雾化吸入布地奈德、特布他林结合机械辅助排痰治疗重症肺炎患儿的疗效及护理
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摘要
目的探讨雾化吸入布地奈德、特布他林结合机械辅助排痰治疗重症肺炎患儿的疗效,并探讨其护理措施。方法选择重症肺炎患儿80例作为研究对象,随机分为对照组和观察组,每组40例。2组患儿均给予退热、止咳、平喘、抗生素和抗病毒等常规治疗措施和护理,观察组在常规治疗基础上雾化吸入布地奈德、特布他林结合机械辅助排痰治疗,并给予针对性护理措施。观察2组临床疗效、症状缓解时间及治疗前后心功能指标[左心室射血分数(LVEF)、左心室收缩末期内径(LVDD)、房室瓣E与A峰比值(E/A)、心指数(CI)]、肺功能指标[肺活量(FVC)、最大呼气第1秒容积(FEV1)、峰值呼气流速(PEF)]、白细胞计数(WBC)、降钙素原(PCT)、血清炎性因子[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)]变化。结果观察组总有效率明显高于对照组,症状缓解时间明显短于对照组,差异有统计学意义(P<0.05)。2组治疗前LVEF、LVDD、E/A、CI、FVC、FEV1、PEF、WBC、PCT、IL-6、TNF-α、CRP比较差异无统计学意义(P>0.05)。2组治疗后LVEF、E/A、CI、FVC、FEV1、PEF明显高于治疗前,LVDD、WBC、PCT、IL-6、TNF-α、CRP明显低于治疗前(P<0.05),且观察组LVEF、E/A、CI、FVC、FEV1、PEF高于对照组,LVDD、WBC、PCT、IL-6、TNF-α、CRP低于对照组,差异有统计学意义(P<0.05)。结论雾化吸入布地奈德、特布他林结合机械辅助排痰治疗重症肺炎患儿,并给予针对性护理措施,临床疗效显著,能够缩短症状缓解时间,增强心肺功能及降低血清炎性因子水平。
Objective To observe the therapeutic effects of atomization inhalation of terbutaline and budesonide combined with mechanical assisted expectoration on severe pneumonia in children,and to explore its nursing intervention.Methods A total of 80 children patients with severe pneumonia who were treated in our hospital from January 2016 to January 2018 were randomly divided into control group(n=40) and observation group(n=40). The patients in both groups were given conventional therapy including pyretolysis, cough relieving, antibiotics and antiviral drugs,moreover,the patients in observation group were treated by atomization inhalation of terbutaline and budesonide combined with mechanical assisted expectoration,with directive nursing intervention. The clinical curative effects,symptoms disappearance time,and the changes of heart function indexes(LVEF, LVDD, E/A,CI),pulmonary function indexes(FVC,FEV1,PEF),WBC,PCT,serum levels of inflammatory cytokines including IL-6,TNF-α,CRP were observed and compared between the two groups.Results The total effective rate in observation group was significantly higher than that in control group,and symptoms disappearance time was significantly shorter than that in control group(P<0.05).Before treatment there were no significant differences in the levels of LVEF,LVDD,E/A,CI,FVC,FEV1,PEF,WBC,PCT,IL-6,TNF-α,CRP between the two groups(P>0.05). After treatment the levels of LVEF,E/A,CI,FVC,FEV1,PEF in both groups were significantly higher than those before treatment,however,the levels of LVDD,WBC,PCT,IL-6,TNF-α,CRP in both two groups were significantly lower than those before the treatment(P<0.05).Moreover the improvement extent in observation group was more significant than that in control group(P<0.05).Conclusion The atomization inhalation of terbutaline and budesonide combined with mechanical assisted expectoration as well as directive nursing intervention can ontain significant therapeutic effects on severe pneumonia in children,which can shorten symptomatic relief time,strengthen the heart and pulmonary function,and reduce the serum levels of inflammatory factors significantly.
