硫酸镁与喘乐宁联合吸入治疗小儿哮喘疗效观察

目的　探讨硫酸镁加喘乐宁联合雾化吸入治疗小儿支气管哮喘的有效性和安全性。方法　将 30例哮喘急性发作患儿随机分为硫酸镁和喘乐宁联合吸入组、单用喘乐宁吸入组。吸入喘乐宁的剂量均为每次 2 5 0～3 75mg ,单用喘乐宁组加 2mL生理盐水 ,联合组加 2mL的 7 5 %硫酸镁溶液。观察两组治疗前后呼吸、心率、血压 ;测量治疗前以及治疗后 10min、2 0min最大呼气峰流速 (PEFR)。结果　联合组PEFR明显高于单用喘乐宁组 ,联合组PEFR增加的百分比是单用喘乐宁组的 2倍 (P <0 0 5 ) ,联合组治疗前PEFR越低治疗后PEFR上升幅度越高。硫酸镁吸入治疗后无一例患儿出现血压下降等不良反应。结论　哮喘急性发作患儿在喘乐宁吸入的基础上加用硫酸镁吸入比单用喘乐宁吸入有更好的治疗效果 ;硫酸镁吸入治疗在儿童是安全的。     

婴幼儿哮喘急性发作雾化吸入硫酸沙丁胺醇对肺功能影响的研究

目的 通过观察哮喘急性发作的婴幼儿雾化吸入硫酸沙丁胺醇前后肺功能的变化,客观评价该药对低龄儿童气道阻力的影响.方法 将轻中度哮喘急性发作的49名婴幼儿按年龄分为1～3岁幼儿(32例)和<1岁婴儿(17例)两组,予0.5%硫酸沙丁胺醇0.25ml/次,驱动式压缩泵雾化吸入,在治疗前及后30min分别检查其肺功能,做潮气呼吸流速容量环检查,采用到达潮气呼气峰流速时的呼气量/潮气量(%V-PF)、呼出75%潮气量时的呼气流速/潮气呼气蜂流速(25/PF)和潮气呼气中期流速/潮气吸气中期流速(ME/MI)参数反映大小气道阻力情况.结果 在幼儿组和婴儿组治疗前肺功能指标%V-PF、25/PF和ME/NI降低,显示大小气道阻力增高,治疗后幼儿组肺功能各指标均有所提高,比较差异有统计学意义(P<0.01);婴儿组治疗前后比较差异无统计学意义(P>0.05).结论 对幼儿哮喘急性发作予雾化吸人硫酸沙丁胺醇后能有效地改善肺功能,降低气道阻力,对婴儿治疗的关键是结合有效的抗炎和积极的祛痰.     

不同药物雾化吸入治疗毛细支气管炎的疗效观察

目的　观察甲组 (喘乐宁组 )、乙组 (病毒唑组 )、丙组 (喘乐宁 +普米克令舒组 )治疗毛细支气管炎(毛支 )的疗效。方法　将 53例毛支患儿随机分为甲、乙、丙三组 ,三组均在综合治疗基础上 ,甲组加用喘乐宁雾化吸入 ,乙组加用大剂量病毒唑雾化吸入 ,丙组用喘乐宁与普米克令舒雾化吸入 ,对治疗前、后临床表现消失时间、治愈率进行疗效比较。结果　丙组疗效明显优于其他两组 ,乙组又优于甲组 (P <0 .0 5)。结论　喘乐宁与普米克令舒联合雾化吸入治疗毛支有协同作用 ,可缩短病程 ,提高治愈率 ,可作为佐治毛支的主要药物     

