甲泼尼龙联合顺尔宁治疗重症毛细支气管炎的临床和诱导痰细胞学研究

目的 研究甲泼尼龙(MP)联合顺尔宁治疗重症毛细支气管炎(毛支)的疗效和治疗前后诱导痰细胞学的变化.方法 将64例重症毛细支气管炎患儿随机分为两组,治疗组32例联用MP和顺尔宁治疗,对照组32例用地塞米松治疗.分别观察两组的喘憋消失时间、肺部体征消失时间和住院天数.同时分析治疗组用MP和顺尔宁联合治疗前后的诱导痰细胞学变化.结果 与对照组相比,治疗组的喘憋消失时间、肺部体征消失时间和住院天数均明显缩短(P均＜0.01).经MP和顺尔宁联合治疗后,治疗组的嗜酸性粒细胞和肥大细胞的比例明显下降(P均＜0.001).结论 MP和顺尔宁联合治疗重症毛支的疗效优于常规治疗方法,同时对其诱导痰细胞学有显著影响.     

A case series of paediatric high flow nasal cannula therapy

IntroductionHigh flow nasal cannula is an emerging treatment option in Paediatric Intensive Care Units for paediatric patients in acute respiratory distress. Yet there is a paucity of literature describing its clinical application in various presenting pathophysiologies.AimTo describe three cases with differing underlying pathophysiologies and their response to high flow nasal cannula oxygen therapy.MethodPatients admitted to the Paediatric Intensive Care Unit with bronchiolitis, asthma and cardiomyopathy, and treated with high flow nasal cannula therapy were searched in the Paediatric Intensive Care database. The most representative cases were chosen to review.ResultsOne infant and two children were reviewed. All were commenced on high flow nasal cannula therapy in the Paediatric Intensive Care Unit and all demonstrated an improvement in their work of breathing. There was also a substantial improvement in their haemodynamic status. No patient required escalation to other forms of respiratory therapy.ConclusionHigh flow nasal cannula therapy is a viable treatment option for a range of patients presenting to the Paediatric Intensive Care Unit with acute respiratory distress. More invasive methods of respiratory support may be avoided by the use of high flow nasal cannula therapy.     

甲基强的松龙治疗RSV毛细支气管炎疗效评价

目的 评价甲基强的松龙对RSV毛细支气管炎的治疗效果。方法 将31毛细支气管炎患儿随机分为两组。对照组:采用综合治疗。治疗组:综合治疗并加用甲基强的松龙每日2mg/kg,静脉滴注。于0,2,4,6天评价疾病严重程度。结果 第2天治疗组评分明显低于对照组(3.6±1.6比5.8±2.2,(P<0.05),而第6天两组无显著性差异(1.8±0.8比2.1±1.1,P<0.05)。结论 甲基强的松龙可早期改善RSV毛细支气管炎患儿临床症状。     

沙丁胺醇及溴化异丙托品联合吸入佐治小儿毛细支气管炎疗效分析

目的 探讨沙丁胺醇及溴化异丙托品吸入治疗小儿毛细支气管炎的疗效。方法 将80例确诊毛细支气管炎患儿随机分为两组，两组均采用综合治疗，观察组加用沙丁胺醇和澳化异丙托品吸入。结果 观察组在呼吸系统症状，降低气道阻力方面明显改善。结论 沙丁胺醇及澳化异丙托品联合吸入可改善毛细支气管炎的症状，改善肺功能，疗效确切，方便而副作用少。     

Follicular Bronchiolitis: A Rare Cause of Bronchiolitis Obliterans Syndrome After Lung Transplantation: A Case Report

This case report is the first confirmed case of follicular bronchiolitis (FB), a rare bronchiolar disorder characterized by peribronchiolar lymphoid follicles, in a series of over 400 lung transplantations performed in our center. It is to our knowledge, the first publication describing FB after lung transplantation (LTx), presenting as chronic allograft dysfunction or bronchiolitis obliterans syndrome (BOS).     

