不同给药方法对潮气肺功能支气管舒张试验结果的影响观察

目的探讨影响潮气肺功能支气管舒张试验参数改善的因素,为婴幼儿哮喘的诊断提供参考依据。方法选择2017年3月至2018年6月就诊于首都儿科研究所哮喘门诊、经临床明确诊断为支气管哮喘且处于急性发作期(喘息发作≤7d)的71例婴幼儿,将患儿依就诊顺序分为气雾剂组20例及雾化组51例,前者采用定量气雾剂给予支气管舒张剂,后者采用雾化吸入给予支气管舒张剂。2组患儿均进行潮气肺功能支气管舒张试验,比较两种给药方式对支气管舒张试验结果的影响,主要观察参数包括呼吸频率、潮气量、吸气时间、呼气时间、吸呼比、达峰时间比、达峰容积比、呼气峰流量;随后进行组内分析,进一步探讨各参数改善率的影响因素。结果给药后,气雾剂组患儿呼吸频率显著下降(P=0.003),吸气时间显著延长(P=0.011);雾化组患儿潮气量、吸气时间、吸呼比、达峰时间比、达峰容积比显著上升(均P0.05)。雾化组患儿吸呼比、达峰容积比上升幅度显著高于气雾剂组(均P0.05)。气雾剂组内,与气道轻度阻塞患儿比较,气道重度阻塞患儿给药后,吸呼比、达峰时间比、达峰容积比改善显著(均P0.05);雾化组内,气道重度阻塞患儿给药后,以上参数亦明显改善。雾化组不同年龄组间比较,2岁以上患儿达峰时间比、达峰容积比上升幅度显著高于1岁以下患儿(均P0.05)。结论通过潮气肺功能技术进行支气管舒张试验,雾化吸入给药方式的舒张效果优于定量气雾剂;给药后肺功能参数的改善与气道阻塞程度有关,也与患儿年龄有关。     

支气管舒张试验在婴幼儿支气管哮喘中的应用价值

目的探讨支气管舒张试验在婴幼儿支气管哮喘(哮喘)中的应用价值。方法对3岁以下哮喘患儿220例(哮喘组)进行潮气呼吸肺功能支气管舒张试验,以同期住院3岁以下支气管肺炎患儿123例为对照(肺炎组),比较2组患儿基础肺功能的差异、舒张前后肺功能改变及不同年龄组舒张阳性率的差异。结果 1.基础肺功能比较:哮喘组达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)及吸呼比(Ti/Te)均显著低于肺炎组,而每千克体质量潮气量(VT/kg)则显著高于肺炎组(Pa<0.05)。2.舒张前后肺功能比较:哮喘组吸药后呼吸频率减慢,吸气时间(Ti)及Ti/Te均增加;肺炎组吸药后TPTEF/TE降低更明显,VT/kg、Ti、Ti/Te均显著增加(Pa<0.05)。3.哮喘不同年龄组阳性率间差异有统计学意义(P<0.05),肺炎不同年龄组阳性率间差异无统计学意义(P>0.05)。结论 1.潮气呼吸肺功能可间接反映婴幼儿哮喘、支气管肺炎的病理生理特征,协助临床诊断。2.TPTEF/TE、VPEF/VE可反映呼吸道阻塞情况,VT/kg可为婴幼儿哮喘和肺炎的鉴别诊断提供参考。3.潮气呼吸支气管舒张试验对2岁以上哮喘患儿有一定参考价值,但对2岁以下者无应用价值。     

