刺络联合舒利迭吸入疗法防治小儿哮喘的疗效观察

目的:探讨刺络联合舒利迭吸入疗法治疗小儿哮喘的临床疗效,并观察其用药前后的代谢组学变化。方法:选取2013年10月至2015年9月上海市宝山区中西医结合医院收治的哮喘患儿50例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组25例。对照组采用沙美特罗替卡松粉吸入剂治疗,观察组在对照组治疗的基础上针刺四缝和少商穴位以及耳尖放血,间隔1 d进行1次,周期90 d。采集患儿用药前0 d,用药30 d,用药60 d,用药90 d的尿液,采用气相色谱-质谱联用技术(GC-MS)检测尿液内源性代谢物,观察治疗前后2组患儿临床症状评分、免疫指标以及代谢谱的变化情况。结果:观察组总有效率高于对照组,2组比较差异有统计学意义(P<0.05);与治疗前比较,2组患儿各项中医症候均明显减轻,观察组改善程度比对照组更为显著,差异有统计学意义,2组免疫学指标与治疗前比较均显著降低(P<0.05),与对照组比较(90 d),观察组(90 d)各指标降低程度更为明显,差异均有统计学意义(P<0.05)。采用有监督的分析-OPLS分析了治疗前对照组和观察组(0 d),治疗后(90 d)对照组和观察组的尿液代谢谱,结果显示4组代谢谱分离良好,鉴定了21个相关代谢标志物。结论:刺络联合舒利迭吸入疗法治疗小儿哮喘的临床效果确切,可改善患儿症状,降低免疫指标,其作用机制可能与丙氨酸,天冬氨酸和谷氨酸代谢、乙醛酸和二羧酸代谢和组氨酸代谢等代谢异常有关。     

通腑安脏汤治疗支气管哮喘伴胃肠功能障碍的临床疗效观察

目的：本研究旨在观察应用通腑安脏汤治疗支气管哮喘伴胃肠功能障碍的临床疗效。方法：将确诊为支气管哮喘合并胃肠功能障碍的患者60例,按照区组随机化方法随机分为治疗组和对照组,对照组给予口服枸橼酸莫沙必利分散片及沙美特罗替卡松粉吸入剂治疗,治疗组给予通腑安脏汤治疗,每日1剂,两组疗程均为14天。观察两组消化道症状积分、肺功能、疗效、生活质量评估（SGRQ）及随访患者3个月后再住院率。结果：与对照组相比,治疗组患者胃肠道功能障碍及生活质量明显改善（P<0.05）;与对照组相比,治疗组患者肺功能无明显改善（P＞0.05）。结论：应用通腑安脏汤治疗支气管哮喘合并胃肠功能障碍的疗效肯定,能显著改善支气管哮喘患者的临床症状、体征,同时改善患者的生活质量,并具有较好的安全性。     

Age-dependency of alpha- and beta-adrenoceptors on thrombocytes and lymphocytes of asthmatic and nonasthmatic children