吸入β2肾上腺素能受体激动剂联合抗胆碱类药物治疗对喘息性支气管炎婴儿肺功能的影响

目的了解吸入β2肾上腺素能受体激动剂联合抗胆碱类药物治疗对喘息性支气管炎婴儿肺功能的影响。方法23例5个月-1岁的喘息性支气管炎患儿，在吸入硫酸沙丁胺醇与异丙托溴铵复合溶液前和吸入后30、60及120min各行1次潮气呼吸流速．容量环（TBFV环）检查，同时以20名健康婴儿作为对照，并进行肺功能各项指标比较，包括TBFV环的形态。反映小气道功能的敏感指标：到达潮气呼气峰流速时的呼气量，潮气量（%V-PFV），呼出75％潮气量时的呼气流速，潮气呼气峰流速（25/PF），潮气呼气峰流速（PTEF）；反映大气道功能的指标：潮气呼气中期流速，潮气吸气中期流速（ME/MI），反映潮气呼吸状态下通气功能的指标：包括呼吸频率和每千克体重潮气量（TV/kg）。结果喘息性支气管炎患儿TBFV环中呼气降支凹陷，呼气峰流速前移，治疗前与吸入药物后30、60及120min患儿的TBFV环形态无明显变化；治疗前与吸入药物后30、60及120min呼吸频率、％V-PF、2．5／PF、ME／MI、PTEF和TV/kg的差异均无统计学意义（P〉0．05）。结论吸入硫酸沙丁胺醇与异丙托溴铵复合溶液后，喘息性支气管炎患儿大小气道阻力及通气功能的改善并不明显，提示β2肾上腺素能受体激动剂联合抗胆碱类药物吸入治疗对喘息性支气管炎患儿的肺功能无显著改善。     

吸入沙丁胺醇溴化异丙托品对喘息性支气管炎婴幼儿肺功能的影响

目的：喘息性支气管炎是3岁以内婴幼儿较常见的一种下呼吸道感染,治疗为抗炎和对症处理,但是否应用支气管扩张剂有所争议,国外的一些研究显示对改善临床症状会有帮助,但对婴幼儿肺功能的影响由于检查方法及检查时配合等问题国内外目前研究不多。该文对吸入沙丁胺醇、溴化异丙托品的20例患儿进行了肺功能的测定。方法：20例2个月至2岁6个月的喘息性支气管炎患儿,在吸入药物沙丁胺醇+溴化异丙托品前、吸入后30,60,120min各行一次潮气流速容量环(TBFV环)检查,并进行肺功能各项指标比较,包括潮气呼吸流速容量环的形态,反映小气道功能的敏感指标到达潮气呼气峰流速时的呼气量/潮气量(%VPF),呼出75%潮气量时的呼气流速/潮气呼气峰流速(25/PF),潮气呼气峰流速(PTEF),反映大气道功能的指标潮气呼气中期流速/潮气吸气中期流速(ME/MI),潮气呼吸状态下的通气功能,包括呼吸频率(RR),每公斤体重潮气量(TV/kg)。结果：吸入药物前患儿的TBFV环中呼气降支凹陷,呼气峰流速前移,%VPF为0.19±0.04,25/PF为0.42±0.11,均提示降低,表明大小气道阻力增高,吸入药物后30,60,120min分别与吸入药物前的RR,%VPF,25/PF,ME/MI,PTEF,TV/kg的指标比较差异均无显著性(P>0.05)。结论：喘息性支气管炎婴幼儿吸入沙丁胺醇+溴化异丙托品后,其大小气道阻力及通气功能的改善并不明显,提示β2肾上腺素能受体激动剂联合抗胆碱类药在治疗婴幼儿喘息性支气管炎中平喘对症的临床作用不大,治疗关键是抗感染,抗炎以减少气道黏膜充血水肿,保持气道通畅,包括分泌物引流。     