不同给药方法对潮气肺功能支气管舒张试验结果的影响观察

目的　探讨影响潮气肺功能支气管舒张试验参数改善的因素,为婴幼儿哮喘的诊断提供参考依据。方法　选择2017年3月至2018年6月就诊于首都儿科研究所哮喘门诊、经临床明确诊断为支气管哮喘且处于急性发作期（喘息发作≤7 d）的71例婴幼儿,将患儿依就诊顺序分为气雾剂组20例及雾化组51例,前者采用定量气雾剂给予支气管舒张剂,后者采用雾化吸入给予支气管舒张剂。2组患儿均进行潮气肺功能支气管舒张试验,比较两种给药方式对支气管舒张试验结果的影响,主要观察参数包括呼吸频率、潮气量、吸气时间、呼气时间、吸呼比、达峰时间比、达峰容积比、呼气峰流量;随后进行组内分析,进一步探讨各参数改善率的影响因素。结果　给药后,气雾剂组患儿呼吸频率显著下降（P＝0.003）,吸气时间显著延长（P＝0.011）;雾化组患儿潮气量、吸气时间、吸呼比、达峰时间比、达峰容积比显著上升（均P＜0.05）。雾化组患儿吸呼比、达峰容积比上升幅度显著高于气雾剂组（均P＜0.05）。气雾剂组内,与气道轻度阻塞患儿比较,气道重度阻塞患儿给药后,吸呼比、达峰时间比、达峰容积比改善显著（均P＜0.05）;雾化组内,气道重度阻塞患儿给药后,以上参数亦明显改善。雾化组不同年龄组间比较,2岁以上患儿达峰时间比、达峰容积比上升幅度显著高于1岁以下患儿（均P＜0.05）。结论　通过潮气肺功能技术进行支气管舒张试验,雾化吸入给药方式的舒张效果优于定量气雾剂;给药后肺功能参数的改善与气道阻塞程度有关,也与患儿年龄有关。     

快速胸腹挤压肺功能测定技术临床价值探讨

目的探讨新型肺功能测定技术——快速胸腹挤压法(RTC)在婴幼儿中的临床应用价值。方法选择102例2～24月龄的呼吸系统疾病患儿。入选患儿均行潮气呼吸肺功能和RTC肺功能测定,其中23例发作期哮喘患儿在支气管舒张试验后再行上述两项肺功能测定。比较不同呼吸系统疾病患儿之间,以及发作期哮喘患儿在支气管舒张试验前后,两项肺功能指标的改变及相关性。结果 RTC肺功能指标——功能残气量位的最大呼气流速(VmaxFRC)在不同呼吸系统疾病患儿之间差异无统计学意义(P>0.05),其改变情况与潮气呼吸肺功能25%潮气量位的流速(TEF25)类似。与哮喘缓解期患儿比较,哮喘发作期患儿的VmaxFRC降低幅度远高于潮气肺功能指标,如VmaxFRC与主要潮气肺功能指标TEF25、达峰时间比具有较好的相关性(r=0.526、0.489,P均<0.01)。发作期哮喘患儿经支气管舒张试验后,VmaxFRC较其基础值显著升高,差异有统计学意义(P<0.01);VmaxFRC改善率亦显著高于潮气呼吸肺功能指标(P<0.05);而潮气呼吸肺功能指标在支气管舒张试验前后的差异无统计学意义。结论 RTC肺功能指标VmaxFRC是反映不同呼吸系统疾病婴幼儿肺功能受损的敏感指标,与潮气呼吸肺功能主要指标之间具有良好的相关性,并在支气管舒张试验方面表现出一定的优越性。     

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目的利用潮气呼吸法进行小年龄儿童的支气管舒张试验,以确立适合0~6岁儿童支气管舒张试验的评定标准。方法2003-06—2004-03就诊于复旦大学附属儿科医院门诊及病房≤6岁的喘息性支气管炎患儿36例,以同期收治的支气管炎患儿25例作为急性支气管炎组,沙丁胺醇和异丙托溴铵两药联合应用作为支气管舒张药物。用潮气呼吸法分析评价支气管炎患儿与喘息性支气管炎患儿吸入两药前后肺功能的变化,以确立小年龄儿童气道高反应性疾病支气管舒张试验的评定标准。结果适合小年龄喘息性支气管炎患儿的支气管舒张试验的评定标准:(1)吸入支气管舒张剂前后,急性支气管炎组呼吸频率(RR)略有改善,喘息性支气管炎组达峰时间比(tPTEF/tE)、达峰容积比(VPEF/VE)明显改善。(2)两组比较达峰时间比(tPTEF/tE)改善率、达峰容积比(VPEF/VE)改善率差异有统计学意义。(3)以达峰时间比(tPTEF/tE)和达峰容积比(VPEF/VE)任意一个改善率≥15%为阳性标准,灵敏度为72·2%,特异度为80·0%。喘息性支气管炎组支气管舒张试验阳性率为72·2%。结论达峰时间比(tPTEF/tE)改善率或达峰容积比(VPEF/VE)改善率≥15%可以作为小年龄儿童支气管舒张试验的评定标准。     

