Incidence of pertussis in subjects aged 50 years and older in France in 2013–2014

Objective

To assess the incidence of pertussis (whooping cough) in subjects aged 50 years and older in France.

中医与现代医学治疗小儿咳嗽变异性哮喘的探讨

咳嗽变异性哮喘（CVA）是一种以慢性咳嗽为主要临床表现的一种特殊类型的哮喘,在我国,儿童为主要发病群体,而在治疗小儿CVA方面,现代医学和中医各具特色。现代医学主要采用口服或吸入药物的方式,常用的药物主要是糖皮质激素、支气管扩张剂及白三烯受体拮抗剂;中医对于CVA的治疗主要从扶正和驱邪两方面入手,分为5个基本证型。通过对比分析现代医学和中医治疗小儿CVA思路与方法的不同,以期为该病更有效的治疗提供新的研究思路和方法。     

某某医院372例慢性咳嗽的病因研究

目的: 对某某医院372例慢性咳嗽的病因进行多因素分析。方法: 选择2019年2月-2020年6月在某某医院就诊的372例慢性咳嗽患者为观察组,以性别、年龄(±5岁)进行1:1配对选择同期健康体检的372例健康人群为对照组。收集可能引起慢性咳嗽的影响因素,在单因素分析基础上行多因素Logistic回归分析。结果: 单因素分析基础上多因素Logistic回归分析,吸烟史、慢性咳嗽家族史、过敏史、反复呼吸道感染病史、胃食管返流慢性咽炎、家庭1年内装修及家中种养花草为慢性咳嗽发生的危险因素(P＜0.05)。结论: 372例慢性咳嗽患者的发病与吸烟史、慢性咳嗽家族史、过敏史等因素有关,临床上可针对上述因素进行干预,以降低慢性咳嗽发生率。     

沈其霖教授辨治肺病经验探析

沈其霖教授擅长诊治慢性咳嗽、过敏性哮喘、肺间质纤维化等肺系疾病。沈教授认为,慢性咳嗽的常见病因为寒邪挟风邪,治以温肺祛风,可加用清热化痰药。过敏性哮喘本虚在肺、脾、肾,标实是风痰,病位在肺,咽喉亦是该病症状最明显之处,治以祛风化痰,固护肺、脾、肾。肺痿以本虚为主,标实为次,治疗应扶正虚、行气滞、化痰浊、祛血瘀,并应加强消散肿结之药,不仅祛邪滞,还可防癌变。     

小儿肺咳颗粒与盐酸氨溴索糖浆治疗小儿慢性咳嗽临床对比研究

目的:对比分析小儿肺咳颗粒与盐酸氨溴索糖浆治疗小儿慢性咳嗽的临床应用价值。方法:将慢性咳嗽患儿200例按数字奇偶法分为研究组与对照组各100例,2组入院后均临床接受常规治疗,在此基础上,对照组给予盐酸氨溴索糖浆治疗,研究组给予小儿肺咳颗粒治疗,连续治疗2周后评估2组患儿临床症状体征变化并评定临床疗效,同时检测其免疫功能指标。结果:总有效率研究组93.00%高于对照组的67.00%,差异有统计学意义(P<0.05)。治疗前,2组中医证候积分比较,差异无统计学意义(P>0.05)。治疗后,2组中医证候积分均下降,研究组低于对照组,差异有统计学意义(P<0.05)。咳嗽缓解时间、咳嗽消失时间研究组早于对照组,差异有统计学意义(P<0.05)。治疗前,2组CD4⁺、CD8⁺、CD4⁺/CD8⁺比较,差异无统计学意义(P>0.05)。治疗后,2组CD8⁺与治疗前比较上升,研究组CD8⁺上升幅度大于对照组;2组CD4⁺、CD4⁺/CD8⁺与治疗前比较下降,研究组CD4⁺、CD4⁺/CD8⁺下降幅度大于对照组,差异均有统计学意义(P<0.05)。结论:小儿肺咳颗粒治疗小儿慢性咳嗽与盐酸氨溴索糖浆比较,更有利于提升临床疗效,缓解患儿临床症状,并能提高患儿免疫抵抗力。     

麻杏石甘汤联合西药治疗小儿肺炎咳喘临床研究

目的:观察麻杏石甘汤加减联合西药治疗小儿肺炎咳喘的临床效果。方法:将小儿肺炎咳喘患者74例,按随机数字表法分为西药组与中西医结合组各37例。西药组根据病情给予抗菌、抗病毒治疗,中西医结合组在西药组的基础上联合麻杏石甘汤治疗。比较2组临床治疗总有效率,观察2组治疗前后中医证候积分情况、临床症状消失时间以及不良反应发生率。结果:中西医结合组总有效率为94.59%,西药组为81.08%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组主症、次症中医证候积分均较治疗前降低(P<0.05),且中西医结合组主症、次症中医证候积分均低于西药组(P<0.05)。中西医结合组体温恢复正常时间、咳嗽消失时间、喘息消失时间、肺部啰音消失时间均短于西药组,差异有统计学意义(P<0.05)。中西医结合组不良反应发生率为5.41%,西药组为2.70%,2组比较,差异无统计学意义(P>0.05)。结论:麻杏石甘汤联合西药治疗对肺炎咳喘,可明显改善患儿的临床症状,提高临床治疗总有效率。     

Respiratory and hemodynamic perioperative adverse events in intravenous versus inhalational induction in pediatric anesthesia: A systematic review and meta‐analysis

