儿童哮喘控制测试在基层医院儿童哮喘管理中的应用

支气管哮喘（简称哮喘）,是儿童期最常见的慢性呼吸道疾病。2000年国内城区儿童哮喘患病率调查统计显示儿童哮喘患病率1．97％,2年现患病率1．54％。近年随着对哮喘发病机制认识的不断深入,治疗药物和方法不断更新和增加,但临床治疗效果仍不满意,未能达到2006版全球哮喘防治创议（GINA）提出的治疗目标。     

儿童哮喘控制测试在基层医院儿童哮喘管理中的应用

支气管哮喘(简称哮喘),是儿童期最常见的慢性呼吸道疾病.2000年国内城区儿童哮喘患病率调查统计显示儿童哮喘患病率1.97%, 2年现患病率1.54%[1].近年随着对哮喘发病机制认识的不断深入,治疗药物和方法不断更新和增加,但临床治疗效果仍不满意,未能达到2006版全球哮喘防治创议(GINA)提出的治疗目标[2].     

哮喘控制测试与呼气峰流速在哮喘管理中的相关性研究

目的观察哮喘控制测试(ACT)与最大呼气峰流速(PEF)在哮喘管理中的作用,探讨二者在哮喘管理中的相关性。方法选择本院呼吸科就诊的40例非急性发作期支气管哮喘患者,均吸入糖皮质激素加长效β2受体激动剂进行缓解期的阶梯治疗。每日早、晚监测PEF值并记录。每4周随访1次,了解PEF、PEF占个人预计值的百分比(PEFpred%)及ACT监测情况。将ACT评分20分、≥20分的哮喘患者分别用A、B组表示,将PEFpred%80%、≥80%的哮喘患者分别用C、D组表示。结果 40例患者每4周随访1次,为期6个月,共进行了280次ACT评分和PEFpred%监测。其中A组62次,B组218次,C组65次,D组215次。A组PEFpred%为(67.80±8.21),显著低于B组(84.54±3.41)(P0.001);C组ACT评分为(17.37±2.20),显著低于D组(21.67±1.38)(P0.001)。ACT评分与PEFpred%具有线性相关关系(r=0.88,P0.001)。结论支气管哮喘患者的ACT评分与其PEF值具有较好的相关性。     

白介素-10和干扰素γ与儿童支气管哮喘的关系——附29例报告

目的：探讨血清白介素-10和干扰素γ与儿童支气管哮喘（哮喘）的关系：方法：29例哮喘急性发作期（中度）患儿，采用ELISA法分别测定哮喘急性发作期和缓解期的血清白介素-10、干扰素γ水平，同时测定FEV1％值。并对同期的血清白介素．10、干扰素γ与FEV1％进行相关分析：结果：哮喘患儿急性发作期的血清白介素-10、干扰素γ水平及FEV1％值均明显低于缓解期（均为P〈0．01），且急性发作期和缓解期的血清白介素-10、干扰素γ水平与FEV，％值呈正相关（均为P〈0．01）：结论：血清白介素-10、干扰素γ水平与哮喘的严重程度密切相关，这对于监测哮喘的病情发展，以及制定有效的治疗措施有重要的意义。     

儿童呼吸和哮喘控制测试改良中文版在儿童哮喘控制中的意义

目的探讨在儿童哮喘控制中使用儿童呼吸和哮喘控制测试(TRACK)改良中文版的意义。方法选择2018年1月至2018年12月在仪征市人民医院接受治疗的哮喘患儿106例纳入效果分析中,所有患儿以随机数字表法为标准分为观察组和对照组,每组53例。对照组接受常规治疗,观察组患儿在常规治疗基础上采用TRACK改良中文版评价患儿的哮喘控制状况,如评分80分,予以针对性的治疗和护理干预。统计并评价两组患儿干预前后哮喘症状评分、肺功能指标水平以及生活质量评分。结果干预后,观察组日间和夜间哮喘症状评分均显著低于对照组,差异有统计学意义(P0.05);观察组各项肺功能均显著优于对照组,差异有统计学意义(P0.05);观察组生活质量评分为(78.42±7.15)分,显著高于对照组的(51.85±6.14)分,差异有统计学意义(P0.05)。结论采用TRACK改良中文版评价患儿哮喘控制情况,并进行有针对性的治疗和护理干预,有助于改善哮喘患儿的肺功能和哮喘症状,提高患儿的生活质量,具有重要指导意义。     