潮气呼吸肺功能检测在1~4岁儿童喘息性疾病中的临床应用

目的 探讨潮气呼吸肺功能检测在1~4 岁儿童喘息性疾病中的临床意义。方法 选择1~4 岁喘息患儿141 例（哮喘41 例、喘息性支气管炎54 例、支气管肺炎46 例）作为观察组,另选取非呼吸道疾病患儿30 例作为对照组,进行潮气呼吸肺功能检测,并观察喘息患儿支气管舒张试验前后肺功能的变化。结果 观察组患儿TBFV 环形态以阻塞性改变为主（65%）,达峰时间比（TPTEF/TE）、达峰容积比（VPEF/VE）亦明显低于对照组（P<0.05）。哮喘组支气管舒张试验后TPTEF/TE、VPEF/VE 较试验前明显改善（P<0.05）。以TPTEF/TE、VPEF/VE 任意一个改善率≥ 15% 作为支气管舒张试验的阳性标准,潮气呼吸支气管舒张试验诊断哮喘的灵敏度为47%,特异度为84%。哮喘组患儿舒张试验前TPTEF/TE ≥ 23% 者的阳性率28%,TPTEF/TE<23% 者的阳性率为65%（P<0.05）。结论 1~4 岁喘息患儿肺功能损害以阻塞性通气障碍为主;潮气呼吸支气管舒张试验可在一定程度上反映哮喘气道可逆性特征;在1~4 岁儿童中以潮气呼吸支气管舒张试验诊断哮喘的敏感性不高,但在阻塞程度重的患儿中诊断意义相对较大。     

婴幼儿支气管哮喘和闭塞性细支气管炎患儿肺功能比较

目的比较婴幼儿支气管哮喘和闭塞性毛细支气管炎(BO)患儿肺功能差异。方法选择57例婴幼儿支气管哮喘和47例BO患儿,应用Master Screen Paed型肺功能仪测定潮气呼吸流量容积曲线,分析参数包括呼吸频率(RR)、每千克体质量潮气量(VT/kg)、吸呼比(TI/TE)、达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)、呼吸气中期流速比值(TEF50/TIF50)。单阻断法测定每千克体质量呼吸系统顺应性(CrsSO/kg)和呼吸系统阻力(Rrs)。结果支气管哮喘和BO患儿VT/kg差异无统计学意义(P>0.05);BO患儿RR、Rrs显著高于支气管哮喘患儿,差异有统计学意义(P均<0.05);BO患儿TI/TE、TPTEF/TE、VPEF/VE、TEF50/TIF50、CrsSO/kg显著低于支气管哮喘患儿,差异有统计学意义(P均<0.05)。结论与婴幼儿支气管哮喘比较,BO患儿呼吸系统阻力显著增高,小气道阻塞程度显著加重,呼吸系统顺应性相对减低,应用婴幼儿肺功能评估可在一定程度上为鉴别婴幼儿支气管哮喘和BO提供帮助。     

