Nebulized hypertonic saline treatment in hospitalized children with moderate to severe viral bronchiolitis

The objective of this study was to determine the efficacy and safety of frequently inhaled nebulized hypertonic saline (HS) in infants with moderate to severe bronchiolitis. One hundred and twenty-six infants were randomized to receive either nebulized 3% hypertonic saline (HS) or 0.9% normal saline (NS), but only 112 patients completed the whole study. Cough, wheezing, pulmonary physical signs, clinical severity scores and the hospital length of stay (LOS) were recorded. The wheezing remission time was 4.8 ± 1.0 days in the NS group and 3.6 ± 0.9 days in the HS group (p <0.01). The cough remission time was 5.5 ± 0.9 days in the NS group and 4.3 ± 0.7 days in the HS group (p <0.01). The moist crackles disappeared at 6.2 ± 0.7 days in the NS group and at 4.4 ± 0.9 days in the HS group (p <0.01). The clinical severity scores decreased more significantly in the HS group than in the NS group on each day within 96 h after enrolment (p <0.01). The LOS decreased from 6.4 ± 1.4 days in the NS group to 4.8 ± 1.2 days in the HS group (p <0.01). The treatment was well tolerated, with no adverse effects attributable to nebulized HS. The conclusions are that frequently inhaled HS relieved symptoms and signs faster than NS, and shortened LOS significantly for infants with moderate to severe bronchiolitis, without apparent adverse effects.     

上颌骨LefortⅠ型截骨中高渗氯化钠羟乙基淀粉40注射液的应用

背景：随着日益严重的血液污染问题和输血相关疾病,血液保护的课题受到了国内外的广泛关注。 目的：观察高渗氯化钠羟乙基淀粉40注射液(高渗晶胶液)用于上颌骨LefortⅠ型截骨前急性高容量血液稀释的血液保护作用。 方法：40例患者随机分为实验组和对照组,每组20例。均采用气管插管全麻,实验组于麻醉后切皮前输入高渗晶胶液 4 mL/kg以10 mL/min的速度输注,于30 min内完成。对照组则不作任何处理。分别于急性高容量血液稀释前(T0)、急性高容量血液稀释后(T1)、急性高容量血液稀释后30 min(T2),60 min(T3),3 h(T4)、术后1 d(T5)、术后3 d(T6)抽血查血常规(包括红细胞压积、血红蛋白、血小板计数)及凝血功能(包括血小板、部分凝血活酶时间、纤维蛋白原),并记录术中输血量、输液量、出血量及尿量。 结果与结论：40例患者均进入结果分析。与对照组相比,实验组的输注异体血数量较少(P < 0.05),尿量较多(P < 0.05);两组患者术中输液量及失血量差异无显著性意义(P > 0.05)。两组患者行控制性降压后,T2、T3的心率较T1明显升高(P < 0.05),T2、T3的收缩压、舒张压、平均动脉压较T1明显降低(P < 0.05)。在T1、T2、T3时间点,实验组心率较对照组明显升高(P < 0.05)。两组患者的中心静脉压各时间点差异均无显著性意义(P > 0.05)。经过急性高容量血液稀释后T1、T2、T3、T4时间点,实验组血红蛋白、血球压积较对照组明显降低(P < 0.05);血小板计数、部分凝血活酶时间较对照组明显延长(P < 0.05)。T1、T2时间点,实验组Na+、Cl-较对照组明显升高(P < 0.05);T5、T6时间点,实验组的血红蛋白、血球压积较对照组明显升高(P < 0.05)。提示高渗晶胶液用于上颌骨LefortⅠ型截骨前急性高容量血液稀释可明显减少或避免输注异体血。     