喘乐宁液气雾吸入治疗在儿童哮喘发作的价值

目的探讨喘乐宁液雾化吸入在儿童哮喘发作的疗效和安全性。方法将63例哮喘发作期的患儿随机分为两组,取0.5%喘乐宁液0.25-1mg/次雾化吸入治疗的为观察组,采用定量型喘乐宁气雾剂的为对照组,分别观察吸入前及吸入后5min、10min、30min最大呼气流速(PEFR),以及呼吸、心率、血压的变化,并与对照组作同期比较。结果　吸入后观察组PEFR值明显高于对照组,而且没有明显的毒副作用。结论　喘乐宁液雾化吸入在儿童哮喘发作抢救中,对于缓解呼吸道阻塞,提高抢救成功率效果优于定量型气雾剂。     

布地奈德治疗急性喉炎、喉气管支气管炎疗效观察

目的　 观察布地奈德 (BUD)混悬液治疗急性喉炎、喉气管支气管炎的疗效。 方法 　通过随机分组 ,5 8例患儿治疗组 3 0例 ,给予雾化吸入BUD混悬液 ;对照组 2 8例 ,给予超声雾化吸入地塞米松 (DXM )。观察用药 1h后患儿症状、体征改善情况及其消失的天数。 结果 　治疗组治疗后 1h患儿症状、体征改善分数、各种症状体征消失的天数等各项指标 ,均明显优于对照组 (P <0 0 1)。 结论 　急性喉炎、急性喉气管支气管炎患儿在抗感染等常规治疗的同时 ,雾化吸入BUD混悬液 ,对改善症状体征、缩短病程 ,明显优于超声雾化吸入DXM ,疗效显著     

氧驱动雾化吸入喘乐宁和爱喘乐治疗毛细支气管炎(附23例报告)

我科用氧气驱动雾化吸入喘乐宁和爱喘乐治疗小儿毛细支气管炎 ,取得满意效果 ,现报告如下。1　资料与结果1 1　对象　为我科 2 0 0 1年 10月—2 0 0 2年 4月诊断为毛细支气管炎 (毛支 )的住院患儿共 4 4例 ,诊断按小儿肺炎防治方案中毛支的诊断标准〔1〕。随机分成两组 ,治疗组 2 3例 ,对照组 2 1例。年龄最小 3个月 ,最大 2岁 ,经 χ2检验 ,治疗组与对照组在性别、年龄及病情严重度方面无显著差异 ,具有可比性 (Ｐ >0 0 5 )。1 2　方法　治疗组雾化吸入 0 0 2 5 %爱喘乐溶液 0 5ｍｌ(含溴化异丙托品0 12 5ｍｇ ,德国勃林格翰公司出品 )…     

炎琥宁氧气驱动雾化治疗毛细支气管炎疗效观察

目的观察氧气驱动雾化吸入炎琥宁对毛细支气管炎的疗效。方法62例毛细支气管炎患儿随机分成两组，在综合治疗的基础上，治疗组30例用氧气驱动雾化吸入炎琥宁，对照组32例用氧气驱动雾化吸入地塞米松、α-糜蛋白酶。结果治疗组与对照组在发热缓解、气急缓解、喘鸣音消失、肺部哕音消失的时间上差异均有显著统计学意义（P〈0．01）。结论炎琥宁氧气驱动雾化吸入治疗毛细支气管炎疗效显著。     

氧驱动雾化吸入治疗毛细支气管炎喘憋发作临床观察

目的　寻找一种快捷、高效的治疗毛细支气管炎(简称毛支炎)喘憋发作的方法。方法将190例毛细支气管炎患儿分治疗组(120例),对照组(70例)。治疗组按随机分配原则分别氧驱动雾化吸入Ⅰ,Ⅱ,Ⅲ号各40例.对照组予静滴氨茶碱及糖皮质激素(氢化考的松琥珀酸钠),各组均予毛细支气管炎相应常规治疗。结果　对照组与治疗组各组相比较,治疗组各组显效率优于对照组(P<0.01),症状缓解时间治疗组各组均优于对照组(P<0.01),而治疗组中又以雾化Ⅱ号(喘乐宁0.25ml加普米克令舒1ml加溴化异丙托品0.5ml加生理盐水2ml)作用尤为显著。结论6L/min氧驱动雾化吸入短效β-受体激动剂加抗胆碱能药及糖皮质激素为治疗毛细气管炎喘憋发作的最佳方法。     

