妥洛特罗贴剂联合布地奈德雾化吸入治疗小儿急性哮喘的临床研究

选取支气管哮喘急性发作患儿70例,随机分为治疗组和对照组各35例,对照组给予布地奈德混悬液雾化吸入治疗,治疗组在对照组治疗基础上联合妥洛特罗贴剂治疗,比较两组患儿治疗效果。治疗组咳嗽、咳痰、喘息、哮鸣音消失时间明显短于对照组(P0.05);治疗组总有效率为97.14%,对照组总有效率为85.17%,治疗组总有效率明显高于对照组(P0.05)。妥洛特罗贴剂联合布地奈德雾化吸入可有效控制小儿支气管哮喘急性发作,疗效显著,适合临床应用和推广。     

妥洛特罗贴剂佐治儿童咳嗽变异性哮喘疗效观察

目的 探讨妥洛特罗贴剂在咳嗽变异性哮喘儿童治疗中的作用.方法 将郑州市儿童医院哮喘门诊确诊为咳嗽变异性哮喘患儿随机分为两组,治疗组与对照组各30例,对照组常规治疗(口服孟鲁司特及抗组胺药物),治疗组除以上常规治疗外每晚应用妥洛特罗贴剂经皮给药,比较两组患儿咳嗽缓解的时间及1周肺功能改善情况.结果 应用妥洛特罗贴剂的患儿咳嗽缓解时间及1周肺功能改善情况明显短于对照组,差异有统计学意义(P＜0.05).结论 妥洛特罗贴剂在缩短咳嗽时间方面起效快,1周肺功能情况改善明显,临床疗效显著.     

妥洛特罗贴剂治疗轻中度婴幼儿支气管哮喘临床观察

目的 观察妥洛特罗贴剂对轻中度婴幼儿支气管哮喘的治疗效果及其安全性.方法 将62例支气管哮喘患儿分为妥洛特罗贴剂组(32例)和对照组(30例),在丙酸氟替卡松气雾剂治疗基础上分别加用妥洛特罗贴刑和盐酸丙卡特罗片剂治疗2周.记录患儿的哮喘症状评分、喘鸣发作次数和短效β2受体激动剂的用量,并记录不良反应发生情况.结果 贴剂组治疗后哮喘日间症状评分[治疗1周后为(2.2±0.9)分/周、治疗2周后为(0.9 ±0.5)分/周]明显低于对照组[治疗1周后为(3.4 ±1.1)分/周、治疗2周后为(1.3±0.6)分/周],差异均有统计学意义(P均<0.05);贴剂组治疗1周后哮喘夜间症状评分[(1.8±0.7)分/周],明显低于对照组[(3.3 ±0.9)分/周],差异有统计学意义(P<0.05);贴荆组治疗期间喘鸣发作次数为(2.3±1.2)次,对照组为(3.6±1.3)次,2组比较差异有统计学意义(t=4.09,P<0.05);贴剂组的β2受体激动剂用量为(2.6 ±0.9)喷/周,对照组为(3.7 ±0.8)喷/周,差异有统计学意义(t=5.07,P<0.05);贴剂组不良反应发生率(3.12%)明显低于对照组(23.33%),2组比较差异有统计学意义(X2=3.89,P<0.05).结论 妥洛特罗贴剂是一种安全、有效的轻中度婴幼儿支气管哮喘治疗药物.     