呼出气一氧化氮测定在成人支气管哮喘治疗中的应用价值

目的探讨呼出气一氧化氮(Fe NO)测定在成人支气管哮喘治疗中的应用价值。方法选取52例成人支气管哮喘患者为研究组,另选取同期52名健康体检者为对照组。检测研究组治疗前(T0)及治疗1个月(T1)、3个月(T2)、6个月(T3)的Fe NO、第1秒用力呼气量占预计值百分比(FEV1%),同时检测对照组(不治疗)同时点的指标情况。分析研究组不同时点FEV1%与Fe NO的相关性。结果研究组T1、T2、T3时点Fe NO显著低于T0时点,且研究组T1、T2时点Fe NO显著高于对照组(P 0. 05)。研究组T1、T2、T3时点FEV1%显著高于T0时点,且研究组T1、T2时点FEV1%显著低于对照组(P 0. 05)。研究组T0时点FEV1%与Fe NO呈显著负相关(P 0. 05)。结论成人支气管哮喘治疗中,Fe NO检测具有重要指导作用。     

儿童哮喘控制测试在哮喘管理中应用效果的观察

目的探讨儿童哮喘控制测试在哮喘管理中应用的效果。方法指导哮喘患儿利用儿童哮喘控制测试问卷进行病情监测,与同期峰流速测定、哮喘专家评估的哮喘控制水平进行比较,判定儿童哮喘控制测试的可信度;观察患儿参加哮喘病情监测后治疗依从性的变化。结果儿童哮喘控制测试结果与同期峰流速测定结果具有良好的趋同性和一致性(P0.01);患儿治疗依从性由儿童哮喘控制测试前的72.5%提高至96.3%(P0.01)。结论儿童哮喘控制测试是有效的哮喘管理手段。     

电子峰流速仪在支气管哮喘患者临床应用中精确性的评估

目的:对比电子峰流速仪与传统肺功能仪测定第1秒用力呼气容积(FEV1)和最大呼气峰流速(PEF)结果,评估此装置的精确性。方法:主诉喘息的患者200例,平均年龄(41.6±18.9)岁。经过指导后,分别使用肺功能仪和电子峰流速仪检测FEV1、PEF。若FEV1/FEV1预计值<80%,行支气管舒张试验,计算FEV1改善率。结果:电子峰流速仪与肺功能仪测定的FEV1、PEF值、FEV1改善率差异无显著性,二者具有良好的相关性。以ROC曲线评估电子峰流速仪诊断支气管哮喘的精确性,以FEV1改善率≥12.18%作为诊断支气管哮喘标准时,敏感性100.0%,特异性90.0%,ROC曲线下面积0.906。结论:价格低廉、使用方便的电子峰流速仪适用于支气管哮喘的筛查和监测。     

哮喘控制测试与支气管激发试验在哮喘管理中的应用

目的评价哮喘控制测试（Asthma control test,ACT）与支气管激发试验（Bronchial provocation test,BPT）在哮喘管理中的应用。方法对我院呼吸内科门诊治疗的214例支气管哮喘（简称哮喘）患者进行ACT和BPT监测。结果 214例哮喘患者中哮喘完全控制112例（52.3%）,部分控制53例（24.8%）,未控制49例（22.9%）;BPT阳性101例（47.2%）;哮喘完全控制组激发试验阳性34例（30.4%）、部分控制组阳性23例（43.4%）、哮喘未控制组阳性44例（89.8%）;三组BPT阳性率比较差异有统计学意义（χ2=44.47,P〈0.01）。结论 ACT与BPT均可用于哮喘疗效的评价和哮喘的管理,两者联合应用评价哮喘控制情况优于单独使用。     