Among the possible mechanisms which may cause wheezing or asthmatic episodes a genetically determined -adrenoceptor blockade and a hyperresponsiveness of -andrenoceptors has been postulated. Evidence to support this hypothesis stems from an increased bronchial sensitivity to -blockers, a reduced formation of cyclic AMP in response to -adrenergic stimulation and enhanced -adrenergic responses in asthmatic subjects. The recent development of techniques for measuring the specific, high-affinity binding of radiolabeled -and -adrenergic antagonists made it possible to study - and -adrenoceptors in vitro. Based upon the assumption that a change in the number and/or affinity of adrenergic receptors might be a general phenomenon, we have performed - and -receptor binding studies on lymphocytes and platelets from wheezing infants and asthmatic children as well as of infants, children, and adults not suffering from these diseases.Using ¹²⁵[I]-cyanopindolol (ICYP) and ³[H]-yohimbine (HYOH) as highly specific ligands for - and -adrenoceptors, the following results were obtained: (1) Lymphocytes and platelets from control subjects and asthamatics bound similar amounts of ICYP and HYOH and thus showed no differences either in the number or the affinity of - and -adrenoceptors. Lymphocytes and platelets of wheezing and nonwheezing infants also bound the same amounts of the radioligands. (2) In asthmatic children receiving 4×2 puffs salbutamol -adrenoceptor were down-regulated and this may mimic -adrenoceptor blockade. (3) When subjects were divided into four categories according to age (0–5, 5–10, 10–20 years, adults) the number of -adrenoceptor binding sites showed an age-dependent increase. The number and affinity of -adreneceptor binding sites on platelets was neither influenced by age nor disease.It is concluded that the - and -adrenoceptors of wheezing infants and asthmatic children at least on blood cells are normal. However the -adrenoceptors show an age-dependent maturation process, which may account for an unresponsiveness to -adrenoceptor agonists in wheezing infants.Supported by a grant from the Ministerium für Wissenschaft und Forschung, NRWPresented at the 19th Workshop for Pediatric Research, University of Göttingen, March 10–11, 1983     

硫酸镁辅助治疗重症支气管哮喘临床疗效观察

目的探讨硫酸镁辅助治疗重症支气管哮喘的临床效果。方法将医院2010-2013年收治的重症支气管哮喘患者129例按不同治疗方案分为对照组51例（给予支气管哮喘常规治疗）和试验组78例（常规治疗基础上给予硫酸镁静脉滴注）,对2组患者治疗效果进行综合比较。结果经治疗后,试验组治疗总有效率为85.90%明显高于对照组的70.59%,差异有统计学意义（P〈0.05）。结论硫酸镁辅助治疗重症支气管哮喘效果显著,值得临床推广应用。     

Innovative pulmonary targeting of terbutaline sulfate-laded novasomes for non-invasive tackling of asthma: statistical optimization and comparative in vitro/in vivo evaluation

Asthma represents a globally serious non-communicable ailment with significant public health outcomes for both pediatrics and adults triggering vast morbidity and fatality in critical cases. The β₂-adrenoceptor agonist, terbutaline sulfate (TBN), is harnessed as a bronchodilator for monitoring asthma noising symptoms. Nevertheless, the hepatic first-pass metabolism correlated with TBN oral administration mitigates its clinical performance. Likewise, the regimens of inhaled TBN dosage forms restrict its exploitation. Consequently, this work is concerned with the assimilation of TBN into a novel non-phospholipid nanovesicular paradigm termed novasomes (NVS) for direct and effective TBN pulmonary targeting. TBN-NVS were tailored based on the thin film hydration method and Box-Behnken design was applied to statistically optimize the formulation variables. Also, the aerodynamic pattern of the optimal TBN-NVS was explored via cascade impaction. Moreover, comparative pharmacokinetic studies were conducted using a rat model. TBN elicited encapsulation efficiency as high as 70%. The optimized TBN-NVS formulation disclosed an average nano-size of 223.89 nm, ζ potential of −31.17 mV and a sustained drug release up to 24 h. Additionally, it manifested snowballed in vitro lung deposition behavior in cascade impactor with a fine particle fraction of 86.44%. In vivo histopathological studies verified safety of intratracheally-administered TBN-NVS. The pharmacokinetic studies divulged 3.88-fold accentuation in TBN bioavailability from the optimum TBN-NVS versus the oral TBN solution. Concisely, the results proposed that NVS are an auspicious nanovector for TBN pulmonary delivery with integral curbing of the disease owing to target specificity.     