妥洛特罗贴剂治疗儿童咳嗽变异性哮喘

目的观察妥洛特罗贴剂治疗咳嗽变异性哮喘(CVA)的临床疗效及不良反应发生情况。方法我院70例CVA患儿随机分为贴剂组和对照组,两组以小剂量吸入激素作为基础治疗。对照组给予盐酸丙卡特罗口服1.25μg/kg,2次/天;贴剂组给予妥洛特罗贴剂,4~9岁1 mg,9~14岁2 mg,每晚1次。治疗2周后,观察并比较两组的治疗效果。结果治疗2周后贴剂组的最大呼气流量(PEF)、咳嗽均显著改善,与对照组比较,差异有统计学意义(P<0.05)。结论使用妥洛特罗贴剂治疗CVA,可以控制患者的临床症状并改善肺功能,且患者的依从性好,安全有效。     

妥洛特罗贴片治疗50例婴幼儿哮喘的临床效果观察与护理

目的:探讨妥洛特罗贴片治疗婴幼儿哮喘的临床效果及护理。方法:将96例婴幼儿哮喘患儿随机分为两组,对照组46例,给予综合治疗(抗感染、抗病毒、止咳、化痰等)及常规护理;治疗组50例,除上述处理外,再给予妥洛特罗贴剂(阿米迪贴剂)0.5mg睡前经皮给药及适当的护理措施,观察两组临床效果。结果:治疗组的临床治疗效果(咳喘及肺部哮鸣音、湿罗音消失)明显优于对照组,经统计学处理,两组疗效对比有显著性差异(P=0.0006)。结论:妥洛特罗贴片治疗婴幼儿哮喘效果显著,能达到缩短病程的效果;良好的护理措施对配合婴幼儿哮喘经皮治疗及改善其临床症状是必要的。     

妥洛特罗贴剂佐治小儿哮喘急性发作的疗效及安全性评价

目的探讨妥洛特罗贴剂佐治小儿哮喘急性发作的疗效及安全性。方法选择2012年12月至2014年12月哮喘急性发作患儿90例,分为观察组和对照组,每组45例。对照组行布地奈德联合特布他林雾化吸入治疗,在此基础上观察组行加用妥洛特罗贴剂治疗。观察并比较两组的治疗效果。结果观察组哮鸣音、咳嗽、气急、湿啰音消失所需的治疗时间少于对照组,差异均有统计学意义(P<0.05)。两组晨间、睡前的最大呼吸流量水平均得到提升,且观察组提升更为显著,差异均有统计学意义(P<0.05)。对照组咳嗽2例、皮疹1例,不良反应率6.67%;观察组皮疹1例、贴药处红肿1例,不良反应率为4.44%。两组不良反应发生率比较差异未见统计学意义(P>0.05)。结论小儿哮喘急性发作的治疗中用妥洛特罗贴剂佐治可降低治疗时间,提升最大呼吸流量,不良反应较少且严重,该佐治方法兼具疗效及安全性,具有较高的应用价值。     

妥洛特罗贴剂在咳嗽变异性哮喘患儿中的临床应用体会

目的:探讨妥洛特罗贴剂在咳嗽变异性哮喘(CVA)患儿中的应用效果及安全性。方法:选择2014年1月~2015年6月于我院儿科住院治疗的CVA患儿90例,采用随机数字表法随机分为观察组和对照组,每组45例。对照组仅给予吸入糖皮质激素治疗。观察组在对照组基础上给予妥洛特罗贴剂治疗,2周为1个疗程。比较两组的肺功能、临床疗效及不良反应情况。结果:治疗后,两组患儿FEV1、PEF均明显升高,与治疗前相比,差异均有统计学意义(P0.05)。而观察组FEV1、PEF升高程度更为显著,与对照组相比,差异均有统计学意义(P0.05)。观察组的临床总显效率为93.3%(42/45),显著高于对照组的53.3%(24/45),P0.05。两组患儿在治疗期间均未发生明显不良反应。结论:CVA患儿在常规吸入糖皮质激素基础上应用妥洛特罗贴剂,可有效缓解CVA患儿的咳嗽症状,改善肺功能,且不良反应少,临床安全有效,值得临床推广应用。     

