特布他林联合氨茶碱治疗78例小儿喘息性疾病的临床观察

从2001年11月-2006年11月以来，盘县第二人民医院儿科结合过去实践经验，采用特布他林联合氨茶碱治疗小儿喘息性疾病获得较满意的疗效，现总结报告如下。     

硫酸特布他林注射液治疗婴幼儿喘息性疾病的有效性和安全性临床研究

目的探讨硫酸特布他林注射液雾化吸入治疗婴幼儿喘息性疾病的疗效和安全性。方法选择2016年12月至2018年4月在苏州大学附属儿童医院、成都市妇女儿童中心医院及大连医科大学附属大连市儿童医院呼吸科住院的440例以咳嗽、喘息为主要表现的下呼吸道感染婴幼儿为研究对象。所有患儿随机分为硫酸特布他林注射液组(A组)、硫酸特布他林雾化液组(B组)和对照组(C组)。比较三组患儿的疗效、不良反应发生情况。结果 A组、B组患儿住院期间喘息症状评分改善显著快于C组(P0.05)。A组和B组对心率均有一定的影响,在雾化后30 min及60 min的心率均高于C组。除了对心率的影响外,A组和C组未发现其他不良反应;B组有1例患儿出现手臂震颤,停药后消失。结论硫酸特布他林注射液雾化吸入治疗婴幼儿喘息性疾病可以缩短治疗时间,有效提高临床治疗效率,临床疗效与硫酸特布他林雾化液相当,同时安全性高,值得在临床上推广和运用。     

布地奈德混悬液与硫酸特布他林雾化液联合治疗儿童哮喘急性发作

目的研究布地奈德混悬液与硫酸特布他林雾化液联合吸入与静脉使用激素、氨茶碱控制儿童哮喘急性发作的效果。方法支气管哮喘急性发作患儿76例随机分为治疗组与对照组。治疗组吸入布地奈德混悬液与硫酸特布他林雾化液;对照组静脉使用激素、氨茶碱。分别在治疗前后测峰流速(PEF),比较其变异率。结果治疗组及对照组治疗后临床表现均有改善,PEF变异率明显提高,治疗组治疗后15、30min PEF与对照组比较均有显著性差异(P均<0.05);治疗后15min、1h两组总有效率均有显著差异(P均<0.05)。结论儿童哮喘急性发作期应用布地奈德混悬液与硫酸特布他林雾化液联合雾化吸入既可快速平喘,又可减少患儿输液率及住院率。     

硫酸特布他林联合氨溴索雾化吸入治疗细支气管炎的疗效观察

目的 探讨硫酸特布他林联合氨溴索雾化吸入治疗细支气管炎的治疗效果.方法 120例细支气管炎患儿分为治疗组60例、对照组A 30例、对照组B 30例.对照组A:硫酸特布他林雾化液2.5 mg/次;对照组B:氨溴索注射液7.5 mg/次;治疗组:硫酸特布他林雾化液2.5 mg/次及氨溴索注射液7.5 mg/次.每组药物均加生理盐水至5ml由空气压缩泵雾化吸入,2次/d,10～ 15 min/次,连用5～7d.观察各组咳嗽、喘憋、气促、哮鸣音和湿哕音好转情况及不良反应.结果 治疗组总有效率与对照组A、对照组B比较,差异均有统计学意义(x2 =4.96,P＜0.05;x2=6.86,P＜0.05).喘憋消失、气促缓解、哮鸣音消失、湿哕音消失及平均住院时间治疗组与对照组A、对照组B比较明显缩短,差异均有统计学意义(P＜0.01).结论 硫酸特布他林联合氨溴索雾化吸入治疗细支气管炎疗效好,症状缓解快,病程短,治愈率高.     