The efficacy of nebulized salbutamol,magnesium sulfate,and salbutamol/magnesium sulfate combination in moderate bronchiolitis

The aim of this paper is to compare the effect of nebulized magnesium sulfate to nebulized salbutamol and salbutamol/magnesium sulfate on successful discharge from the emergency department. A total of 56 infants were included in this double-blinded, prospective study. Infants were grouped according to the nebulized treatment they received: group 1—salbutamol/normal saline, group 2—magnesium sulfate and normal saline, and group 3—salbutamol plus magnesium sulfate. Heart beat, bronchiolitis, clinical severity scores (CSS), and oxygen saturation of the patients were determined before and after nebulization (0, 1, 4 h). The patients were monitored for adverse reactions. Post-treatment mean CSS results were significantly lower than pre-treatment scores in all groups at 4 h with no significant difference within groups. CSS scores were lower in the salbutamol/magnesium sulfate group when compared with the magnesium sulfate and salbutamol groups (3.4 (2.4–4.3), 4.7 (3.8–5.7), 4.0 (3.2–4.3)). CSS were significantly lower than those from the magnesium sulfate group. Conclusion: Nebulized magnesium sulfate plus salbutamol may have additive effects for improving the short-term CSS.     

Nebulized hypertonic saline/salbutamol solution treatment in hospitalized children with mild to moderate bronchiolitis

Background: The objective of this study was to determine the efficacy and safety of nebulized 3% hypertonic saline solution and salbutamol in the treatment of mild to moderate bronchiolitis. Methods: In a randomized controlled trial, 93 infants with mild to moderate bronchiolitis were divided into two groups. The infants received inhalation of 2.5 mg (0.5 mL) salbutamol dissolved in either 4.0 mL normal (0.9%) saline (control group, n= 43) or 4.0 mL hypertonic (3%) saline (treatment group, n= 50). The therapy was repeated three times daily until discharge. Cough, wheezing, pulmonary physical signs, and the length of hospital stay were recorded. Results: Wheezing remission time was 3.8 ± 1.1 days in the control group and 2.7 ± 0.9 days in the treatment group (P < 0.01). Cough remission time was 6.3 ± 0.9 days in the control group and 5.3 ± 0.8 days in the treatment group (P < 0.01). The moist crackles disappeared at 5.4 ± 0.8 days in the treatment group versus 6.2 ± 0.9 days in the control group (P < 0.01). Furthermore, the average length of hospital stay decreased from 7.4 ± 1.5 days in the control group to 6.0 ± 1.2 days in the treatment group (P < 0.01). No obvious adverse effects were observed. Conclusions: Inhalation of nebulized 3% hypertonic saline solution and salbutamol is a safe and effective therapy for patients with mild to moderate bronchiolitis.     

Salbutamol or mist in acute bronchiolitis

Abstract Background : The role of bronchodilators in the treatment of bronchiolitis remains controversial.
Methods : A double-blind, placebo controlled trial was performed to evaluate the clinical response to nebulized salbutamol. One hundred and fifty-six infants aged between 7 weeks and 24 months who had had an episode of wheezing and other signs and symptoms of bronchiolitis were randomized to three groups as follows: (i) nebulized salbutamol was administered to 52 patients in group I at a dose of 0.15 mg/kg in 2 mL saline; (ii) saline was nebulized to 52 patients in group II and (iii) in group III 52 patients received mist in a tent. All three groups were administered oxygen during the procedures. Treatment was repeated with the same agent after 30 min if the respiratory score was 5 or more. Respiratory rate, heart rate, oxygen saturation and presence of cyanosis, wheezing, retractions were recorded before and after each treatment.
Results : The decrease in the respiratory score was 5.2 ± 1.8, 0.82 ± 2.4 and 1.7 ± 1.3 in group I, II and III, respectively. The decrease in group I was significantly higher than in the other groups. Heart rate was similar between groups. Oxygen saturation decreased in group I without reaching statistical significance.
Conclusions: Salbutamol was shown to be effective and safe in the treatment of acute bronchiolitis.     

