中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2015年
21期
1630-1633
,共4页
支气管哮喘%急性发作%肺炎%儿童
支氣管哮喘%急性髮作%肺炎%兒童
지기관효천%급성발작%폐염%인동
Asthma%Exacerbation%Pneumonia%Child
目的：对学龄期儿童支气管哮喘（哮喘）中重度急性发作病例的临床特征和治疗转归进行总结分析，为哮喘急性发作的管理提供实践依据。方法收集2005年1月至2013年12月北京儿童医院全部学龄期（≥6岁）哮喘急性发作住院病例214例，分析其临床特点，将全部病例分为哮喘并肺炎组（ A 组，88例）、哮喘组（B 组，126例），比较2组间差异。结果入组病例年龄中位数9（6~18）岁，男女比例1.5：1.0。中度急性发作78.0％（167/214例），重度22.0％（47/214例）；需机械通气的危重病例7.0％（15/214例）。与 B 组相比，A 组病例全身激素使用比例高（53.4％比38.9％，χ2＝4.416，P ＝0.036）、危重症病例比例高（12.5％比3.3％，χ2＝5.476，P ＝0.019）、住院时间长（9.0 d 比8.0 d，Z ＝-3.063，P ＝0.002）、住院费用高（1.0万元比0.9万元，Z ＝-2.058，P ＝0.000）；喘鸣音持续天数与氨茶碱使用与否无关（5.7 d 比5.9 d，t ＝-0.233，P ＝0.817）。24例在喘息病程中行支气管灌洗治疗，22例（91.7％）灌洗后3 d 内喘鸣音消失；气管镜下有分泌物壅塞的病例，吸入变应原致敏种类数明显多于无该征象者（3.3±1.4比2.2±1.2，t ＝2.190，P ＝0.036）。结论并发肺炎的哮喘急性发作可能更需要早期足量应用全身激素抗炎治疗。致敏变应原的暴露可能使呼吸道分泌物增多，气管镜灌洗有益于改善因分泌物增多造成的呼吸道梗阻。氨茶碱在哮喘发作中的应用需进一步研究论证。
目的：對學齡期兒童支氣管哮喘（哮喘）中重度急性髮作病例的臨床特徵和治療轉歸進行總結分析，為哮喘急性髮作的管理提供實踐依據。方法收集2005年1月至2013年12月北京兒童醫院全部學齡期（≥6歲）哮喘急性髮作住院病例214例，分析其臨床特點，將全部病例分為哮喘併肺炎組（ A 組，88例）、哮喘組（B 組，126例），比較2組間差異。結果入組病例年齡中位數9（6~18）歲，男女比例1.5：1.0。中度急性髮作78.0％（167/214例），重度22.0％（47/214例）；需機械通氣的危重病例7.0％（15/214例）。與 B 組相比，A 組病例全身激素使用比例高（53.4％比38.9％，χ2＝4.416，P ＝0.036）、危重癥病例比例高（12.5％比3.3％，χ2＝5.476，P ＝0.019）、住院時間長（9.0 d 比8.0 d，Z ＝-3.063，P ＝0.002）、住院費用高（1.0萬元比0.9萬元，Z ＝-2.058，P ＝0.000）；喘鳴音持續天數與氨茶堿使用與否無關（5.7 d 比5.9 d，t ＝-0.233，P ＝0.817）。24例在喘息病程中行支氣管灌洗治療，22例（91.7％）灌洗後3 d 內喘鳴音消失；氣管鏡下有分泌物壅塞的病例，吸入變應原緻敏種類數明顯多于無該徵象者（3.3±1.4比2.2±1.2，t ＝2.190，P ＝0.036）。結論併髮肺炎的哮喘急性髮作可能更需要早期足量應用全身激素抗炎治療。緻敏變應原的暴露可能使呼吸道分泌物增多，氣管鏡灌洗有益于改善因分泌物增多造成的呼吸道梗阻。氨茶堿在哮喘髮作中的應用需進一步研究論證。
목적：대학령기인동지기관효천（효천）중중도급성발작병례적림상특정화치료전귀진행총결분석，위효천급성발작적관리제공실천의거。방법수집2005년1월지2013년12월북경인동의원전부학령기（≥6세）효천급성발작주원병례214례，분석기림상특점，장전부병례분위효천병폐염조（ A 조，88례）、효천조（B 조，126례），비교2조간차이。결과입조병례년령중위수9（6~18）세，남녀비례1.5：1.0。중도급성발작78.0％（167/214례），중도22.0％（47/214례）；수궤계통기적위중병례7.0％（15/214례）。여 B 조상비，A 조병례전신격소사용비례고（53.4％비38.9％，χ2＝4.416，P ＝0.036）、위중증병례비례고（12.5％비3.3％，χ2＝5.476，P ＝0.019）、주원시간장（9.0 d 비8.0 d，Z ＝-3.063，P ＝0.002）、주원비용고（1.0만원비0.9만원，Z ＝-2.058，P ＝0.000）；천명음지속천수여안다감사용여부무관（5.7 d 비5.9 d，t ＝-0.233，P ＝0.817）。24례재천식병정중행지기관관세치료，22례（91.7％）관세후3 d 내천명음소실；기관경하유분비물옹새적병례，흡입변응원치민충류수명현다우무해정상자（3.3±1.4비2.2±1.2，t ＝2.190，P ＝0.036）。결론병발폐염적효천급성발작가능경수요조기족량응용전신격소항염치료。치민변응원적폭로가능사호흡도분비물증다，기관경관세유익우개선인분비물증다조성적호흡도경조。안다감재효천발작중적응용수진일보연구론증。