哮喘控制测试结合峰流速在评估哮喘患者控制状况的研究

目的：评价哮喘控制测试（ACT）结合呼气峰流速（PEF）在评估哮喘患者控制状况的应用效果。方法选取收治的非急性发作期哮喘患者200例，采用前瞻性自身对照研究方式，通过Spearson相关性分析，对ACT、PEF以及ACT结合PEF三者评估哮喘控制状况与专家评价结果进行相关性分析。结果 ACT、PEF以及ACT结合PEF评估结果与专家评估结果间差异无统计学意义。 Spearson相关性分析显示，ACT、PEF以及ACT结合PEF三者评估哮喘控制状况与专家评价结果具有显著相关性（ r＝0.718、0.744、0.775，P＜0.05）。结论 ACT与PEF与专家评估结果均具较好的相关性，但二者结合相关性更高，可以较全面准确地反映哮喘患者的病情，更加有利于哮喘病情控制。     

儿童哮喘照顾者健康信念及家庭功能对哮喘控制的影响

目的调查儿童哮喘照顾者健康信念、家庭功能与哮喘控制情况,并分析两者及哮喘控制的关系。方法采用问卷调查法,以中文版儿童哮喘控制测试(Children Asthma Control Test,C-ACT)评估儿童哮喘控制情况,Champion健康信念模型量表评估患儿照顾者的健康信念,家庭功能量表(Family Assessment Device,FAD)评估家庭功能,并使用SPSS 16.0软件包进行统计分析。结果儿童哮喘总体控制率为55.07%。不同哮喘控制情况的患儿照顾者的健康信念及家庭功能差异有统计学意义(P0.05)。除易感性、严重性认知因子外,哮喘患儿照顾者健康信念及家庭功能与哮喘控制情况呈显著相关性(P0.05或P0.01)。结论哮喘患儿照顾者的健康信念及家庭功能与其哮喘管理水平具有密切关系,医护人员在对哮喘患儿及其主要照顾者进行相关治疗管理时,应帮助指导患儿及其主要照顾者提高健康信念和改善家庭功能。     

雾化吸入灭活草分枝杆菌治疗中度支气管哮喘的临床研究

目的 首次将雾化吸入灭活草分枝杆菌用于防治中度支气管哮喘,并观察临床效果.方法 本研究为前瞻性、对照性研究.收集2009年3月至2010年12月于广西医科大学第一附属医院门诊确诊的哮喘患者,满足以下条件纳入研究:年龄≥14岁,符合2008年全球哮喘防治创议(GINA)支气管哮喘慢性持续中度标准,在1个月内无全身使用糖皮质激素、酮替芬或孟鲁斯特等抗炎抗过敏药物并无明显呼吸道感染及已知有其他任何严重的疾病或异常.选取100名哮喘患者,其中男/女比例为37/63,年龄(32.11±12.95)岁.将其随机(随机数字法)分为两组,A组为治疗组,男/女比例为16/34,年龄(33.56±14.23)岁;B组为对照组,男/女比例为21/29,年龄(30.66±11.50)岁;各50名.两组患者的年龄、性别构成差异均无统计学意义,具有可比性.A组雾化吸入灭活草分枝杆菌F.U.36注射液1.72μg/mL×2支加入3 mL生理盐水,1次/d,连续5 d.B组吸入沙美特罗替卡松粉吸入剂(50/100μg),每天两次,持续使用.观察1个月,期间两组患者均可按需吸入硫酸沙丁胺醇气雾剂缓解症状并记录使用喷数.于第0天、第6天、第31天查患者肺功能及哮喘激发试验,治疗前后测ACT评分.结果 于治疗后第6天、第31天,A组哮喘激发试验转阴率分别为82%,78%,B组分别为84%,90%,两组治疗后患者激发试验均明显转阴,经x2检验两组间相比差异无统计学意义(P＞0.05).经完全随机设计资料的方差分析:治疗后A,B组乙酰甲胆碱累积用量明显增加(P＜0.05),而两组之间无差别;A组治疗后第一秒用力呼气容积(FEV1)有改善趋势,但差异无统计学意义,B组显著增高(P＜0.05),在第31天较A组明显增高(P＜0.05);两组最大呼气流量(PEF)在治疗后第6天、第31天均显著增高(P＜0.05),在第31天B组较A组增高明显(P＜0.05);治疗后两组患者哮喘控制测试(ACT)评分均显著提高、硫酸沙丁胺醇气雾剂的使用量均明显减少(P＜0.01),B组较A组明显(P＜0.05).治疗期间仅有2例患者在治疗期间出现一过性低热的不良反应,以第3天明显.结论 雾化吸入灭活草分枝杆菌能在短期内抑制中度哮喘患者的气道高反应性并改善症状、减少发作,减少缓解药物的使用量,在一定时间内对中度哮喘发作有防治作用.