肠内输入高渗盐糖溶液对严重烧伤犬肠黏膜屏障及脏器功能的影响

目的 了解烧伤犬休克期经肠道补充高渗盐糖溶液(HEGS)进行复苏后,肠道屏障及脏器功能的变化. 方法 将24只35%TBSAⅢ度烧伤犬按随机数字表法分为不补液(NF)组、静脉等渗补液(Ⅱ)组、肠内等渗补液(EI)组和肠内高渗补液(EH)组,每组6只.2个等渗补液组于伤后30 min分别通过静脉或肠道给予含50 g/L葡萄糖的生理盐水,24 h补液量为4 mL·kg~(-1)·%TBSA~(-1)(前8 h匀速输入总量的一半,后16 h匀速输入另一半);EH组经肠道输入HEGS(含18 g/L氯化钠、50 g/L葡萄糖),伤后24 h内补液量为2 mL·kg~(-1)·%TBSA~(-1),补液方式同前.测定各组犬肝肾功能指标[血清ALT、心肌型肌酸激酶同工酶(CK-MB)活性及肌酐、尿素氮水平]、血清二胺氧化酶(DAO)活性以及伤后24 h肠黏膜Na~+-K~+·ATP酶活性. 结果 各组犬血清ALT活性相近.3个补液组血肌酐、尿素氮水平普遍低于NF组;伤后2 h CK-MB活性均明显升高,EH组伤后2～8 h低于NF、Ⅱ组.Ⅱ、EI、EH组血清DAO活性于伤后4 h或6 h起逐渐降低,分别为(3.9±0.6)～(3.6±0.5)U/L、(4.8±0.4)～(2.8±0.8)U/L和(6.4±1.8)～(3.5±0.8)U/L,均显著低于NF组(12.5±0.4)～(9.7±1.1)U/L(EH组与NF组比较,伤后4、6、8、24 h t值分别为10.25、12.44、17.99、16.21,P值均小于0.05).伤后24 h各组肠黏膜Na~+-K~+-ATP酶活性从高到低依次为Ⅱ组、EH组、EI组、NF组(前3组与NF组比较,t值分别为10.09、8.32、4.96,F值为26.79,P值均小于0.05). 结论 HEGS对烧伤休克犬的肠黏膜屏障无明显不良影响.与NF比较,HEGS能显著改善伤犬心、肝、肾功能;减少1/2补液量,能达到与肠内或静脉输入等渗盐糖溶液相似的复苏效果.     

高渗盐水联合肾十腺素、异丙肾上腺素治疗毛细支气管炎

目的观察3％盐水（HS）联合小剂量肾上腺素、异丙肾上腺素吸入治疗毛细支气管炎的效果。方法选择109位毛细支气管炎住院治疗的患儿,随机分为对照组与治疗组。分别用小剂量肾上腺素、异丙肾上腺素溶于HS或0．9％生理盐水（NS）中雾化吸入治疗。比较两组患儿临床症状改善情况、住院天数及治疗前后患儿肺功能的改变。结果治疗后两组临床症状、体征均明显改善;治疗组改善更明显,平均住院日更短、肺功能改善更优。结论HS联合小剂量肾上腺素、异丙肾上腺素吸入治疗毛细支气管炎有效。     

高渗氯化钠对单肺通气肺的病理学影响

目的探讨高渗氯化钠对单肺通气患者的病理学影响。方法选择拟单肺通气剖胸手术ASAⅠ-Ⅱ级的患者60例,随机分为高渗氯化钠治疗组（H组）和对照组（C组）,每组30例。在单肺通气30min时经中心静脉导管输注7．5％氯化钠溶液（H组）或生理盐水（C组）2mL／kg。观察开始进行单肺通气（T1）、单肺通气30min（T2）、输注完成后30min（L）、输注后60min（L）、单肺通气结束（L）5个时点的动态肺顺应性（Cdyn）、气道峰压（Ppeak）、气道平均压（Pmean）、动脉血氧分压（P（O2））、血清Na^＋浓度,并于T1、T5时各取肺组织1块,切片染色高倍镜下观察。结果2组患者T1与T2时间段比较,Cdyn、P（O2）明显降低,Ppeak、Pmean明显升高。H组T3、T4、T5与T2比较,Cdyn、P（O2）逐渐升高,Ppeak、Pmean逐渐下降,且H组T3、T4、T5的Cdyn、P（O2）明显高于C组,Ppeak明显低于C组,H组T4、T5的Pmean明显低于C组。而C组患者T3、T4、T5的Cdyn、Ppeak、Pmean、P（O2）与T2比较无显著性差异。切片观察到H组出现肺组织病理学改变的明显少于C组。结论7．5％氯化钠溶液对单肺通气患者的各呼吸力学参数有改善作用,能明显减少肺组织损伤,对肺通气功能具有保护作用。     

不同浓度盐水雾化吸入治疗毛细支气管炎临床观察#br#

目的：比较不同浓度盐水雾化吸入治疗毛细支气管炎住院患儿的临床疗效、安全性及其经济性。方法：纳入2012年1月至12月本院儿童呼吸科的毛细支气管炎住院患儿共66例,用随机数字表将患者分成3组,分别为0.9% NaCl组、3% NaCl组、5% NaCl组,分别给予0.9% NaCl液3 mL、3% NaCl液3 mL、5% NaCl液3 mL雾化吸入。采用空气压缩雾化器与面罩吸入,入院12 h内接受治疗每天3次（早上、中午、晚上,间隔4 h以上）直至出院。主要观察指标包括临床严重度评分（CBSS）、住院时间、不良事件发生率及住院费用。结果：各组毛细支气管炎患儿入院第1～第3天的临床严重度评分（CBSS1、CBSS2、CBSS3）、住院时间、临床症状缓解时间等比较,差异无统计学意义（P＞0.05）。5% NaCl组不良事件发生率为12.2%,显著高于0.9% NaCl组（为2.3%）和3% NaCl组（为4.6%）,差异有统计学意义（x2=34.199,P＜0.01）。不良事件主要包括雾化过程中出现普通咳嗽、剧烈咳嗽和呕吐。结论：毛细支气管炎住院患儿治疗中应用高渗盐水（3% NaCl液、5% NaCl液）与0.9% NaCl液雾化吸入的疗效相当且未增加医疗费用;3% NaCl液雾化吸入的安全性较5% NaCl液好,但两者均未出现明显严重不良事件。     