Objective To observe the therapeutic effects of atomization inhalation of terbutaline and budesonide combined with mechanical assisted expectoration on severe pneumonia in children,and to explore its nursing intervention.Methods A total of 80 children patients with severe pneumonia who were treated in our hospital from January 2016 to January 2018 were randomly divided into control group(n=40) and observation group(n=40). The patients in both groups were given conventional therapy including pyretolysis, cough relieving, antibiotics and antiviral drugs,moreover,the patients in observation group were treated by atomization inhalation of terbutaline and budesonide combined with mechanical assisted expectoration,with directive nursing intervention. The clinical curative effects,symptoms disappearance time,and the changes of heart function indexes(LVEF, LVDD, E/A,CI),pulmonary function indexes(FVC,FEV1,PEF),WBC,PCT,serum levels of inflammatory cytokines including IL-6,TNF-α,CRP were observed and compared between the two groups.Results The total effective rate in observation group was significantly higher than that in control group,and symptoms disappearance time was significantly shorter than that in control group(P<0.05).Before treatment there were no significant differences in the levels of LVEF,LVDD,E/A,CI,FVC,FEV1,PEF,WBC,PCT,IL-6,TNF-α,CRP between the two groups(P>0.05). After treatment the levels of LVEF,E/A,CI,FVC,FEV1,PEF in both groups were significantly higher than those before treatment,however,the levels of LVDD,WBC,PCT,IL-6,TNF-α,CRP in both two groups were significantly lower than those before the treatment(P<0.05).Moreover the improvement extent in observation group was more significant than that in control group(P<0.05).Conclusion The atomization inhalation of terbutaline and budesonide combined with mechanical assisted expectoration as well as directive nursing intervention can ontain significant therapeutic effects on severe pneumonia in children,which can shorten symptomatic relief time,strengthen the heart and pulmonary function,and reduce the serum levels of inflammatory factors significantly.
引文
1 Soofi S,Ahmed S,Fox MP,et al.Effectiveness of community case management of severe poeumonia with oral amoxicillin in children aged 2-59 months in Matiari district,rural Pakistan:a cluster-randomized controlled trial.Lancet,2012,379:729-737.
2 Dom Nguez,Soldevila N,Toledo D,et al.Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain.PLoS One,2017,12:e0171943.
3 李小盼,李世清,胡瑜.护理干预联合氧驱动雾化对小儿重症肺炎咳嗽的临床观察研究.安徽医药,2014,18:1179-1181.
4 龚晓莉,沈铭熙,褚旭丽.盐酸氨溴索联合布地奈德治疗小儿重症肺炎的效果及护理.中华现代护理杂志,2013,19:3805-3806.
5 PrayGod G,Mukerebe C,Magawa R,et al.Indoor air pollution and delayed measles vaccination increase the risk of severe pneumonia in children:results from a case-control study in Mwanza,Tanzania.PLoS One,2016,11:e0160804.
6 金国信,林宗泽,吴亮,等.经鼻持续气道正压通气治疗小儿重症肺炎临床疗效观察.中华全科医学,2014,12:773-774.
7 王建明.干扰素雾化吸入治疗婴幼儿支气管肺炎50例疗效观察.中国中西医结合儿科学,2013,5:364-365.
8 汤彩娥.氨溴索不同用法辅助治疗小儿肺炎的临床效果观察.中国当代医药,2014,21:79-80.
9 刘婷婷,梁宗安.高频胸壁震荡的应用.中华结核和呼吸杂志,2012,12:951-953.
10 张杰.小儿肺炎支原体肺炎临床诊断及治疗效果观察.中外医学研究,2012,10:189-199.
11 吴莎丽.小儿重症肺炎的护理体会.中国急救医学,2015,35:97.
12 陈贞祥,沈怀云,诸宏伟,等.雾化吸入布地奈德、硫酸特布他林佐治小儿重症肺炎30例.蚌埠医学院学报,2011,36:467-469.
13 茅雪莉,柴梅月,韩玲.98 例小儿支气管肺炎疗效分析.实用中西医结合临床,2014,14:80-81.