Abstract：

Objective To introduce inhaled inactivated-mycobacterium phlei on prevention and treatment of moderate bronchial asthma to observe the clinical effect. Method This study was a prospective and controlled study. The patients diagnosed with asthma in our out-patient from March 2009 to December 2010 were collected, who met the following conditions were included in the study: age≥ 14 years; met the criteria of moderate chronic persistent bronchial asthma in Global Initiative for Asthma (GINA) in 2008; suspended receiving systemic corticosteroids, Montelukast, ketotifen and other anti-inflammatory and anti-allergic drugs in one month; no significant respiratory tract infections; and other serious illnesses or abnormalities known.A total of 100 patients with asthma were selected, including 37 males and 63 females, age (32.11 ± 12.95 )years. The patients were randomly(random number) divided into two groups: A group(treatment group; 16males and 34 females, age 33.56 ± 14.23 years) and B group (control group; 21 males and 29 females,age 30.66 ± 11.50 years); 50 in each group. No significant difference was noted between the two groups on age and gender composition. The patients in A group were treated with inhaled inactivated-mycobacterium phlei F. U. 36 Injection 1.72 μg/mL × 2 that adding 3 mL normal saline, once a day for 5 days. The patients in B group were treated with salmeterol xinafoate and fluticasone propionate powder for inhalation (50/100 μg), twice daily for sustainable use. The patients in the two groups were observed for one month. During this course, the patients in the two groups could inhale the salbutamol sulphate aerosol as need to relieve symptoms. And the number of using was recorded. Pulmonary function test and asthma provocative test were carried out on the Day O, 6 and 31. ACT scores were measured before and after the treatment. Results On Day 6 and 31 after treatment, the negative conversion rates of asthma provocative test of the patients in A group were 82% and 78% respectively, B group were 84% and 90% respectively. Provocative test of the patients in the two groups were negative conversion significantly before and after treatment. There was no significant difference between the two groups by chi-square test (P ＞ 0. 05 ). Completely random designed data was analyzed by analysis of variance. The analysis showed that the accumulated doses of methacholine of the patients in the two group increased significantly ( P ＜ 0. 05 ), but no difference between the two groups.There was a improvement trend on forced expiratory volume in one second( FEV1 )of the patients in A group after treatment, but no difference. FEV1 of the patients in B group increased significantly higher ( P ＜0.05), which was significantly higher than A group on the 31th day (P ＜0. 05); Peak expiratory flow (PEF) of the patients in the two group increased significantly on Day 6 and 31 after treatment (P ＜0.05 ).On Day 31, B group was significantly higher than A group ( P ＜ 0. 05 ); Scores of asthma control test (ACT)of the patients in the two group were significantly increased, and the number of using of salbutamol sulfate aerosol was significantly reduced (P ＜0.01 ). B group was obvious than group A (P ＜0.05 ). During treatment, there were only two adverse reaction cases of transient low fever; most obvious was on the third day.Conclusions Inhaled inactivated-mycobacterium phlei would inhibit the airway hyperresponsiveness of the patients with moderate bronchial asthma in short time, improve the symptoms, reduce the acute exacerbation, and reduce the use of rescue medication, which has the roles of prevention and treatment of moderate asthma in a certain period of time.     

