沙丁胺醇加布地奈德微量泵吸入治疗小儿毛细支气管炎的疗效观察

目的 :评价沙丁胺醇 (喘乐宁 )加布地奈德 (普米克令舒 )微量泵吸入治疗小儿毛细支气管炎的疗效。方法 :随机将 72例患儿分为两组。对照组在综合疗法基础上单用喘乐宁微量泵吸入治疗 ,治疗组加用喘乐宁及普米克令舒微量泵吸入治疗。观察两组疗效及气急缓解和喘鸣音消失时间。结果 :显效率治疗组为 94.4% ,对照组为 72 .2 % ,两者相比有显著性差异 ( χ2 =4.9,P <0 .0 5 ) ;治疗组气急缓解、喘鸣音消失时间均较对照组短。结论 :喘乐宁加普米克令舒微量泵吸入治疗小儿毛细支气管炎较单用喘乐宁有较好疗效。     

速尿雾化吸入辅助治疗婴幼儿毛细支气管炎30例

目的：探讨速尿雾化吸入辅助治疗婴幼儿毛细支气管炎临床疗效。方法：将58例毛细支气管炎患者儿分为2组，观察组30例在常规治疗的基础上采用速尿雾化吸入治疗（2－4mg/kg.d)；常规组28例仅用常规方法治疗。结果：观察组临床疗效显效率为40．00％，总有效率为100．00％，常规组分别为10．71％及92．86％，两组比较差异均有显著性（P均＜0．05）。结论：速尿雾化吸入辅助治疗毛细支气管炎疗效优于常规治疗。     

呼吸道合胞病毒毛细支气管炎特应性与血清IL-10及病情恢复的关系

为探讨呼吸道合胞病毒(RSV)毛纫支气管炎患儿特应性与血清白介素10(IL-10)水平及病情恢复的关系，应用酶联免疫吸附法分别检测17例年龄50天--12月，特应性体质的RSV毛细支气管炎患儿急性期与恢复期血清IL-l0水平，并以24例非特应性患儿及37例正常儿为对照组。结果显示，急性期待应性组IL—10水平与正常对照组相比，差异无显著性(P＞0．05)，但明显低于无特应性组(P＜0．001)；特应性组喘憋和肺部体征消失均较非特应性组慢，住院时间延长(P＜0．05)；恢复期两组IL-l0差异无显著意义。提示特应性体质患儿RSV感染后不能上调IL-l0产生，结果可导致病变恢复缓慢。     

Salbutamol or mist in acute bronchiolitis

Abstract Background : The role of bronchodilators in the treatment of bronchiolitis remains controversial.
Methods : A double-blind, placebo controlled trial was performed to evaluate the clinical response to nebulized salbutamol. One hundred and fifty-six infants aged between 7 weeks and 24 months who had had an episode of wheezing and other signs and symptoms of bronchiolitis were randomized to three groups as follows: (i) nebulized salbutamol was administered to 52 patients in group I at a dose of 0.15 mg/kg in 2 mL saline; (ii) saline was nebulized to 52 patients in group II and (iii) in group III 52 patients received mist in a tent. All three groups were administered oxygen during the procedures. Treatment was repeated with the same agent after 30 min if the respiratory score was 5 or more. Respiratory rate, heart rate, oxygen saturation and presence of cyanosis, wheezing, retractions were recorded before and after each treatment.
Results : The decrease in the respiratory score was 5.2 ± 1.8, 0.82 ± 2.4 and 1.7 ± 1.3 in group I, II and III, respectively. The decrease in group I was significantly higher than in the other groups. Heart rate was similar between groups. Oxygen saturation decreased in group I without reaching statistical significance.
Conclusions: Salbutamol was shown to be effective and safe in the treatment of acute bronchiolitis.     

Differential patterns of circulating adhesion molecules in children with bronchial asthma and acute bronchiolitis

The object of the study was to assess the levels of circulating forms of the cellular adhesion molecules ICAM-I, VCAM-1, E-selectin, L-selectin and P-selectin in young children with asthma and acute bronchiolitis. Thirty-nine children aged 12 to 84 months with mild or moderate asthma were studied at admission for acute asthma (n = 15) or in a stable phase (n = 24). Ten of the children with acute asthma were seen again after one month. Twenty-two children aged 1 to 17 months with acute bronchiolitis and nine non-atopic controls were also included in the study. In children with acute asthma, the mean concentration of circulating soluble ICAM-1 (SICAM-I) was increased compared to children with stable asthma (mean 442 μg/l versus 363 μg/l; p < 0.001) and to controls (363 μg/l; p < 0.05). The levels of SICAM-1 remained high at follow up. In children with stable asthma, the mean serum concentration of soluble L-selectin (sL-selectin) (2080 μg/l) was significantly higher than in the controls (1664 μg/l; p < 0.05). The levels of circulating cellular adhesion molecules were similar in atopic and non-atopic asthmatics. Children with acute bronchiolitis had increased serum levels of soluble VCAM-1 (sVCAM-I) (1637 μg/l versus 1019 μg/l in the controls; p < 0.01) and sL-selectin (2041 μg/l versus 1664 μg/l in the controls; p < 0.05). There was no difference between the levels of circulating cellular adhesion molecules in children with respiratory syncytial virus (RSV) positive and RSV negative bronchiolitis. Soluble E-selectin (sE-se-lectin) and soluble P-selectin (sP-selectin) in serum were not significantly increased in any of the groups studied. In conclusion, our data suggest differential patterns of circulating cellular adhesion molecules in young children with acute asthma, stable asthma, and acute bronchiolitis, which may reflect differences in the underlying inflammatory processes in these obstructive pulmonary diseases.     

卡介苗、干扰素γ及维生素A预防毛细支气管炎患儿发生哮喘的临床研究

目的　探讨卡介苗 (BCG)或联用干扰素γ(IFN γ) /维生素A(VitA)预防毛细支气管炎 (毛支 )患儿发生喘息的效果。方法　 4 4例毛支患儿予单独BCG或联用IFN γ/VitA治疗 ,于治疗前和治疗 3个月后进行PPD皮试 ,并随访 ,平均 1年时间 ,观察喘息发作情况。 19例未接受BCG接种的毛支患儿 ,作为疾病对照组。结果　BCG接种后PPD平均硬结直径大于干预前及对照组恢复期 ,以联合IFN γ/VitA治疗组更突出。BCG单用或联用IFN γ/VitA组 1年内喘息发作频率低于对照组恢复期 ,单用或联用组间差异无显著意义。结论　BCG可促进毛支患儿PPD皮试阳转 ,1年内喘息发作频率降低 ,可预防毛支患儿日后发展为哮喘。IFN γ/VitA与BCG具有一定的协同作用。     

Atypical respiratory complications of dengue fever

In last decade, dengue has emerged as one of the most important vector born disease. With increasing cases, uncommon presentations and complications are now commonly recognized. Here, we report two cases of rare pattern of respiratory involvement in dengue: acute respiratory distress syndrome and bronchiolitis with respiratory failure.