家庭雾化吸入治疗注意事项

随着临床上需长期雾化吸入性糖皮质激素（inhaled corticosteroids,ICS）治疗患儿的增多,家庭雾化吸入治疗模式日益受到关注。家庭雾化ICS是治疗儿童慢性呼吸系统疾病的重要方法之一,科学管理能提高长期治疗的依从性并改善患儿疾病的预后。需要更加关注家庭雾化的多个细节,提高治疗的总体疗效。     

喘乐宁空气压缩雾化治疗婴儿毛细支气管炎疗效判定

目的　应用 β2 受体激动剂治疗的急性毛细支气管炎效果一直有争议。该研究观察毛细支气管炎患儿喘乐宁雾化吸入治疗前后肺功能的变化 ,并探讨其临床意义。方法　 30例急性毛细支气管炎患儿随机分为治疗组 1 6例 (喘乐宁雾化吸入 )和对照组 1 4例 (生理盐水雾化吸入 ) ,在雾化吸入前、吸入后即刻、1 5min和 30min分别测定潮气呼吸流速容量环 (TBFV)、呼吸系统静态顺应性及阻力的变化。结果　治疗组到达潮气呼气峰流速时呼出气量 /潮气量 (%V PF)在吸入后 30min与吸入前比较 ,差异有显著性 (P <0 .0 5 )。两组雾化后即刻 2 5 /PF、吸气时间 (Ti)差异有显著性 (P <0 .0 5 )。结论　喘乐宁雾化吸入后 30min可明显降低小气道阻力 ,改善通气。     

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（P＜0.05）。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。     

The synergistic effects of stimulants and parental psychotherapy in the treatment of attention deficit hyperactivity disorder

A 5-year-old boy presented with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder and separation anxiety disorder. The clinical assessment revealed longstanding parent-child relationship problems, ongoing family stress, and a chronic level of low grade depression in the mother. The treatment approach consisted of drug treatment of the child and long-term psychotherapy of the mother. At termination symptoms associated with ADHD were markedly reduced and parent-child relationship problems were no longer evident. It is argued that in a subgroup of children family stress and attachment difficulties may be involved in the development of ADHD. These difficulties should be considered separately in the treatment of children with ADHD, especially if still present after the symptomatic treatment. The treatment outcome raises the question whether or not certain symptoms attributed to ADHD may be reversible, and the long-term adverse outcome of the condition preventable.     

Effect of racemic epinephrine on ventilatory function in the neonate postextubation

The use of nebulized racemic epinephrine to improve ventilatory function in the newborn postextubation was studied. Forty-five infants intubated for more than 3 days were randomized to receive racemic epinephrine by nebulization immediately postextubation or to receive only warmed, humidified gas. Measurements of air flow, esophageal pressure, tidal volume, respiratory rate, and heart rate were made before treatment and every 10 min for 1 h after treatment. Resistance was calculated from recorded data. Changes from baseline values were calculated for each time period. Analysis of variance of these variables for treatment, sex, and time main effects and their interactions, with appropriate adjustments for covariables, was performed. Although some sex interactions were seen, there were no significant time effects or interactions. This study provides no evidence that using nebulized racemic epinephrine in infants postextubation improves ventilatory function.     

Clinical features of postinfectious bronchiolitis obliterans in children undergoing long-term nebulization treatment

Background

Limited data are available in relation to the clinical features of PIBO undergoing prolonged nebulization treatment with budesonide, terbutaline and ipratropium bromide. This retrospective study aimed to outline the features of clinical, high-resolution computed tomography (HRCT) and pulmonary function test (PFT) of PIBO, undergoing maintenance therapy utilizing a triple nebulization treatment and to determine the factors associated with prognosis.

Methods

Children diagnosed with PIBO were followed up between April 2014 and March 2017. The clinical features after maintenance nebulization treatment for 12 months were thereafter summarized.

