硫酸镁和/或沙丁胺醇雾化吸入对哮喘患儿吸入乙酰胆碱激发后肺功能影响的随机对照研究

目的观察硫酸镁雾化能否改善哮喘患儿吸入乙酰胆碱激发后的肺功能,并与雾化吸入沙丁胺醇和硫酸镁＋沙丁胺醇进行比较。方法330例乙酰胆碱激发试验阳性的哮喘患儿随机分为3组,3组分别给予雾化吸入硫酸镁,沙丁胺醇,硫酸镁+沙丁胺醇,观察用药后2个时点（10 和20 min）第1秒用力呼气量（FEV1）、最大呼气流速(PEF）的肺功能指标。结果①3组患儿用药后2个时点的FEV1、PEF值均较激发值显著上升（P<0.05）,但3组2个时点的FEV1、PEF值两两比较差异无统计学意义（P>0.05）;②沙丁胺醇组及硫酸镁+沙丁胺醇组2个时点的FEV1、PEF值占预计值的百分比高于硫酸镁组（P<0.05）;③硫酸镁组和硫酸镁+沙丁胺醇组用药后20 min时点的FEV1及PEF值占预计值的百分比高于用药后10 min时点的百分比（P<0.05）。 结论硫酸镁雾化吸入能改善哮喘患儿吸入乙酰胆碱激发后的肺功能,但其效果不如单用沙丁胺醇;硫酸镁+沙丁胺醇联合应用不具有协同效应。     

319例哮喘患儿喘乐宁雾化吸入前后肺功能变化

３１９例哮喘患儿喘乐宁雾化吸入前后肺功能变化李元陈育智李硕赵京韩秀兰丁燕通过对哮喘患儿进行喘乐宁雾化吸入前后肺功能的监测、分析，为临床提供判断病情的客观指标，以利于指导临床的治疗工作。方法：３１９例观察对象全部来自我所哮喘专业门诊的患儿，诊断按１９９...     

布地奈德雾化吸入对支气管哮喘儿童肺功能的影响

目的观察布地奈德混悬液雾化吸入对支气管哮喘患儿肺功能的影响。方法100例支气管哮喘患儿随机分为治疗组和对照组,每组各50例。对照组常规治疗,治疗组在常规治疗基础上加用布地奈德雾化吸入治疗3~7 d。观察两组疗效及肺功能指标第1秒最大呼气量(FEV1)、FEV1%、最大呼气流速峰值(FVC)、FVC%、峰流速(PEF)、PEF%的变化。结果治疗组显效42例,有效8例,显效率84%;对照组显效28例,有效22例,显效率58%。治疗组治疗后FEV1、FEV1%、FVC、FVC%、PEF、PEF%均较治疗前及对照组明显升高。结论布地奈德混悬液雾化吸入对支气管哮喘患儿的肺功能指标有明显改善作用。     

规范化管理教育对哮喘患儿肺功能的影响

目的探讨规范化管理教育对哮喘患儿肺功能的影响。方法在儿科哮喘门诊就诊或住院的哮喘患儿110例,随机分为管理组和非管理组各55例。对管理组患儿家长和学龄患儿进行哮喘及其药物基本知识教育,根据病情吸入不同剂量的布地奈德或丙酸倍氯米松(必可酮),定期随诊,适时升级或降级治疗;对照组仅进行发作期治疗。观察1年,对两组治疗前后临床疗效及肺功能进行比较。结果1年后管理组总有效率高于对照组(P<0.05);管理组患儿各项肺功能指标升高,与对照组比较差异有显著性(P<0.05),对照组观察前后各项指标比较差异无显著性(P均<0.05);管理组患儿1年内哮喘发作次数及治疗费用较观察前明显减少(P<0.05),对照组观察前后两项指标比较差异无显著性(P均>0.05)。结论对哮喘患儿进行规范化管理教育后患儿临床症状得到控制,肺功能显著改善,值得推广应用。     