气管支气管软化患儿潮气呼吸肺功能特征的研究

目的探讨气管支气管软化(TBM)患儿潮气呼吸肺功能的特征,为TBM患儿的诊断、疗效评估、预后判断提供新的思路。方法选取30例经电子支气管镜诊断为TBM的患儿作为研究组,30例健康儿童作为正常对照组。正常对照组和TBM组初诊时以及确诊后3个月、6个月、9个月、12个月进行潮气呼吸肺功能测定。结果 TBM确诊时与对照组在潮气量及吸气时间、呼气时间、吸呼比的差异无统计学意义(P0.05);与对照组比,TBM组确诊时的呼吸频率较快,达峰时间比和达峰容积比较低,差异具有统计学意义(P0.01);TBM患儿初诊时及确诊后3、6、9、12个月的潮气呼吸肺功能达峰时间比、达峰容积比逐渐增大。结论 TBM患儿潮气呼吸肺功能具有特征性改变,而且随着年龄增大,潮气呼吸肺功能逐渐接近正常。     

体外过敏原与潮气呼吸肺功能测定在毛细支气管炎中的作用

目的 研究体外过敏原与潮气呼吸肺功能测定在毛细支气管炎中的作用.方法 毛细支气管炎77例、婴幼儿哮喘81例、支气管肺炎72例纳入本次研究.应用Pharmacia UniCAP免疫检测分析仪,进行血吸入过敏原、食人过敏原筛查和尘螨特异性IgE检测,同时检测血总IgE和血嗜酸性粒细胞阳离子蛋白(ECP).患儿镇静后进行潮气呼吸肺功能检测,主要测定参数为每公斤体质量潮气量(VT)、达峰时间比(TPTEF/TE)、达峰容积比(VPTEF/VE).结果 毛细支气管炎组(毛支组)与哮喘组吸人过敏原、食入过敏原阳性率、总IgE均高于肺炎组;毛支组VT值、TPTEF/TE值、VPTEF/VE值与哮喘组相比,差异无统计学意义;毛支组血ECP水平低于哮喘组,与肺炎组相比差异无统计学意义,毛支组血ECP与TPTEF/TE、VPTEF/VE无相关;毛支组吸入过敏原检测阳性14例,该14例患儿的血ECP水平与哮喘组相比差异无统计学意义,且血ECP与TPTEF/TE、与VPTEF/VE呈负相关.结论 通过检测血过敏原、ECP、肺功能,有助于了解毛细支气管炎气道炎症变化及肺部阻塞情况.     

潮气呼吸分析参数结合胸部CT在评价先天性心脏病患儿肺功能中的应用

目的 探讨潮气呼吸分析参数结合胸部CT在评价先天性心脏病患儿肺功能中的临床应用价值.方法 对44例先天性心脏病儿童进行潮气呼吸肺功能测定,并对其中28例进行胸部螺旋CT三维重建气管、支气管树成像(CTB).同时选取普通肺炎患儿64例进行潮气呼吸肺功能测定作为对照,并对其中49例进行胸部CT检查.结果 44例先天性心脏病患儿呼吸频率(RR)增快,吸气时间(TI)缩短,达峰时间比(TPTEF/TE)、到达潮气呼气峰流速时的呼气量(VPTEF)、达峰容积比(VPEF/VE)明显下降(P<0.01),呼气峰流速(PTEF)和75%潮气量时的潮气呼气流速(TEF 75)升高(P<0.05).28例先天性心脏病患儿胸部CT显示肺部感染、气道狭窄、肺气肿和肺不张,患病率明显高于对照组(P<0.05).结论 潮气呼吸参数中TPTEF/TE、VPTEF、VPTEF/VE能反映先天性心脏病阻塞性通气功能障碍,胸部CT能进一步显示通气功能障碍的原因,两种无创技术相结合,能较全面反映先天性心脏病患儿的肺功能状态.     

Resilience in Families with a Child with Cancer

The aim of this study was to identify and explore resilience factors associated with family adaption after a child had been diagnosed with cancer. Using a cross-sectional survey research design, parents (n = 26), and children (n = 25) from the same families independently completed six self-report questionnaires, as well as responded to an open-ended question about those qualities that helped their family through the period following the diagnosis. The most significant results came from the children's data. According to these results, connectedness within the family, the experience of control over life events, family routines, positive, and supportive communication, redefinition of crisis situations, and lastly, a passive appraisal of crisis situations, were positively linked to better family adaptation. The identified factors should be strengthened and developed in families finding themselves in a similar situation.     