大剂量布地奈德混悬液治疗小儿哮喘急性发作的疗效观察

目的探讨大剂量布地奈德混悬液雾化吸入治疗小儿哮喘急性发作的疗效及不良反应。方法将84例哮喘急性发作的患儿随机分为两组,在常规治疗的基础上,治疗组给予布地奈德混悬液1 mg/次雾化吸入,每30分钟1次,共3次,之后2 mg,每12小时1次;对照组给予甲泼尼龙2 mg/（kg.d）静脉滴注,之后布地奈德混悬液0.5 mg每12小时1次雾化吸入。观察两组治疗前及治疗后1、24 h的临床症状、体征及最大呼气峰流速（PEFR）变化以及不良反应。结果治疗1 h后治疗组患儿临床控制率及PEFR与对照组比较差异无统计学意义,且两组较治疗前有显著改善。治疗24 h后治疗组患儿临床控制率及PEFR较控制组改善明显,且两组较治疗前有显著改善。两组均未见明显不良反应。结论大剂量布地奈德混悬液雾化吸入治疗哮喘急性发作起效快、疗效显著,可替代全身使用激素,不良反应少。     

Acupuncture in children and adolescents with bronchial asthma: a randomised controlled study

Objective

This randomised controlled trial evaluates the immediate effects of acupuncture as an add-on therapy in in-patient rehabilitation of children and adolescents with bronchial asthma.

Patients and methods

In a pre–post design, the severity of symptoms, lung function, illness-specific quality of life (Paediatric Asthma Quality of Life Questionnaire – PAQLQ) and general and asthma-specific level of anxiety (State-Trait Anxiety Inventory for Children – STAIC) were investigated in 46 acupuncture and 47 control patients. In addition to asthma sports, climate therapy and behavioural training, the intervention group received acupuncture treatment with a standardised needle pattern (12× 30 min.).

Results

With acupuncture, the peak expiratory flow variability differs significantly (p < 0.01) from that of the control patients’ group. Moreover, the acupuncture group differs significantly in their rehabilitation response at the time of discharge concerning perceived anxiety (STAIC-S). The lung function tests do not present differences between groups.

Conclusion

After additional acupuncture, amelioration of peak expiratory flow variability and anxiety can be shown, without any difference in objective lung function tests and quality of life between study groups. Further studies might evaluate the effects of acupuncture on childhood asthma in an outpatient setting.     

脉冲振荡肺功能检测在哮喘儿童支气管舒张试验中的临床价值

目的探讨脉冲振荡肺功能检测在哮喘儿童支气管舒张试验中的临床价值。方法选取80例哮喘患儿随机分为实验组和对照组,采用ISO检测法和常规检测法分别进行检测并比较结果。结果实验组患者阳性37例(92.50%),对照组18例(55.00%),2组患者肺功能各项临床指标检出率比较,差异均有统计学意义(P0.05)。所有患儿在试验后1秒用力呼气容积(FEV1)、共振频率(Fres)、呼吸总阻抗(Zrs)、总气道黏性阻力(R5)、周边气道黏性阻力(R20)、周边弹性阻力(X5)各项临床指标均有明显的改善,差异均有统计学意义(P0.05)。结论脉冲振荡肺功能检测可以准确判断支气管哮喘的各项临床指标的变化,具有临床应用价值。     