Objective To understand the clinical features and current therapies on asthma exacerbation,so as to provide practical evidence for managing asthma episodes. Methods Two hundred and fourteen school - age(≥6 years old)cases who were admitted for asthma exacerbation in Beijing Children's Hospital,from January 2005 to De-cember 2013,were enrolled. All the cases were categorized into 2 groups:asthma with pneumonia group(group A,n =88)and asthma group(group B,n = 126). Results There were 214 cases enrolled,the median age was 9(6 - 18) years old,and the male - female ratio was 1. 5: 1. 0,78. 0%(167 / 214 cases)of the patients enrolled had moderate asthma exacerbation,and 22. 0%(47 / 214 cases)were defined as severe episodes,7. 0%(15 / 214 cases)were on me-chanical ventilation. Compared with group B,group A had more systemic corticosteroids use(53. 4% vs 38. 9% ,χ2 =4. 416,P = 0. 036),higher proportion of cases needing mechanical ventilation(12. 5% vs 3. 3% ,χ2 = 5. 476,P =0. 019),longer durations in hospital(9. 0 d vs 8. 0 d,Z = - 3. 063,P = 0. 002),and higher hospitalization expenses (10 000 yuan vs 9 000 yuan,Z = - 2. 058,P = 0. 000). The prescription of Aminophylline didn't help to shorten the duration of wheeze days(5. 7 d vs 5. 9 d,t = - 0. 233,P = 0. 817). Twenty - four cases received bronchial lavage through bronchoscope during wheezing days,in which 22 cases(91. 7% )of wheezing disappeared within 3 days after the lavage. There were more sensitized allergens detected in those patients who showed hypersecretion status under bronchos-copy(3. 3 ±1. 4 vs 2. 2 ±1. 2,t =2. 190,P =0. 036),compared with those without such signs. Conclusions Pneumonia may increase the demand for systemic use of corticosteroids in asthma exacerbations. The early use of systemic corticoste-roids may have an effect on reducing the severity of asthma attack,especially those with pneumonia. Multi - sensitization may contribute to the hypersecretion in bronchi. The bronchial lavage may help improve the bronchial ventilation caused by mucous plugin. The clinical usage of Aminophylline is still controversial,and it needs to be optimized.
