as suffering from severe (48%) or mild (52%) asthma. The mean FEV1/FVC ratio (P less than 0.05) and the mean FEV1 were lower (P less than 0.02) in the children with severe asthma compared with those with mild asthma. In the group with severe asthma, 68% of the children were considered to be receiving suboptimal therapy; 45% had never had their FEV1 or FVC measured. Among those who were receiving suboptimal therapy, 40% had measurable airflow obstruction compared with 17% of children with mild asthma. Because poor management of asthma remains common in children, the need to make doctors and parents aware of the fact that suboptimal therapy may contribute significantly to the morbidity of the condition is emphasized.     

Active approach to recognising asthma in general practice

The general practice medical records of 214 children born in 1977 were scrutinised for a diagnosis of asthma. In 18 (8%) of these a diagnosis of asthma had been entered. Using a scoring system based on the medical record a further group of children who were thought likely to have undiagnosed asthma was exercise tested. Twelve children (6%) had demonstrable exercise induced asthma. In addition, seven children (3%) had both frequent respiratory symptoms and borderline exercise test results, indicating that they too had clinically important airways obstruction. As expected, histories of atopic eczema, nocturnal cough, persistent cough (more than one week), and wheezing appeared often in the medical records of the children with asthma. In combinations these diagnostic clues were more than 50% predictive of asthma. A more active approach in general practice to the diagnosis of asthma in children is both necessary and possible.