Effect of salbutamol on respiratory mechanics in bronchiolitis

The effect of inhaled bronchodilators in bronchiolitis has been difficult to evaluate due to problems with techniques for assessing respiratory function in infants. Two new techniques were used to assess the response to inhaled salbutamol in 17 infants with bronchiolitis. With one technique, expiratory flow, volume, and airway occlusion pressure were measured and used to derive compliance (Crs) and conductance (Grs) of the respiratory system from a passive expiration induced by a brief end-inspiratory airway occlusion. With the other technique, the maximum flow at functional residual capacity (VmaxFRC) was measured from a partial maximum expiratory flow-volume curve generated by external chest compression. For the group, there was no change in compliance or conductance after salbutamol, but salbutamol caused a fall in maximum flow at functional residual capacity (p less than 0.01) and in the time constant of tidal expiration (p less than 0.01). The decrease in maximum flow at functional residual capacity with salbutamol is consistent with increased airway collapse on forced expiration. The decrease in tidal time constant suggests that the drug decreases expiratory braking. Presence of such braking activity may be an important strategy for maintaining lung volume. In summary, salbutamol failed to produce a beneficial effect on airways in bronchiolitis, but did produce changes in expiration which may be harmful in some infants.     

儿童右肺中叶综合征的肺功能变化及其意义

目的：探讨右肺中叶综合征患儿治疗前后的肺功能变化及其临床意义。方法：将30例儿童右肺中叶综合征住院患儿分成两组,≤4岁组患儿20例选用2600型肺功能仪,>4岁组患儿10例选用MIR型肺功能仪,分别在治疗前和治疗后做肺功能测定,比较其治疗前后的肺功能参数的变化。2600型肺功能仪测定的主要参数取75%潮气量与最高呼气流速之比(25/PF)和潮气量与最高潮气呼气流速之比(%V-PF)2个参数来反映0~4岁组患儿的肺功能变化,MIR型肺功能仪测定的主要参数取最大肺活量(FVC)、1秒率(FEV1)和最高呼气流速(PEF)共3个参数来反映>4岁组患儿的肺功能变化。结果：≤4岁组治疗前肺功能参数的测定值分别为25/PF=0.42±0.08,%V-PF=0.28±0.03;治疗后的肺功能参数的测定值为25/PF=0.58±0.12,%V-PF=0.39±0.06。两者治疗前后比较差异有显著性,t=4.21,3.82;均P<0.05。>4岁组治疗前肺功能参数的测定值分别为FVC=1.75±0.32,FEV1=1.36±0.52, PEF=2.56±0.78;治疗后的肺功能参数的测定值分别为FVC=2.37±0.78,FEV1=2.08±0.65, PEF=3.68±0.80。治疗前后比较,分别t=3.05, 2.98,3.12;均P<0.05。结论：右肺中叶综合征患儿治疗前后的肺功能变化是明显的,治疗后肺功能可恢复正常。［中国当代儿科杂志,2009,11（8）：669-671］     

Heliox como fuente de nebulización del tratamiento broncodilatador en lactantes con bronquiolitis