Enhanced central hypertonic saline-induced activation of angiotensin II-sensitive neurons in the anterior hypothalamic area of spontaneously hypertensive and Dahl S rats

High dietary salt intake activates the brain renin-angiotensin system in spontaneously hypertensive rats (SHR) and Dahl S rats, resulting in sympathetic hyperactivity and hypertension. Increases of sodium concentration in cerebrospinal fluid (CSF) and/or enhanced responses to CSF sodium are considered to be involved in the high dietary salt-induced activation of central nervous system pathways in those rats. Previously we have demonstrated that intracerebroventricular injection of hypertonic saline increases the neural activity of angiotensin II-sensitive neurons trans-synaptically via endogenous angiotensins in the anterior hypothalamic area (AHA) of rats. In the present study, we examined whether the AHA angiotensin II-sensitive neuron response to hypertonic saline would differ in SHR and Dahl S rats from those of their controls. Male 15- to 16-week-old SHR and age-matched Wistar Kyoto rats (WKY), Dahl S rats and Dahl R rats and Wistar rats were anesthetized and artificially ventilated. Extracellular potentials were recorded from single neurons in the AHA. Intracerebroventricular injection of hypertonic saline increased the firing rate of AHA angiotensin II-sensitive neurons. The threshold sodium concentration for the central sodium-induced increase of neural firing was lower in SHR than those of WKY, Dahl S rats, Dahl R rats and Wistar rats. The increase in neural firing induced by hypertonic saline (250 mM) was greater in SHR than those of other four kinds of rats. Similarly, the threshold sodium concentration was lower in Dahl S rats than those of WKY, Dahl R rats and Wistar rats and the increase in neural firing induced by hypertonic saline (250 mM) was greater in Dahl S rats than those of WKY, Dahl R rats and Wistar rats. In SHR, intracerebroventricular injection of the amiloride-sensitive sodium channel blocker benzamil abolished the hypertonic saline (250 mM)-induced increase in neural firing, but the sodium channel blocker itself did not affect the basal firing of these neurons. These findings indicate that central sodium-induced activation of AHA angiotensin II-sensitive neurons is enhanced in SHR and Dahl S rats.     

高渗盐水雾化吸入治疗毛细支气管炎临床观察

目的探讨雾化吸入高渗盐水和氨溴索治疗毛细支气管炎的效果。方法将60例毛细支气管炎患儿随机分为高渗盐水组（治疗组）、氨溴索组（对照1组）和常规组（对照2组）,每组各20例,治疗组和对照1组在常规治疗基础上分别给雾化高渗盐水4mL或吸入氨溴索7．5mg,每8小时1次（q8h）,连用1周,对照2组仅常规治疗。比较临床咳嗽、喘憋、肺部体征消失时间、住院时间等。结果60例患儿均治愈出院,治疗组疗效明显优于对照1组和对照2组,临床喘憋消失、咳嗽消失、体征消失和住院天数比较差异均有统计学意义（ t1值分别为-9．173、-3．252、-9．672、-3．968,均P＜0．01;t2值分别为-7．952、-2．0433、-8．114、-4．793,均P＜0．01）。结论高渗盐水雾化吸入治疗毛细支气管炎优于氨溴索雾化吸入。     

高渗盐水雾化在治疗毛细支气管炎中的应用

目的评估高渗盐水雾化在治疗毛细支气管炎中的疗效。方法对2012年1月至12月期间在西安市儿童医院呼吸一科住院的毛细支气管炎患儿按照随机对照开放的方法分为高渗盐水组50例,对照组50例。以两组症状及综合症状评分在治疗第3天改善情况、总住院天数、住院总费用为观察指标进行分析。结果两组在毛细支气管炎治疗中均有显著临床疗效。高渗盐水组治疗前后症状综合评分差值较对照组差异有统计学意义（t=2．00,P〈0．05）。两组间住院天数、住院总费用比较差异均有统计学意义（t值分别为8．24、-2．60,均P〈0．05）。结论高渗盐水雾化治疗毛细支气管炎是安全有效的方法。