Results

Thirty patients, 21 boys and 9 girls, were enrolled in the study. The median age of patients was 17.4 months, with a range between 3.0 and 33 months. Persistent coughing and wheezing were detected whilst wheezing and crackles were the common manifestations presented. HRCT scans revealed patchy ground and glass opacity, while PFT showed fixed airway obstruction in all patients. Four patients were lost during follow-up. After treatment, the clinical symptoms were improved greatly in all patients (P?<?0.01). The mean increase in the percentage of TPEF%TE and VPEF%VE were improved greatly (P?<?0.01). Images of the HRCT scan indicated marked improvements in 18 patients (81.8%) in comparison with scans obtained pre-treatment.

Conclusions

Our data suggest a potential role of long-term nebulization treatment of budesonide, terbutaline, ipratropium bromide on PIBO, due to its efficacy as indicated in the improved clinical symptoms, pulmonary functions and CT manifestations identified in the children. New prospective and controlled studies are required to confirm this proposition.

     

Predictors of long-term outcome in children with attention-deficit/hyperactivity disorder

In determining the influence of various factors on outcome, one must keep in mind that these parameters do not act alone but probably exert their influence in a cumulative and interactive manner. Thus, characteristics of the child such as severity of symptoms, comorbidity, and IQ interact with family parameters such as parental pathology, socioeconomic status, family adversity, and treatment to influence long-term outcome. Some of these variables (e.g., comorbid CD, low IQ, parental pathology) have been important in influencing negative outcome. Treatment, particularly stimulant treatment, has been shown to be effective in many short-term studies, but the long-term impact of treatment remains uncertain. The continuation of treatment may be crucial in influencing positive long-term outcome. Particular treatment modalities or combinations (e.g., multimodal treatment) may be required for specific patient subgroups (e.g., subjects comorbid for LD, CD, or anxiety; subjects with low socioeconomic status or high parental pathology). Research in the area continues to evolve. New findings hopefully will continue to improve both the quality of life for patients and families and positive influence of long-term outcome.     

Nebulization of sodium nitroprusside in lung-lavaged newborn piglets

The aim of the present study was to test the hypothesis that nebulization of the nitric oxide donor sodium nitroprusside may selectively reduce pulmonary vascular resistance and improve oxygenation in lung-lavaged newborn piglets. Thirteen anesthetized piglets (1-3 d old) were subjected to repeated lung lavages and then randomly assigned to one of the following two groups: 1) an SNP group, which received SNP nebulization, and 2) a saline group, which received saline nebulization. Pulmonary arterial pressure and pulmonary vascular resistance increased significantly after lung lavage, whereas cardiac output decreased significantly in both groups. After SNP nebulization, pulmonary arterial pressure decreased from 32+/-1 to 17+/-1 mm Hg (p < 0.01) and PVR decreased from 255+/-20 to 172+/-15 mm Hg L(-1) min(-1) kg(-1) (p < 0.01). The arterial tension of oxygen concomitantly increased from 9.4+/-4.0 to 17.0+/-3.0 kPa (p < 0.01), and the arterial/alveolar ratio of oxygen tension increased from 0.11+/-0.01 to 0.22+/-0.03 (p < 0.01). Systemic hemodynamics were not modified significantly during nebulization of SNP. On the other hand, all variables were stable during nebulization of saline. These data suggest that SNP nebulization produces a selective pulmonary vasodilatation and improves oxygenation in lung-lavaged newborn piglets.     

哌醋甲酯治疗儿童注意缺陷多动障碍依从性的影响因素分析

目的：了解注意缺陷多动障碍（attention deficit hyperactivity disorder, ADHD）患儿接受药物治疗与否及服药依从性好坏的影响因素。方法：以188例符合DSM-Ⅳ诊断标准的首诊ADHD儿童为研究对象,完成相关症状评定及认知功能测试,评估哌醋甲酯治疗的依从性。结果：情绪状态好、较少逆反和多动行为的患儿及有精神疾病家族史、数字划消测验得分低者更倾向服药和（或）有更好的服药依从性。其中,logistic回归分析显示患儿不好动、逆反少、数字划消测验得分低是愿意接受药物治疗的预测因素,情绪状态得分高是服药依从性好的预测因素;注意缺陷为主型患儿较混合型患儿接受服药比例更高且服药依从性更好;而性别、年龄、症状严重程度等因素则并不影响是否接受治疗和（或）服药依从性。结论：要特别重视提高伴多动冲动及逆反行为ADHD患儿的服药依从性,改善患儿长期的社会功能。