14 Simpson AJ,Bood JR,Anderson SD,et al.A standard,single dose of inhaled terbutaline attenuates hyperpnea-induced bronchoconstriction and mast cell activation in athletes.J Appl Physiol(1985),2016,120:1011-1017.
15 杜晓宁,梁丽霞,严慧芳,等.阿奇霉素序贯疗法联合特步他林治疗小儿支原体肺炎的临床观察.中国药房,2016,27:740-742.
16 韩金芬,王文秀,王川云,等.布地奈德联合阿奇霉素治疗儿童肺炎支原体肺炎疗效观察.新乡医学院学报,2016,33:684-685,691.
17 Rütten S,Schusser GF,Abraham G,et al.Release kinetics of tumor necrosis factor-α and interleukin-1 receptor antagonist in the equine whole blood.BMC Vet Res,2016,12:117.
18 赵小花,沈国武,徐长艳.阿奇霉素对小儿支原体肺炎患者C反应蛋白与心肌酶含量影响及临床疗效.中国医院药学杂志,2014,34:562-564.
2 Dom Nguez,Soldevila N,Toledo D,et al.Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain.PLoS One,2017,12:e0171943.
3 李小盼,李世清,胡瑜.护理干预联合氧驱动雾化对小儿重症肺炎咳嗽的临床观察研究.安徽医药,2014,18:1179-1181.
4 龚晓莉,沈铭熙,褚旭丽.盐酸氨溴索联合布地奈德治疗小儿重症肺炎的效果及护理.中华现代护理杂志,2013,19:3805-3806.
5 PrayGod G,Mukerebe C,Magawa R,et al.Indoor air pollution and delayed measles vaccination increase the risk of severe pneumonia in children:results from a case-control study in Mwanza,Tanzania.PLoS One,2016,11:e0160804.
6 金国信,林宗泽,吴亮,等.经鼻持续气道正压通气治疗小儿重症肺炎临床疗效观察.中华全科医学,2014,12:773-774.
7 王建明.干扰素雾化吸入治疗婴幼儿支气管肺炎50例疗效观察.中国中西医结合儿科学,2013,5:364-365.
8 汤彩娥.氨溴索不同用法辅助治疗小儿肺炎的临床效果观察.中国当代医药,2014,21:79-80.
9 刘婷婷,梁宗安.高频胸壁震荡的应用.中华结核和呼吸杂志,2012,12:951-953.
10 张杰.小儿肺炎支原体肺炎临床诊断及治疗效果观察.中外医学研究,2012,10:189-199.
11 吴莎丽.小儿重症肺炎的护理体会.中国急救医学,2015,35:97.
12 陈贞祥,沈怀云,诸宏伟,等.雾化吸入布地奈德、硫酸特布他林佐治小儿重症肺炎30例.蚌埠医学院学报,2011,36:467-469.
13 茅雪莉,柴梅月,韩玲.98 例小儿支气管肺炎疗效分析.实用中西医结合临床,2014,14:80-81.
14 Simpson AJ,Bood JR,Anderson SD,et al.A standard,single dose of inhaled terbutaline attenuates hyperpnea-induced bronchoconstriction and mast cell activation in athletes.J Appl Physiol(1985),2016,120:1011-1017.
15 杜晓宁,梁丽霞,严慧芳,等.阿奇霉素序贯疗法联合特步他林治疗小儿支原体肺炎的临床观察.中国药房,2016,27:740-742.
16 韩金芬,王文秀,王川云,等.布地奈德联合阿奇霉素治疗儿童肺炎支原体肺炎疗效观察.新乡医学院学报,2016,33:684-685,691.
17 Rütten S,Schusser GF,Abraham G,et al.Release kinetics of tumor necrosis factor-α and interleukin-1 receptor antagonist in the equine whole blood.BMC Vet Res,2016,12:117.
18 赵小花,沈国武,徐长艳.阿奇霉素对小儿支原体肺炎患者C反应蛋白与心肌酶含量影响及临床疗效.中国医院药学杂志,2014,34:562-564.