IntroductionHeliox is a helium-oxygen mixture which improves laminar flow and decreases airway resistance and the work of breathing. The aim of this study was to assess the effects of salbutamol or epinephrine nebulization driven by heliox in infants with moderate-to-severe bronchiolitis.Materials and methodsThis prospective, observational, interventional, controlled and randomized study included ninety-six children who came to our pediatric emergency department with first episode of moderate-to-severe bronchiolitis. The patients were randomized to receive salbutamol or epinephrine nebulized with either oxygen (control group) or heliox (70% helium and 30% oxygen) as the driving gas. Heart rate, respiratory rate, pulse oximetry oxygen saturation and clinical score were measured before and after the treatment period. We also reported hospitalization rates and the number of patients who returned to the emergency department in the following seventy two hours.ResultsThere were no significant differences between both groups. The only statistically significant difference was that, in the heliox group, patients with severe bronchiolitis needed a lower number of nebulizations than infants in the control group.ConclusionsAccording to our study, heliox-driven salbutamol or epinephrine is not an effective therapy in patients with acute bronchiolitis.     

Lung Function Test via Tidal Breathing in Infants before and after the Treatment of Pneumonia

Ｉｔｈａｓｂｅｅｎｄｅｍｏｎｓｔｒａｔｅｄｔｈａｔｒｅｓｐｉｒａｔｏｒｙｄｉｓｏｒ ｄｅｒｉｓｔｈｅｍａｉｎｄｉｓｅａｓｅｉｎｃｈｉｌｄｒｅｎ .Ｉｔｒｅｐｒｅｓｅｎｔｓｔｈｅｍｏｓｔｃｏｍｍｏｎｃａｕｓｅｏｆｄｅａｔｈｉｎｉｎｆａｎｔｓｗｏｒｌｄｗｉｄｅ .     

Co-administration of salbutamol and fluticasone for emergency treatment of children with moderate acute asthma.

This study aimed to compare the efficacy of nebulized therapy with salbutamol alone or in combination with fluticasone. In a randomized, double-blind clinical trial, 150 children with moderate acute asthma were randomly assigned to receive by nebulizations either (i) three doses of salbutamol 30 microl/kg per dose, each dose administered every 15 min, (ii) three doses of salbutamol plus two doses of fluticasone 500 microg/dose at 15 and 30 min after first dose of salbutamol, or (iii) three doses of salbutamol/fluticasone 500 microg/dose, each combined dose administered every 15 min. Pulse oxymetry (SaO2), peak expiratory flow (PEF) and Wood et al. (Am J Dis Child, 123, 1972, 123) clinical scale were evaluated at baseline, 15, 30, 45, 60, 90 and 120 min after the first nebulization. Patients in the three groups significantly improved since 15 min after the first nebulization. We did not observe differences in the recovery of SaO2 and PEF among the three groups of treatment (p > 0.10). In group 3, children showed better clinical response at 120 min than the other two groups (p < 0.05). No significant adverse effects were observed with any treatment. To summarize, in children with acute moderate asthma, nebulized salbutamol at an accumulated dose of 90 mul/kg plus fluticasone at an accumulated dose of 1500 microg produced better clinical relief after 2 h. However, similar PEF and SaO2 responses were observed with salbutamol alone or in combination with different doses of fluticasone.     

Randomized trial of salbutamol in acute bronchiolitis

To test whether nebulized salbutamol (albuterol) is safe and efficacious for the treatment of young children with acute bronchiolitis, we enrolled 83 children (median age 6 months, range 1 to 21 months) in a randomized, double-blind clinical trial. Participants received two treatments at 30-minute intervals of either nebulized salbutamol (0.10 mg/kg in 2 ml 0.9% saline solution) or a similar volume of 0.9% saline solution placebo. Outcome measures were the respiratory rate, pulse oximetry, and a clinical score based on the degree of wheezing and retractions. Patients in the salbutamol arm had significantly greater improvement in clinical scores after the initial treatment (p = 0.04). There was no difference between the groups in oxygen saturation (p = 0.74); patients treated with salbutamol had a small increase in heart rate after two treatments (159 +/- 16 vs 151 +/- 16; p = 0.03). We conclude that salbutamol is safe and effective for the initial treatment of young children with acute bronchiolitis.