妥洛特罗贴剂佐治小儿急性支气管肺炎48例临床分析

目的:观察妥洛特罗贴片佐治小儿急性支气管肺炎的临床疗效。方法:将2012年1月到2013年10月收治的急性支气管肺炎患儿90例随机分为对照组和研究组各45例,对照组采用抗感染、化痰止咳等常规治疗,研究组在对照组常规治疗的基础上,每晚加妥洛特罗贴片贴于患儿背部脊柱旁并固定,每日更换1次,背部垫小毛巾以吸汗,连续治疗10 d为1个疗程,疗程结束后比较两组疗效。结果:研究组的临床症状、体征消失时间均明显少于对照组(P0.05),研究组的总有效率97.8%显著高于对照组的77.8%(P0.05)。结论:妥洛特罗贴片辅助治疗小儿支气管肺炎的疗效显著,不良反应少,且使用方便,建议临床推广应用。     

妥洛特罗贴剂治疗婴幼儿哮喘30例的疗效

目的观察妥洛特罗贴剂治疗婴幼儿哮喘的临床疗效。方法选择在江西省儿童医院呼吸科住院治疗的婴幼儿哮喘患儿60例,按随机数字表法分为观察组和对照组,每组30例。2组在常规治疗的基础上,观察组给予妥洛特罗贴片（阿米迪贴剂）0.5 mg.贴-1,每日20：00～21：00贴于前胸或后背处,每日更换部位;对照组给予硫酸特布他林2.5 mg＋生理盐水2 mL予6 L.min-1氧气驱动雾化吸入,2次.d-1。2组均5 d为1个疗程。观察2组患儿咳嗽、喘息、哮鸣音消失时间,住院时间,气道阻力的变化及药物的不良反应。结果 2组治疗5 d后咳嗽、喘息、哮鸣音消失及住院时间的比较差异均无统计学意义（均P〉0.05）;2组治疗后气道阻力与治疗前比较均有明显下降（均P〈0.05）;2组治疗前后气道阻力变化的比较差异均无统计学意义（均P〉0.05）。观察组出现局部皮肤瘙痒1例,通过更换妥洛特罗贴片的粘贴部位完成治疗,无全身不良反应。结论妥洛特罗贴剂治疗婴幼儿哮喘与特布他林雾化吸入治疗临床效果一致,且无严重不良反应发生,是一种安全有效的新型哮喘治疗药物。     

妥洛特罗贴片治疗儿童支气管哮喘急性发作的疗效观察

众所周知,吸入型β2受体激动剂是支气管哮喘急性发作期的首选用药。能快速扩张支气管达到止喘效果。妥洛特罗（丁氯喘）属选择性β2受体激动剂。妥洛特罗贴片1998年已在日本应用于支气管哮喘,国内报道较少。本研究旨在了解妥洛特罗贴片对儿童支气管哮喘急性发作的疗效,现将观察结果报道如下。     

Tulobuterol in childhood asthma: single dose ranging and repeated oral dose comparative studies

Fifteen asthmatic patients participated in a dose-ranging study using tulobuterol syrup in single doses of 10 to 60 mcg/kg. A second trial was performed to compare tulobuterol and terbutaline in 64 asthmatic children. The tulobuterol dosages were 30 and 40 mcg/kg twice daily; the terbutaline dosage was 75 mcg/kg three times daily. The dose-ranging study showed that tulobuterol had a rapid and prolonged bronchodilator action, even at the lower doses. Tulobuterol had a more prolonged duration of action than terbutaline in the comparative study. Both drugs had statistically comparable magnitudes of effect. Adverse reactions were minimal. No laboratory abnormalities occurred, and blood pressure and pulse rate were clinically unaffected by either drug. Tulobuterol twice daily had an equal or greater positive clinical effect on pulmonary function in asthmatic children than terbutaline three times a day.     