羧甲半胱氨酸糖浆与硫酸特布他林片口服治疗支气管炎患儿临床疗效观察

目的评估羧甲半胱氨酸糖浆与硫酸特布他林片合用在临床上治疗支气管炎患儿咳嗽、咳痰、哮鸣等临床表现的疗效及安全性。方法120例6个月～10岁患急性支气管炎的儿童，随机分为治疗组（羧甲半胱氨酸糖浆＋硫酸特布他林片）和对照组（抗生素＋病毒灵＋化痰止咳冲剂），观察两组治疗前后咳嗽、哮鸣、咳痰等的评分及综合评分变化。结果．治疗组、对照组治疗后咳嗽、咳痰、哮鸣音均较治疗前明显好转，治疗组治疗后3～5天后呼吸道症状改善总有效率高于对照组。结论羧甲半胱氨酸糖浆与硫酸特布他林片合用对改善支气管炎患儿咳嗽、咳痰、喘鸣音等症状疗效显著。     

特布他林气雾剂治疗儿童哮喘的临床观察

目的　观察特布他林气雾剂治疗儿童哮喘的临床疗效。方法　 38例哮喘儿童吸入特布他林 5 0 0 μg ,另有 30例患儿吸入沙丁胺醇 30 0 μg作为对照组。应用Jaeger公司IOS肺功能仪测定吸入前和吸入后 2 0分钟 1秒钟用力呼气容积 (FEV1)、最大呼气峰流速 (PEF)和总气道阻力 (R5)。结果　两组患儿吸药后呼吸功能有不同程度改善 ,FEV1和PEF有所增加 ,但与治疗前相比 ,P >0 0 5 ;R5明显降低 ,P <0 0 1。结论　特布他林和沙丁胺醇气雾剂吸入治疗均能改善哮喘儿童的呼吸功能 ,其中以R5更为敏感     

联合吸入布地奈德混悬液和特布他林雾化液治疗婴幼儿哮喘的疗效

目的探讨联合吸入布地奈德混悬液和特布他林雾化液治疗婴幼儿哮喘的疗效及安全性。方法对75例哮喘婴幼儿采用双盲对照随机抽样法,设单纯吸入特布他林雾化液（A组）及联合吸入布地奈德混悬液和特布他林雾化液（B组）、单纯吸入布地奈德混悬液（C组）3组分别进行治疗,每组25例。观察比较3组疗效及安全性。结果A组治愈16例,显效3例,无效6例,总有效率76%;B组治愈22例,显效2例,无效1例,总有效率96%;C组治愈14例,显效4例,无效7例,总有效率72%。A、B组总有效率比较有显著性差异（P〈0.05）;B、C组总有效率比较有显著性差异（P〈0.05）;A、C组总有效率比较差异无显著性（P〉0.05）。结论联合吸入布地奈德混悬液和特布他林雾化液治疗婴幼儿哮喘疗效优于单纯吸入特布他林雾化液和单纯吸入布地奈德混悬液,不良反应少,安全性好。     

硫酸特布他林雾化引起肢体麻木1例

患儿,男,1l岁,因反复干咳1年入院.1年前无明显诱因出现咳嗽,以晨起为著,无痰,多次使用抗生素及对症治疗,干咳未改善,使用平喘药口服时干咳能减轻.     

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.     

A comparison between nebulized terbutaline, nebulized corticosteroid and systemic corticosteroid for acute wheezing in children up to 18 months of age

One hundred and twenty-three children, aged 1.5–18 months, participated in a randomized, double-blind, placebo-controlled multicentre study comparing different treatments for acute wheezing. The children were admitted to one of five participating paediatric departments. They were randomized into one of four treatment groups: (I) soluble prednisolone +placebo inhalation + terbutaline inhalation; (2) soluble placebo + budesonide inhalation + terbutaline inhalation; (3) soluble placebo+placebo inhalation + terbutaline inhalation; and (4) soluble placebo + placebo inhalation + normal saline inhalation. On admission, measurements of temperatures, respiratory rate and heart rate were made and once-a-day thereafter. Wheezing, accessory respiratory muscle use, prolonged expiration and general condition were scored on a scale ranging from 0 to 3. Significantly more treatment failures were recorded in the placebo group. Children from both steroid groups were discharged earlier than children from the terbutaline group. Compared with children from the placebo group, children from all three treatment groups had a greater improvement in symptom score, but this was significant for the budesonide group only.     