皮肤点刺试验在哮喘儿童中的应用

目的了解本地区哮喘儿童的变应原,为预防和治疗儿童哮喘提供依据。方法对我院2007年1月至2008年2月463例1～14岁哮喘患儿行变应原皮肤点刺试验,婴幼儿哮喘组126例,儿童哮喘组337例。变应原分为吸入组和食物组。结果哮喘患儿变应原皮肤点刺试验总阳性率高达96．3％,吸入组中尘螨阳性率最高38．2％,其次为室尘、柳树花粉等,尘螨强阳性率最高10．4％,其次为柳树花粉、室尘等。食物组中牛奶阳性率和强阳性率均最高,分别为34．6％、3．9％,其次为海虾、鸡蛋等。尘螨和牛奶阳性率在婴幼儿组和儿童组差异均有统计学意义（P〈0．05）,尘螨和牛奶强阳性率在婴幼儿组和儿童组差异均无统计学意义（P〉0．05）。结论在过敏因素中吸入变应原是本地区儿童哮喘发作的主要因素,而尘螨、室尘、柳树花粉等又是吸入变应原中的主要变应原,在食物过敏因素中牛奶和海虾是婴幼儿哮喘发作不能忽略的重要因素。     

雾化吸入灭活草分枝杆菌治疗中度支气管哮喘的临床研究

Objective To introduce inhaled inactivated-mycobacterium phlei on prevention and treatment of moderate bronchial asthma to observe the clinical effect. Method This study was a prospective and controlled study. The patients diagnosed with asthma in our out-patient from March 2009 to December 2010 were collected, who met the following conditions were included in the study: age≥ 14 years; met the criteria of moderate chronic persistent bronchial asthma in Global Initiative for Asthma (GINA) in 2008; suspended receiving systemic corticosteroids, Montelukast, ketotifen and other anti-inflammatory and anti-allergic drugs in one month; no significant respiratory tract infections; and other serious illnesses or abnormalities known.A total of 100 patients with asthma were selected, including 37 males and 63 females, age (32.11 ± 12.95 )years. The patients were randomly(random number) divided into two groups: A group(treatment group; 16males and 34 females, age 33.56 ± 14.23 years) and B group (control group; 21 males and 29 females,age 30.66 ± 11.50 years); 50 in each group. No significant difference was noted between the two groups on age and gender composition. The patients in A group were treated with inhaled inactivated-mycobacterium phlei F. U. 36 Injection 1.72 μg/mL × 2 that adding 3 mL normal saline, once a day for 5 days. The patients in B group were treated with salmeterol xinafoate and fluticasone propionate powder for inhalation (50/100 μg), twice daily for sustainable use. The patients in the two groups were observed for one month. During this course, the patients in the two groups could inhale the salbutamol sulphate aerosol as need to relieve symptoms. And the number of using was recorded. Pulmonary function test and asthma provocative test were carried out on the Day O, 6 and 31. ACT scores were measured before and after the treatment. Results On Day 6 and 31 after treatment, the negative conversion rates of asthma provocative test of the patients in A group were 82% and 78% respectively, B group were 84% and 90% respectively. Provocative test of the patients in the two groups were negative conversion significantly before and after treatment. There was no significant difference between the two groups by chi-square test (P ＞ 0. 05 ). Completely random designed data was analyzed by analysis of variance. The analysis showed that the accumulated doses of methacholine of the patients in the two group increased significantly ( P ＜ 0. 05 ), but no difference between the two groups.There was a improvement trend on forced expiratory volume in one second( FEV1 )of the patients in A group after treatment, but no difference. FEV1 of the patients in B group increased significantly higher ( P ＜0.05), which was significantly higher than A group on the 31th day (P ＜0. 05); Peak expiratory flow (PEF) of the patients in the two group increased significantly on Day 6 and 31 after treatment (P ＜0.05 ).On Day 31, B group was significantly higher than A group ( P ＜ 0. 05 ); Scores of asthma control test (ACT)of the patients in the two group were significantly increased, and the number of using of salbutamol sulfate aerosol was significantly reduced (P ＜0.01 ). B group was obvious than group A (P ＜0.05 ). During treatment, there were only two adverse reaction cases of transient low fever; most obvious was on the third day.Conclusions Inhaled inactivated-mycobacterium phlei would inhibit the airway hyperresponsiveness of the patients with moderate bronchial asthma in short time, improve the symptoms, reduce the acute exacerbation, and reduce the use of rescue medication, which has the roles of prevention and treatment of moderate asthma in a certain period of time.