儿童支气管哮喘防治常规（试行）

支气管哮喘是儿童时期最常见的呼吸道慢性疾病之一。2000年调查我国0～14岁城市儿童的患病率为0．5％～3．4％。1994年WHO组织全球30多位专家制订了“全球哮喘防治的创议”(GINA)，1998年、2002年相继进行了修订，1993年我国儿科呼吸学组相应制订了我国的“儿童哮喘防治常规”并于1998年进行了修订。现参照2002年新GINA方案并结合我国实情再次修订。     

8省12市哮喘新知识调查问卷结果分析

目的调查国内儿科呼吸专业医师对全球哮喘防治战略(GINA)的了解及掌握程度.方法由首都儿科研究所哮喘防治与教育中心制订有关GINA方案的调查问卷,于1997～1998年在国内8个省份12个城市的哮喘培训班或讲座前向参加的专业医师共700人发放问卷.结果能正确选择哮喘的病理基础是气道慢性炎症者占56%～97.5%,选择中度以上哮喘的最重要治疗是吸入疗法者占28%～83.3%,对哮喘非重症急性发作时最佳的给药方式选择吸入者占64%～100%,能正确使用峰流速仪并记录曲线者占0～24.5%,已执行GINA方案者为0～36%.结论专业医师必须正确认识哮喘的新观念、吸入疗法及应用峰流速仪等作为哮喘病情及治疗监测指标等新方法,加强对GINA方案的推广应用.     

应用GINA方案防治儿童支气管哮喘160例调查分析

支气管哮喘是儿童最常见的慢性呼吸道疾病之一，近10年世界各国哮喘患病率都呈明显上升趋势，尤其是在儿童中。哮喘已是全球慢性疾病发病和死亡的一个主要原因，并成为严重的公共卫生问题。《全球哮喘防治创议》——GINA方案已成为全球防治哮喘     

哮喘儿童吸入糖皮质激素治疗回顾性分析

对哮喘患儿进行长期、持续、规范化治疗是提高哮喘综合管理水平的关键。我科哮喘学组自1996年1月起 ,遵循《全球哮喘防治创议》(GlobalInitiativeforAsthma,GINA)[1]及1993年、1998年中华医学会儿科呼吸学组制定的哮喘防治指南 [2 ,3],进行以糖皮质激素 (glucosecorticosteroid,GCS)吸入为主的治疗措施 ,现总结如下。对象与方法一、对象1996年1月～2000年12月接受糖皮质激素吸入治疗的支气管哮喘患儿326例 ,男178例 ,女148例 ,男女之比为1∶2。首次就诊时的年龄范围为2个月～16岁 ,其中2个月～3岁91例(占27.9 % ) ,～6岁137例 (占42.0 %…     

应用布地奈德（普米克都保）针对轻度持续性哮喘进行早期干预的随机双盲试验

1996年10月～1998年1月期间，由“全球哮喘防治创议(GINA)”的专家牵头，在全球32个国家的499个临床研究中心应用布地奈德(普米克都保)针对轻度持续性哮喘进行了早期干预的随机、双盲试验临床研究，中国有45个中心及871例患者参加了这项临床研究。     

哮喘管理进展

<正>全世界哮喘患者有3亿,中国有3千万,且其发病率和病死率仍呈逐年上升趋势,日益成为一个巨大的社会经济问题。哮喘全球防治创议(GINA)在世界卫生组织推动下不断得到修订和完善,但真正按照该方案进行正规治疗的患者仅占6%,大部分尚未得到良好控制[1]。此外,有大量     

全球哮喘防治的创议2002版与1995版异同点阐述

1993年美国国立卫生院心肺血液研究所与世界卫生组织制定了"哮喘管理和预防的全球策略",并于1995年出版了一套名为《全球哮喘防治的创议》(Global Initrative for Asthma,GINA)系列丛书,即GINA 1995版。这套丛书包括《全球哮喘管理和预防的策略》(Global Strategy for Asthma Management and Prevention)、《哮喘的管理和预防》(Asthma     

《全球哮喘防治的创议(2002)》方案哮喘长期控制治疗中对病情再评估的描述之我见

在慢性哮喘长期控制治疗期间的复核定级中，增加了治疗关键因素的综合分析，以确定复核后用药的级别，是《全球哮喘防治的创议(2002)》(GINA2002)的主要改进点之一。     