肥胖对不同年龄段哮喘患儿肺功能的影响

目的研究肥胖对不同年龄段初诊哮喘患儿肺功能的影响。方法 294名初诊哮喘患儿按年龄分为学龄前期组(6岁)及学龄期组(6~12.5岁),并根据不同体重指数(BMI)分为体重正常哮喘组、超重哮喘组及肥胖哮喘组,检测患儿肺功能,包括大气道通气功能指标[用力肺活量(FVC)、第1秒用力呼气量(FEV1)]和小气道通气功能指标[用力呼气25%、50%及75%流量的实测值占预计值的百分比,即MEF25%、MEF50%、MEF75%]。结果在校正了性别及BMI分组因素后,学龄期组FEV1%、MEF25%、MEF50%低于学龄前期组(P0.05)。两年龄组正常体重患儿间比较,学龄期组基础肺功能FEV1%、MEF25%、MEF50%低于学龄前期组(P0.05);两年龄组超重患儿间比较,学龄期组FVC%及MEF50%低于学龄前期组;两年龄组肥胖患儿间比较,肺功能各指标差异均无统计学意义。学龄前期肥胖组FVC%、FEV1%及MEF75%均低于体重正常组,而学龄期肥胖组仅FVC%和FEV1%与体重正常组间差异有统计学意义(P0.05)。结论肥胖对哮喘患儿基础肺功能的影响存在年龄差异,于学龄前期更明显。     

雾化吸入普米克令舒和舒喘灵对支气管哮喘患儿肺功能的影响

支气管哮喘是当今世界十分关注的公共健康问题。也是儿童时期最常见的慢性非感染性呼吸系统疾病。哮喘是一种气道慢性非特异性疾病,气道高反应性是其主要特征。急性发作时可导致呼吸困难,病情加重时可危及生命。因此,应及时给予有效的治疗,降低气道高反应性。1资料和方法1.1一般资料2005年3月~2006年6月我院共收治50例哮喘发作患儿,其中男32例、女18例。年龄3~9岁。病例均符合全球哮喘防治组儿童哮喘诊断标准[1]。1.2方法用普米克令舒和舒喘灵各1mL加生理盐水稀释至4mL雾化吸入10~15min,2次/d,每天观察咳嗽、喘息及肺部口罗音等情况。哮喘…     

支气管哮喘患儿肺功能改变的特征

支气管哮喘患儿肺功能改变具有特征性,突出表现在气道反应性增高和阻塞性肺通气功能障碍两个方面,其通气功能障碍具有可逆性、可变性、多样性等,并可随着病情变化而改变.肺功能检测在哮喘诊断和管理中具有不可替代的作用,但哮喘患儿肺功能改变与临床症状并非完全平行,同时需要甄别非哮喘呼吸系统疾病导致的肺功能改变,正确解析检查结果,密...     

肥胖哮喘患儿肺功能改变特点观察

目的 了解门诊哮喘患儿中肥胖者所占比例;探究肥胖与肺通气功能的关系。方法 将2011年1月至2013年12月于上海儿童医学中心哮喘专科门诊就诊的2343例哮喘儿童,根据体重指数（BMI）分为肥胖组358例（15.3%）、超重组476例（20.3%）及体重正常组1509例（64.4%）。检测3组患儿治疗前、随访及规范化治疗1年后的肺功能指标：包括第1秒用力呼气容积（FEV1）、用力肺活量（FVC）、1秒率（FEV1/FVC）,用力呼气流量（FEF）占用力肺活量的25%,50%,75%（FEF25%、FEF50%、FEF75%）,呼吸峰流速（PEFR）。结果 358例肥胖哮喘患儿中,男性明显多于女性［307（85.8%） vs. 51(14.2%),P＜0.01］;随着BMI增加,哮喘患儿FEV1/FVC明显降低,三组间比较差异具有统计学意义（83.3±9.04 vs. 81.54±9.08 vs. 80.26 ±8.66, F＝3.41,P＝0.03）;随访期间,各组哮喘患儿肺功能组间无明显差异;与初诊时基础肺功能相比,每次随访各肺通气功能参数前后比较差异均有统计学意义（P值均＜0.05）;治疗1年后,肥胖组哮喘患儿FEF75%明显低于超重组及体重正常组（0.70±0.26 vs. 0.65±0.24 vs. 0.60±0.25,P＝0.04）。结论 在肥胖哮喘患儿中,男性多见;BMI增高与FEV1/FVC降低有关,且降低规范化治疗对哮喘患儿肺功能的改善效应,表现为治疗1年后肥胖患儿FEF75%较正常体重组差异明显。     