哮喘肥胖患儿血清脂联素水平变化及其临床意义研究

目的探讨哮喘肥胖患儿血清脂联素水平的变化及其临床意义。方法 2014年1月至2015年12月,以120例确诊的哮喘急性发作期肥胖患儿为研究对象(哮喘组),并根据病情将患儿分为轻度亚组、中度亚组和危重度亚组。于患儿入院当天和出院当天检测血清脂联素、总氧化态(TOS)、总抗氧化态(TAS)和氧化应激指数(OSI)水平。以非哮喘肥胖儿童为对照组。结果哮喘组患儿出院时TOS、OSI水平较入院时明显下降(P0.05)。哮喘组患儿入院时脂联素水平低于对照组(P0.05),出院时脂联素水平较入院时明显上升(P0.05)。危重度亚组患儿TOS水平明显高于轻度亚组患儿(P0.05),脂联素水平则明显低于轻度亚组患儿(P0.05)。以患儿入院时血清脂联素水平2.3mg/L作为cut-off值,则脂联素诊断肥胖患儿哮喘急性发作期的受试者工作特征曲线下面积为0.799(95%置信区间:0.699~0.878),灵敏度为85.6%,特异度为80.4%。脂联素与哮喘急性发作和严重程度分级呈负相关,与TOS、OSI亦呈负相关(P0.05)。OSI16.1U和脂联素水平2.3mg/L是哮喘急性发作的独立危险因素(P0.05)。结论脂联素通过调控氧化应激水平参与肥胖患儿哮喘急性发作的病理学发病机制。脂联素可作为肥胖患儿哮喘急性发作的潜在标记物。     

Clinical evaluation of tulobuterol aerosol in childhood asthma

An open clinical trial was performed to assess the efficacy and safety of 400 micrograms tulobuterol aerosol given four times daily in childhood bronchial asthma. A total of 54 children were enrolled with bronchial asthma shown to be reversible by an increase of forced expiratory volume in 1 s (FEV1) of more than 15% following 200 micrograms of salbutamol. Tulobuterol was administered for 3 weeks and regular use of salbutamol was continued for 12 patients during the 7-day lead-in period and six patients took theophylline throughout the study; other drugs were discontinued. The mean FEV1, mean adjusted FEV1, mean peak expiratory flow rate (PEFR) and mean forced vital capacity (FVC) were significantly increased (P less than 0.001) following treatment. Mean FEV1 increases ranged from 9.2% to 14.0%, with 24.5-43.4% of patients showing clinically significant increases of at least 15%. Globally, there was improvement in 46 patients (85%). Headache and nervous system complaints were the most common side-effects. Although this was an uncontrolled study, the indications are that tulobuterol aerosol is effective and safe for use in children with asthma.     

Treatment of asthma with tulobuterol or albuterol in school-age children

The subjects were 40 children aged 6 to 16 years with stable chronic asthma; 20 were randomly assigned to receive 40 micrograms/kg of tulobuterol twice daily and 20 received 100 micrograms/kg of albuterol three times daily for three months. Patients were assessed by spirometry after the morning dose of medication at 0, 2, 4, 8, and 12 weeks of treatment. After initial dosing, the mean percentage increases in forced expiratory volume in one second (FEV1) were significantly higher in the tulobuterol-treated patients than in the albuterol-treated patients: at 30 minutes after dosing, the mean increase was 17.2% in the tulobuterol group and 5% in the albuterol group; at one hour, 20.3% and 6.8%. Similar results were found at 12 weeks. Mean changes in forced vital capacity and peak expiratory flow rate were similar to the changes in FEV1. Treatment side effects were reported by seven tulobuterol-treated patients and by four albuterol-treated patients. Tulobuterol treatment was withdrawn in one patient because of severe vomiting and headache of unknown cause. No changes in cardiovascular function were found in any patient. It is concluded that tulobuterol taken twice daily was more effective than albuterol taken three times daily in the treatment of asthma in children.     