Therapeutic experience with hepatoblastoma associated with trisomy 18

Trisomy 18 is often fatal, but patients with this disease can now have longer survival due to proactive treatment intervention. However, hepatoblastomas may develop in these patients. In this study, we report four cases of hepatoblastoma associated with trisomy 18. All of the patients had congenital heart disease and three had undergone intracardiac surgical repair. Tumor growth was relatively slow in all cases, and there were no problems with chemotherapy tolerability and surgical resection. Three of the patients are currently disease‐free and the fourth is alive with remaining of the tumor. These cases suggest that combined chemotherapy and surgical resection may be an option to treat hepatoblastoma associated with trisomy 18 when cardiac pulmonary function is relatively stable.     

Colonization with Clostridium difficile in Children with Cancer

Objective

Clostridium difficile is a gram-positive, anaerobic, spore-forming bacillus. Usually it does not cause disease unless a patient who is colonized with toxin-producing strains has been treated with antibiotics, particularly those that change the anaerobic flora of the large intestine.

Methods

We investigated in a prospective study intestinal colonization of C. difficile and its toxins in children with malignancy that used different antibiotics and cytotoxic drugs.

Findings

One hundred fifty-two patients were included in this prospective study. Stool samples were obtained within the first 48 hours after admission and cultured for C. difficile; cytopathic effect of C. difficile was detected on HELA cells, also ELISA test was performed for detection of toxins A and B. 25% of patients had positive culture for C. difficile; 36/38 (92%) revealed positive cytopathic effect on HELA cells. No significant relation was found between age, gender, history of antibiotic consumption and C. difficile positive culture and cytopathic effect on HELA cells. The only relation was seen between cotrimoxazol usage and cytopathic effect on HELA cells (P=0.03).

Conclusion

Although the rate of C. difficile colonization (25.6%) and toxigenic strains (23.7%) in admitted children in hematologic ward is high, the rate of ELISA positive test for toxin A+B was not correspond with culture and cytopatic effect on HELA cell. With respect to sensitivity and specificity of ELISA test, possibility for existence of toxin C with cytopathic effect is high in this type of patients.     

Tyrosinemia associated with perinatal infection with cytomegalovirus.

A premature infant presented with elevated concentrations of tyrosine in blood and urine, evidence of hepatocellular damage, demineralization of the bones, and a renal Fanconi syndrome. This is the clinical picture found in hereditary tyrosinemia. The infant also had a perinatal infection with cytomegalovirus.     

Treatment with Probucol of Children with Familial Hypercholesterolemia

ABSTRACT. Nine children with familial hypercholesterolaemia, age range 2 to 12 years, were treated with a low cholesterol diet and probucol (10 mg/kg/day). The year before, the children received, as only treatment, a low fat-cholesterol diet. During this period their mean plasma total cholesterol level fell from 8.2±1.45 mmol/l to 7.17±0.84 mmol/l (12.6%). This level was further reduced to 5.92±0.63 mmol/l (17.1%) after the addition of probucol. Plasma high density lipoprotein cholesterol levels were lowered in absolute terms but not in relation to total cholesterol. No apparent side effects were observed. However, the use of probucol should be restricted for the moment to severe cases of hypercholesterolaemia as the long-term excretion of the drug in children is not yet known.     

Juvenile rheumatoid arthritis with myelofibrosis with myeloid metaplasia

Myelofibrosis with myeloid metaplasia is defined as a myeloproliferative disorder characterized by leukoerythroblastosis, tear drop erythrocytes, extramedullary hematopoesis and varying degree of myelofibrosis. It may be idiopathic or secondary to a large number of conditions. Here is a rare case of myelofibrosis occurring in a patient with juvenile rheumatoid arthritis.