气道中心性间质纤维化

气道中心性问质纤维化是新近报道的目前认为不同于现有已知任何一型的间质性肺疾病.其病因不明,性质不清,女性多见,以慢性咳嗽和缓慢进展的呼吸困难为主要症状,肺功能显示限制性通气功能障碍,支气管肺泡灌洗液有轻到中度的淋巴细胞增加,其病理特点为以膜性及呼吸性细支气管为中心的间质纤维化和细支气管上皮化生,影像学显示病变累及大气道,激素治疗效果差,预后不佳.现就气道中心性间质纤维化作一综述.     

氧气驱动雾化吸入肾上腺素佐治毛细支气管炎

目的观察氧气驱动雾化吸入肾上腺素佐治毛细支气管炎的疗效.方法157例毛支炎患儿随机分为二组,对照组77例,用复方氯喘片治疗;治疗组80例,用6 L/min氧气驱动雾化吸入肾上腺素每次0.4～0.6 mg/kg,雾化吸入15 min,每日2～3次.两组其他常规如抗感染、吸氧等对症处理相同.观察两组临床症状体征消失时间.结果治疗组有效率83.7%,明显优于对照组48.1%,(P＜0.01).结论氧气驱动雾化吸入肾上腺素是佐治毛支炎安全有效的方法之一.     

Effect of inhaled nitric oxide on respiratory mechanics in ventilated infants with RSV bronchiolitis

Objective: To evaluate the bronchodilator effect of inhaled nitric oxide (NO) in infants with respiratory failure caused by respiratory syncytial virus (RSV) bronchiolitis and to compare the effect with the one obtained by salbutamol. Design: Prospective study. Setting: Pediatric intensive care unit of a university children's hospital. Patients: Twelve acutely ill, intubated infants (mean age 4.5 months, mean weight 4.9 kg) with respiratory failure due to documented RSV bronchiolitis. Interventions: Total respiratory system resistance (Rrs) was measured by single breath occlusion at the baseline and after inhaling NO at 20, 40 and 60 ppm for 1 h, and after inhalation of a standard β ₂-agonist, salbutamol. Arterial blood gas analysis was performed at each study level on 6 of the 12 patients. Results: The baseline mean Rrs (SE) was 0.29 (0.04) cm H₂O/ml per s. At each dose of NO, the mean Rrs (SE) was 0.28 (0.04) cm H₂O/ml per s. With salbutamol, the mean Rrs (SE) was 0.21 (0.03) cm H₂O/ml per s. These values were not significantly different from each other (by ANOVA). Inhaled NO produced a significant decrease in Rrs of greater than 4 times the coefficient of variation of the baseline measurement in 3 of 12 patients. Seven of 12 patients had no significant change while two patients had a significant increase in Rrs. Inhaled salbutamol produced a significant decrease in Rrs in 5 of 11 patients, while 6 showed no change in Rrs. Conclusion: Inhaled NO has no apparent bronchodilator effect in the majority of acutely ill infants with RSV bronchiolitis and does not appear to provide any additional benefit over the use of salbutamol. The clinical benefit of inhaled NO as a bronchodilator is questionable under these conditions. Received: 15 June 1998 Final revision received: 23 September 1998 Accepted: 29 September 1998     

博利康尼及普米克令舒吸入治疗毛细支气管炎疗效观察

目的:观察博利康尼及普米克令舒压力驱动吸入治疗毛细支气管炎(毛支)的疗效。方法:将90例毛支患儿随机分成观察组(42例)和对照组(48例),观察组采用常规治疗加博利康尼、普米克吸入疗法,对照组采用常规疗法。结果:观察组在缓解喘憋、缩短啰音及咳嗽持续时间上均明显优于对照组(P<0.05)。结论:博利康尼和普米克令舒吸入疗法治疗毛细支气管炎有效、方便、安全。