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目的探讨联合降阶梯方案治疗婴幼儿喘息的疗效和安全性。方法以2010年10至12月于上海交通大学医学院附属新华医院哮喘专科门诊及普通儿科呼吸门诊就诊的婴幼儿喘息患儿97例作为研究对象,以规范采用联合降阶梯疗法患儿作为治疗组,以仅采用门诊常规治疗的患儿作为对照组(非联合降阶梯疗法组)。两组均采用相同综合性治疗,包括吸氧、退热等对症处理。治疗组口服泼尼松5mg/d,每天1次,疗程3d;口服阿奇霉素0.1g(/kg·d),疗程3d;每晚用妥洛特罗贴剂1贴(0.5mg/d),疗程7d;口服氯雷他定3mL/d,疗程14d;口服孟鲁司特钠4mg/d,疗程21d。对照组采用目前门诊常用治疗方案,包括采用静脉滴注琥珀氢考或甲强龙、平喘药物、抗生素、祛痰止咳合剂、雾化吸入激素等。结果治疗组患儿咳嗽、喘息、哮鸣音评分及症状体征消失天数显著低于对照组(P<0.05),治疗组1个月内复发次数、治疗费用、家长误工天数显著低于对照组(P<0.05),且治疗组患儿对该方案接受度较高(P<0.05)。结论联合降阶梯疗法应用于婴幼儿喘息疗效肯定,且方便、安全,值得临床应用推广。     

Efficacy of prednisolone in children hospitalized for recurrent wheezing

Data on the efficacy of corticosteroids on respiratory picornavirus-induced wheezing are limited. To determine whether prednisolone is effective in rhinovirus- or enterovirus-induced recurrent wheezing, we conducted a controlled trial comparing oral prednisolone (2 mg/kg/day in three divided doses for 3 days) with placebo in hospitalized wheezing children and studied post hoc virus-specific efficacy in early wheezing (<3 episodes, reported elsewhere) and in recurrent wheezing (>or=3 episodes). Virus-negative children where excluded. Our primary endpoint was the time until children were ready for discharge. Secondary endpoints included oxygen saturation and exhaled nitric oxide during hospitalization, duration of symptoms, blood eosinophil count, and impulse oscillometry 2 wk after discharge, and occurrence of relapses during the following 2 months. Virus-specific effects were analyzed with interaction analysis in a multivariate regression model. During the study period, 661 patients were hospitalized, 293 randomized, and 59 were accepted in this analysis (mean age 2.6 yr, s.d. 1.3). Prednisolone did not significantly decrease the time until ready for discharge in all patients (prednisolone vs. placebo, medians, 18 vs. 24 h, p = 0.11). However, prednisolone decreased the time until ready for discharge in children with picornavirus infection (respectively, 12 vs. 24 h, p = 0.0022) and more specifically, in children with enterovirus infection (6 vs. 35 h, p = 0.0007). In the secondary endpoints, prednisolone decreased the duration of cough and dyspnea in rhinovirus-affected children (p = 0.033 for both). Prospectively designed clinical trial is needed to test the hypothesis that prednisolone reduces symptoms in picornavirus-affected wheezing children.     