福莫特罗治疗哮喘急性发作期患儿即刎肺功能变化

目的探讨哮喘急性发作期患儿吸入福莫特罗后起效时间和及即刻肺功能变化。方法能掌握肺功能测定方法及都保吸入方法的急性发作支气管哮喘患儿52例,测基础肺功能,随机分为A组吸入福莫特罗4.5μg,B组吸入9.0μg,吸药3～5min后复查肺功能。结果两组吸药后第1秒用力呼气肺活量占预计值的百分比(FEV1%)、呼气峰流速占预计值的百分比(PEF%)及最大呼气中段流速占预计值的百分比(MMEF%)均有明显改善(P均<0.05)。B组吸药后肺功能改善较A组更显著。结论福莫特罗起效迅速,可快速缓解哮喘症状。     

哮喘缓解期患儿及并结核、支原体感染的肺功能改变

目的 观察儿童哮喘缓解期合并结核感染、支原体感染对肺功能的影响。方法 哮喘缓解期患儿107例，分无感染、结核感染、支原体感染三组。对照组28例。观察FVC、VC、FEV1、PEF、V50、V25 6项指标的变化。结果 三组6项指标均值较对照组明显降低（P＜0．001）。结感组、支感组FVC、VC、FEV1核无感组降低，两者差异显著（P＜0．05）。结论 儿童哮喘缓解合并结核感染、支原体感染者以中重度较多，并以限制性通气障碍为主的混合性通气功能障碍多见。     

A meta-analysis on intravenous magnesium sulphate for treating acute asthma

Aim: To evaluate the effectiveness of intravenous magnesium sulphate in the treatment of acute asthmatic attacks in children by meta-analysis. Methods: A systematic and comprehensive search of the literature was performed to identify controlled clinical trials of magnesium sulphate in paediatric acute asthma which evaluated outcomes of hospitalisation or short term pulmonary function tests or symptom scores. Unpublished data were searched by personal contacts with authors and specialists. Two reviewers independently assessed trial qualities and synthesised data. Heterogeneity among studies was evaluated by the Cochrane Q test. Outcome data were pooled by random or fixed effect models depending on presence or absence of heterogeneity. Results: Five randomised placebo controlled trials involving a total of 182 patients were identified. They compared intravenous magnesium sulphate to placebo in treating paediatric patients with moderate to severe asthmatic attacks in the emergency department, with co-therapies of inhaled ß₂ agonists and systemic steroids. The studies were of high quality with results judged to be valid. Four studies showed that magnesium sulphate was effective, while one study found it ineffective. There was no significant heterogeneity in the primary outcome of hospitalisation. In the fixed effect model, magnesium sulphate is effective in preventing hospitalisation (OR 0.290, 95% CI 0.143 to 0.589). The number needed to treat is 4 (95% CI 3 to 8). Secondary outcomes of short term pulmonary function tests and clinical symptom scores also showed significant improvement. Conclusion: Intravenous magnesium sulphate probably provides additional benefit in moderate to severe acute asthma in children treated with bronchodilators and steroids.     

A meta-analysis on intravenous magnesium sulphate for treating acute asthma.