Perioperative respiratory and hemodynamic adverse events are still a cause of morbidity and mortality in pediatric anesthesia. It has been suggested that volatile agents might be associated with more respiratory adverse events compared to intravenous agents (eg, propofol), which have been associated with a higher risk of bradycardia compared to volatile agents. We performed a systematic review and meta‐analysis to evaluate the risk of perioperative hemodynamic and respiratory adverse events, comparing intravenous induction with inhalational induction in pediatric anesthesia. We searched PubMed, Embase, and Medline up to February 12, 2020. Randomized controlled trials were included. A quality assessment was carried out using a modified version of the “Cochrane Risk of Bias Tool for Randomized Controlled Trials.” Of the 1602 applicable publications, four were included in the final review. Two studies found no significant differences in perioperative respiratory or hemodynamic adverse events. Two studies found a higher risk of respiratory perioperative adverse events in inhalation versus intravenous induction, with a relative risk varying from 1.64 to 3.83. Data were heterogenous, and pooled estimates may not be reliable. The present systematic review and meta‐analysis revealed no significant difference in the occurrence of perioperative respiratory adverse events between inhalation and intravenous induction. More respiratory adverse events during and after inhalation induction were found, in particular in children with multiple risk factors for respiratory adverse events. This did not reach significance. Future research should include a large randomized controlled trial comparing inhalation and intravenous induction with respiratory and hemodynamic adverse events as primary outcome and adequately blinded outcome assessors.     

妥洛特罗贴剂联用氯苯那敏治疗小儿慢性咳嗽

目的观察妥洛特罗贴剂联合氯苯那敏治疗小儿慢性咳嗽的临床疗效。方法80例慢性咳嗽患儿随机分为两组,每组40例。在口服氯苯那敏基础上,试验组加用妥洛特罗贴剂(每帖0.5 mg,1^<3岁每次0.5 mg,3<3岁每次0.5 mg,3⁵岁每次1.0 mg)贴于前胸,每日一次;对照组加用复方愈创木酚磺酸钾口服溶液(15岁每次1.0 mg)贴于前胸,每日一次;对照组加用复方愈创木酚磺酸钾口服溶液(1^<2岁每次1 mL,2<2岁每次1 mL,2⁵岁每次2 mL),口服,每日三次。两组均治疗10 d,比较两组患儿日间和夜间的咳嗽症状、不良反应。结果两组治疗前日间、夜间咳嗽评分无显著差异(P>0.05)。治疗10 d后,试验组日间、夜间咳嗽评分分别为(0.54±0.37)、(0.39±0.42)分,对照组分别为(0.78±0.42)、(0.86±0.63)分,试验组日间、夜间咳嗽评分均低于对照组(P<0.05)。治疗组总有效率82%(33/40),对照组为62%(25/40),两组疗效比较差异显著(P<0.05)。治疗组出现给药部位红斑1例,两组均无严重不良反应发生。结论妥洛特罗贴剂联合氯苯那敏治疗小儿慢性咳嗽疗效显著,安全可靠,患儿依从性好。     

A randomized placebo controlled trial to evaluate the effects of butamirate and dextromethorphan on capsaicin induced cough in healthy volunteers

Aims

The examination of cough reflex sensitivity through inhalational challenge can be utilized to demonstrate pharmacological end points. Here we compare the effect of butamirate, dextromethorphan and placebo on capsaicin-induced cough in healthy volunteers.

Methods

In this randomized, placebo-controlled, six way crossover study the effect of dextromethrophan 30 mg, four doses of butamirate and placebo was evaluated on incremental capsaicin challenges performed at baseline and 2, 4, 6, 8, 12 and 24 h following dosing. The primary end point was the area under the curve (AUC(0,12h)) of log₁₀ C5 from pre-dose to 12 h after dosing. Plasma butamirate metabolites were analyzed to evaluate pharmacokinetic and pharmacodynamic relationships.

Results

Thirty-four subjects (13 males, median age 25 years) completed the study. Cough sensitivity decreased from baseline in all arms of the study. Dextromethorphan was superior to placebo (P = 0.01) but butamirate failed to show significant activity with maximum attenuation at the 45 mg dose. There was no apparent relationship between pharmacokinetic and pharmacodynamic parameters for butamirate.

Conclusions

We have demonstrated for the first time that dextromethorphan attenuates capsaicin challenge confirming its broad activity on the cough reflex. The lack of efficacy of butamirate could be due to formulation issues at higher doses.     

孟鲁司特钠与美敏伪麻液联合治疗上气道咳嗽综合征疗效观察

目的:观察孟鲁司特钠与美敏伪麻液联合治疗上气道咳嗽综合征的疗效。方法:将239例上气道咳嗽综合征患者随机分为治疗组与对照组,治疗组患者口服孟鲁司特钠(10 mg,qn,5 d)与美敏伪麻液(10 ml,tid,5 d),对照组患者口服孟鲁司特钠(10mg,qn,5 d)与复方甘草口服液(10 ml,tid,5 d),根据咳嗽症状评分评价临床疗效。结果:治疗前,治疗组与对照组患者的咳嗽症状评分分别为1.99±0.58和1.99±0.61(P>0.05);治疗后,治疗组与对照组患者的咳嗽症状评分分别为0.31±0.23和1.21±0.63(P<0.05);治疗组与对照组的总有效率分别为92.44%、60.83%(P<0.05)。结论:孟鲁司特钠与美敏伪麻液联合治疗上气道咳嗽综合征效果好,可在临床推广。