碳酸氢钠雾化吸入治疗支气管哮喘的疗效观察

目的观察碳酸氢钠雾化吸入在儿童支气管哮喘治疗中的作用。方法支气管哮喘急性发作患儿128例,随机分为观察组和对照组。对照组给予常规抗感染和激素、支气管扩张剂雾化吸入治疗,观察组在对照组基础上加用碳酸氢钠雾化吸入治疗。观察患儿治疗前后治疗效果以及外周血白细胞介素－6（IL-6）、白细胞介素-8（IL-8）和肿瘤坏死因子－α（TNF－α）等的水平的变化。结果观察组显效率（59．4％）和总有效率（95．3％）均优于对照组（40．6％,82．8％）,差异均有统计学意义（均P〈0．05）。观察组患儿症状和体征消失时间以及平均住院时间均显著短于对照组。两组患儿治疗后IL-6、IL－8和TNF－α等的水平均较治疗前显著降低,观察组降低更为显著,差异均有统计学意义（均P〈0．05）。结论碳酸氢钠雾化吸入治疗支气管哮喘可显著改善患儿症状和体征、缩短病程,并降低炎性因子的水平。     

一例孟鲁斯特钠诱发的精神异常患者的药学监护体会

目的对1例支气管哮喘急性发作伴肺部感染的患者进行跟踪治疗,探讨患者在药物治疗中出现精神异常的原因。方法检索国内外关于可疑药物—孟鲁斯特钠等致精神异常的相关文献,整理相应的理论依据,为临床药物治疗提出合理建议。结果诱发精神异常等不良反应的药物较多,分析患者所用药物,锁定可疑药物孟鲁斯特钠和莫西沙星,予及时停用孟鲁司特钠,10 d后患者病情好转出院。结论有精神性疾病的哮喘患者使用孟鲁斯特钠时,需密切关注该药引起的精神异常,减少药害事件的发生。     

支气管镜下冷冻联合球囊扩张治疗支气管结核性气道狭窄的观察

目的：观察经支气管镜冷冻联合球囊扩张治疗结核性气道狭窄的疗效。方法收集青岛市立医院呼吸内科2013年11月~2014年11月收治的28例支气管结核性气道狭窄患者的临床资料,随机分成对照组与治疗组。对照组行球囊扩张治疗,治疗组行冷冻联合球囊扩张治疗,观察比较两组所需扩张次数。结果对照组平均扩张(4.92±0.79)次,治疗组平均扩张(2.69±0.95)次;两组并发症发生率比较,差异无统计学意义(P>0.05)。结论冷冻联合球囊扩张治疗结核性气道狭窄安全、有效。     

支气管哮喘急性发作期雾化吸入治疗

目的观察雾化吸入布地奈德和特布他林对门诊轻、中急性发作期支气管哮喘患者的疗效。方法48例急性发作期支气管哮喘患者随机分为治疗组（26例）和对照组（22例）。治疗组每天雾化吸入布地奈德和特布他林雾化液7d，7d后吸入布地奈德气雾剂；对照组吸入布地夺德气雾剂和沙丁胺醇气雾剂（分别增加2次的剂量）；均于治疗前和治疗后第3、7和14d给予症状评分。结果治疗组治疗后第3、7d症状评分较对照组明显降低，但第14d两组无明显差异。结论雾化吸入布地奈德和特布他林起效快，可为门诊轻、中度急性发作期哮喘的首选给药方法。     

孟鲁司特联合布地奈德治疗哮喘50例疗效观察

目的探讨孟鲁司特联合布地奈德治疗哮喘的临床效果。方法选择江苏大学附属人民医院2006年11月至2010年11月支气管哮喘患者100例,随机分为观察组和对照组。对照组给予常规治疗,同时给予布地奈德雾化吸入,观察组在对照组治疗基础上给予孟鲁司特口服。测定两组患者治疗前后肺功能。结果观察组治疗后FEV1/FVC%和PEF分别与对照组治疗后比较,差异有统计学意义(P<0.05);观察组咳嗽、胸闷、喘息缓解时间与对照组比较,差异有统计学意义(P<0.05);观察组白天和夜间发作次数分别与对照组比较,差异有统计学意义(P<0.05)。结论孟鲁司特联合布地奈德能够显著改善哮喘发作患者临床症状,改善患者肺功能,临床效果显著。