儿童哮喘不同阶段肺炎衣原体感染情况分析

[目的]探讨儿童哮喘各阶段肺炎衣原体(CP)感染状况.[方法]对儿童哮喘急性发作期(n=32)、慢性持续期(n=35)和临床缓解期(n=29)及30例健康儿童对照组,用ELISA方法检测肺炎衣原体血清抗体IgA、IgG、IgM.[结果]儿童哮喘急性发作期、慢性持续期和临床缓解期,健康儿童CP急性感染率分别为31.3％、25.7％、6.9％和6.6％,慢性感染率分别为18.8％、28.6％、3.5％和0％,儿童哮喘急性发作期与慢性持续期的CP感染率均显著高于临床缓解期及对照组(P＜0.05).[结论]CP感染是儿童哮喘急性发作期的重要诱因.     

Intravenous magnesium sulphate in the management of moderate to severe acute asthmatic children nonresponding to conventional therapy.

Management of severe acute asthma attacks in children sometimes bring difficulties to the physician. Some current treatment strategies have focused on intravenous magnesium sulphate administration in patients nonresponding to therapy with beta-2 agonists and corticosteroids. The use and efficacy of this drug has been discussed in this randomized, double-blind, placebo-controlled clinical trial consisting of 20 children with moderate to severe acute asthma exacerbation admitted to the emergency department in Dicle University Hospital, Turkey. Magnesium sulphate infusion therapy of 40 mg/kg doses (maximum 2 g) or an equivalent volume of normal saline solution were administered to randomly assigned 10 patients in each group to the selected patients who were being treated for an acute asthma exacerbation with a peak expiratory flow rate (PEFR) less than 60% of the predicted value after receiving three beta-2 adrenergic nebulizer treatments (salbutamol) given at an interval of 20 minutes each. Vital signs, PEFR and physical examinations were serially recorded at 15 minutes intervals for a total of 90 minutes after the initiation of magnesium sulphate therapy. At 30 minutes, compared with the placebo group, the magnesium sulphate receiving group had lower clinical asthma scores (4.0+/-0.5 vs. 5.5+/-0.5, p = 0.0002) and a significantly greater percentage of improvement from baseline in PEFR (43.0+/-6.3% vs. 14.6+/-3.7%, p = 0.0002). These significant changes persisted at 45, 60, 75 and 90 minutes. No significant side effects were observed. In conclusion, severe asthmatic cases may benefit from magnesium sulphate therapy when beta-2 agonists are inadequate in preventing deterioration.     

Performance of a Novel Clinical Score, the Pediatric Asthma Severity Score (PASS), in the Evaluation of Acute Asthma

OBJECTIVES: To evaluate the reliability, validity, and responsiveness of a new clinical asthma score, the Pediatric Asthma Severity Score (PASS), in children aged 1 through 18 years in an acute clinical setting. METHODS: This was a prospective cohort study of children treated for acute asthma at two urban pediatric emergency departments (EDs). A total of 852 patients were enrolled at one site and 369 at the second site. Clinical findings were assessed at the start of the ED visit, after one hour of treatment, and at the time of disposition. Peak expiratory flow rate (PEFR) (for patients aged 6 years and older) and pulse oximetry were also measured. RESULTS: Composite scores including three, four, or five clinical findings were evaluated, and the three-item score (wheezing, prolonged expiration, and work of breathing) was selected as the PASS. Interobserver reliability for the PASS was good to excellent (kappa = 0.72 to 0.83). There was a significant correlation between PASS and PEFR (r = 0.27 to 0.37) and pulse oximetry (r = 0.29 to 0.41) at various time points. The PASS was able to discriminate between those patients who did and did not require hospitalization, with area under the receiver operating characteristic curve of 0.82. Finally, the PASS was shown to be responsive, with a 48% relative increase in score from start to end of treatment and an overall effect size of 0.62, indicating a moderate to large effect. CONCLUSIONS: This clinical score, the PASS, based on three clinical findings, is a reliable and valid measure of asthma severity in children and shows both discriminative and responsive properties. The PASS may be a useful tool to assess acute asthma severity for clinical and research purposes.