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??Objective??To evaluate the efficacy and safety of combined de-escalation therapy in the treatment of infant wheezing. Methods??Stratified random??open??parallel control method was adopted. A total of 206 cases of infant wheezing??mild-to-moderate at acute exacerbation?? were recruited from 4 clinical research centers from Feb. 2013 to Jan. 2015??and were divided into the experiment group??n??106?? and the control group??n??100??. ??The experiment group was given the combined de-escalation therapy??prednisone acetate tablets 0.5 mg/??kg·d????QD for 3 d??azithromycin suspension 10 mg/??kg·d????QD for 3 d??tulobuterol tape 0.5 mg/d??QD for 7 d??loratadine syrup 3 mg/d??QD for 14 d??montelukast sodium 4 mg/d??QD for 28 d. The drugs were taken orally or used externally. ??The control group was given the conventional therapy??methylprednisolone 1 mg/??kg·d????QD for 3 d??cephalosporin??medication dosage referring to the drug instructions?? for 3 d??ambrocol oral solution??2.5-7.5 mL each time??Q12 h??taken as prescribed but not more than 7 d??. Both methylprednisolone and cephalosporin were administered by intravenous drip. Before and after treatment??observe the symptom and sign improvement??the treatment effect and the repeatedness of wheezing. Results??After 7 d of treatment??the mean decreased value of symptom score was 5.89 in experiment group and 4.84 in control group??the total effective rate was 98.11% in experiment group and 92.00% in control group??P??0.05??. After 28 d of treatment??the experiment group has lower rate of recurrent wheezing incidence??12.26%?? than the control group??24.00%????P??0.05??. Conclusion??The efficacy of combined de-escalation therapy for infant wheezing??mild-to-moderate at acute exacerbation?? is superior to conventional therapy with good clinical safety. The combined de-escalation therapy may achieve good social and economic benefits by reducing the risk of recurrent wheezing.     

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目的 评价左乙拉西坦(LEV)治疗小儿癫痫的疗效和安全性.方法 2007年8月 2008年8月武汉市儿童医院神经内科病房和门诊收治的56例癫痫患儿口服LEV片.其中32例单药治疗;24例添加治疗,即在原有抗癫痫药物剂量及用法不变的基础上添加LEV口服.起始剂量为5.2～20.8 mg/(kg·d),2次/d;目标剂量为14.4～41.6 mg/(kg·d),2次/d.随访时间为3～12个月.结果 LEV单药治疗有效率为68.8%,无发作率为40.6%.添加治疗有效率为41.7%,无发作率为8.3%.两组比较差异有统计学意义(P<0.05).LEV副反应较少,主要为胃肠不适、头晕、嗜睡、易激惹等.结论 LEV治疗儿童癫痫有效,单药治疗疗效高于添加治疗,患儿对其有较好的耐受性.     

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目的了解博卡病毒(HBOV)在急性喘息患儿中的流行病学特点及病毒载量与相应疾病严重程度的关系。方法收集2011年3月至2011年8月温州育英儿童医院住院部237例急性喘息患儿和同期96例无喘息住院患儿鼻咽部分泌物标本。采用荧光定量多聚酶链反应方法进行HBOV检测。结果 237例急性喘息患儿鼻咽部吸取物中共检出HBOV阳性62例(26.2%),96例无喘息患儿鼻咽部吸取物中,共检出HBOV12例(12.5%),两组HBOV检出率差异有统计学意义(χ2=7.377,P<0.01)。62例HBOV阳性患儿中,28例(45.16%)混合其他病毒感染,其中合并RSV感染21例(33.87%)。RSV单一感染与HBOV单一感染患儿、HBOV单一感染与HBOV混合感染患儿临床资料两两比较,差异无统计学意义(P>0.05)。HBOV阳性患儿的鼻咽部吸取物中病毒载量介于2.59×103～5.36×109拷贝/mL,中位数为6.2×103拷贝/mL(四分位数间距,2.6×103～4.4×104拷贝/mL);HBOV单一感染组患儿疾病严重程度与病毒载量的等级呈显著正相关,相关系数r=0.752(P<0.01);HBOV混合感染组患儿疾病严重程度评分与病毒载量的等级无相关性(P>0.05)。结论 HBOV在急性喘息患儿中流行,是导致婴幼儿喘息的重要病原。HBOV单一感染时其致病作用随着病毒载量等级的升高而增强。