婴幼儿哮喘的诊断和早期干预

2006年全球哮喘防治创议(GINA)的主要特点是总体简化、具体细化、依据循证、注重实用。虽然不同年龄哮喘的基本病理生理变化相似,但在疾病的诊断手段、严重度的评估、对不同药物的治疗反应等方面有明显的不同。为此针对临床上在5岁及以下儿童哮喘的诊断、药物有效性和安全性评估及给药方法等方面存在的困难,2006GINA根据循证医学的证据,列出专门章节对5岁及以下儿童的哮喘进行了较详细的阐述。15岁及以下儿童哮喘的临床类型在婴幼儿期,发作性的喘息和咳嗽是常见的临床症状,但并非所有的婴幼儿喘息都是哮喘。这次GINA将5岁及以下儿童的…     

全球哮喘防治创议(GINA)2022青少年哮喘管理解读

支气管哮喘(简称哮喘)是儿童最常见的慢性呼吸系统疾病, 近年来患病率呈明显上升趋势。青少年时期是心理和生理迅速发育的关键阶段, 其哮喘管理与儿童时期和成人时期不同, 需进一步关注青少年哮喘的诊断和管理。全球哮喘防治创议2022(GINA 2022)更新了青少年重症哮喘评估和治疗的内容。现对GINA 2022中与青少年哮喘的诊断、评估、初始治疗及方案调整、重症哮喘管理和青少年哮喘自我管理相关内容进行解读, 为临床工作中青少年哮喘的诊断与治疗提供参考, 以期提高青少年哮喘的管理水平。     

Evidence for changing guidelines for routine screening for retinopathy of prematurity

CONTEXT: Existing guidelines recommended by the Canadian Pediatric Society (CPS) and American Academy of Pediatrics (AAP) for routine screening for retinopathy of prematurity (ROP) remain controversial. OBJECTIVE: To determine whether current guidelines for routine screening for ROP should be changed. DESIGN: We examined data that were collected as part of a larger study of 14 neonatal intensive care units (NICUs) in Canada. We examined the effect of strategies using different birth weight (BW) and gestational age (GA) criteria for routine ROP screening, and performed a cost-effectiveness analysis. SETTING: The 14 NICUs (except one) are regional tertiary level referral centres serving geographic regions of Canada, and include approximately 60% of all tertiary-level NICU beds in Canada. PATIENTS: This large cohort included all 16 424 infants admitted to 14 Canadian NICUs from January 8, 1996, to October 31, 1997. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Treatment for ROP. RESULTS: The most cost-effective strategy was to routinely screen only infants having a BW of 1200 g or less. This included all infants treated for ROP (except 1 outlier at 32 weeks GA and 1785 g BW), at a marginal cost per additional person with improved vision of $513 081 for screening patients between 28 weeks GA and 1200 g BW, compared with $1 800 039 and $2 075 874 for using the current AAP and CPS guidelines, respectively (cryotherapy outcomes). Results for laser therapy were similar, but costs were slightly lower. This strategy reduced the number of infants screened under the current CPS guidelines by 46%. CONCLUSION: Screening only infants having a BW of 1200 g or less is the most cost-effective strategy for routine ROP screening.     

Evidence for newborn screening for cystic fibrosis

Different strategies are available for studying the effectiveness of newborn screening for cystic fibrosis (CF). Although observational studies suggest clinical benefits, their results are difficult to interpret because of the potential for several methodological problems. Randomised studies show that age at time of diagnosis is an important factor in the nutritional status of pancreatically insufficient patients and that a delayed diagnosis increases the risk of malnutrition in childhood. Effects on lung disease are more controversial. Advantages other than better clinical outcome or survival may be obtained by the implementation of CF neonatal screening, mainly the opportunity for presymptomatic trials and treatments and more informed reproductive choices for parents and relatives. Disadvantages of neonatal screening for CF include the detection of heterozygotes and the discovery of mild forms of disease.     

A new method for screening for hyperammonemia

A new method for the detection of hyperammonemia, using a kit based on the principle of microdiffusion of ammonia, is described. The method requires only one drop of blood and takes only 15 min to complete. Experiments for recovery and reproducibility were satisfactory, and good correlation was obtained when compared with an enzymatic method for blood ammonia determination. The new method is considered to be useful for routine, low-cost mass-screening of newborn infants for hyperammonemia. It will also be useful for monitoring blood ammonia levels at the bedside in cases with hepatic disease or receiving parenteral nutrition.