AIM: To evaluate the effectiveness of intravenous magnesium sulphate in the treatment of acute asthmatic attacks in children by meta-analysis. METHODS: A systematic and comprehensive search of the literature was performed to identify controlled clinical trials of magnesium sulphate in paediatric acute asthma which evaluated outcomes of hospitalisation or short term pulmonary function tests or symptom scores. Unpublished data were searched by personal contacts with authors and specialists. Two reviewers independently assessed trial qualities and synthesised data. Heterogeneity among studies was evaluated by the Cochrane Q test. Outcome data were pooled by random or fixed effect models depending on presence or absence of heterogeneity. RESULTS: Five randomised placebo controlled trials involving a total of 182 patients were identified. They compared intravenous magnesium sulphate to placebo in treating paediatric patients with moderate to severe asthmatic attacks in the emergency department, with co-therapies of inhaled beta2 agonists and systemic steroids. The studies were of high quality with results judged to be valid. Four studies showed that magnesium sulphate was effective, while one study found it ineffective. There was no significant heterogeneity in the primary outcome of hospitalisation. In the fixed effect model, magnesium sulphate is effective in preventing hospitalisation (OR 0.290, 95% CI 0.143 to 0.589). The number needed to treat is 4 (95% CI 3 to 8). Secondary outcomes of short term pulmonary function tests and clinical symptom scores also showed significant improvement. CONCLUSION: Intravenous magnesium sulphate probably provides additional benefit in moderate to severe acute asthma in children treated with bronchodilators and steroids.     

口服茶碱类药物治疗小儿哮喘的系统评价证据

目的 对口服茶碱类药物治疗d＇JL哮喘的疗效进行循证的系统评价。方法 使用相关的检索词检索Cochrane Library（1996～2006．6）、Medline（1985—2006．6）、EMBASE（1996—2006．6）,获得关于茶碱类药物治疗小儿哮喘的随机对照研究;用系统评价的专用统计分析软件ReVman4．2对纳入文献的资料作Meta分析。结果 共纳入34篇随机对照研究,将茶碱类药物与安慰剂、β受体激动剂、吸入皮质激索、色甘酸钠、酮替酚进行对比。结论 茶碱类药物在治疗小儿慢性轻至中度哮喘时,给予足够的剂量及疗程可以缓解哮喘的症状。未发现茶碱类药物且有影响小儿行为方面的不良反应．     

Doses of systemic corticosteroids in hospitalised children with acute asthma: A systematic review

AIM: To present the doses of systemic corticosteroids reported by clinical trials in hospitalised children with acute asthma and to assess the possible relationship between doses of corticosteroids and clinical responses. METHODS: An electronic search of MEDLINE databases (January 1949-February 2005) and Cochrane Controlled Clinical Trials Register (February 2005) was undertaken using a combination of indexing terms related to systemic corticosteroids and acute asthma. Studies were selected if they met the following criteria: (i) randomized controlled trial; (ii) children aged 1-18 years and admitted to hospital for acute asthma; and (iii) treatment group consisting of systemic corticosteroids. RESULTS: Nine trials were included for this review. There was considerable variation between the reported doses of systemic corticosteroids. Only two trials assessed clinical responses to different doses of systemic corticosteroids. Both trials failed to show any therapeutic advantage of higher doses over lower doses. The results of the two trials were not suitable for pooling. CONCLUSIONS: Current data are not sufficient for establishing dose-response relationship of systemic corticosteroids in hospitalised children with acute asthma. Larger randomized trials are needed.     

Prognosis of asthma in children: a cohort study into adulthood

Fifty-six children with asthma, randomly selected from a hospital clinic, were followed prospectively for 15 years from a median age of 9–24 years of age. Four follow-ups were performed and included scoring of the frequency of wheezing, the need for medication, admissions to hospital, spirometry, skin prick tests and RAST to common inhaled allergens, and evaluation of living conditions. One patient died of asthma. The remaining 55 reported for all follow-ups. After the second follow-up at a median age of 13 years, all parameters of severity of asthma showed improvement, which was significant at the last follow-up when all subjects were more than 20 years of age. Only 16% of the subjects had been free from wheezing and medication the year prior to the last follow-up. Approximately 90% of the children had clinical allergies and positive allergy tests to pollens and danders and the majority of children retained both the allergies and the reactivity into adulthood. Reactivity to moulds and mites was less frequent (40% and 31 %, respectively) and seemed to decrease in adulthood. Approximately 10% of the subjects developed neither clinical allergies nor reactivity in allergy tests. Children with atopic eczema usually retained their eczema as adults. Frequent wheezing and abnormal spirometry in childhood and early onset of asthma were associated with poorer outcome. The social prognosis was excellent.