婴幼儿喘息-浙江大学.pptVIP

RSV毛细支气管炎: ----治疗？ ?2-受体激动剂 糖皮质激素 肾上腺素 白三烯受体拮抗剂 Vitamin A NO Palivizumab rhDNase Surfactant Heliox 1 King VJ,Arch Pediatr Adolesc Med, 2004;158:127 2 Welliver RC. Pediatr Respir Rev,2004;5:S127 气道异物的处理 硬支气管镜治疗 纤维支气管镜的检查和治疗 胃食道反流病的治疗 改变儿童生活习惯 抬高床头位 药物治疗－有效率80％ 胃动力药 制酸药 H2拮抗剂（西咪替丁／雷尼替丁） 质子泵抑制剂（奥美拉唑） 手术治疗 仅应用于顽固病症 PY Chow, et al. Chronic cough in children, Singapore Med J, 2004,45(10)462. 高蛋白低脂饮食，少零食，睡 前2～3小时不进食 支气管软化的处理原则 体位引流 胸部物理治疗 色苷酸钠吸入 溴化异丙托品 避免使用?类激动剂 Behrman,et al. Nelson textbook of pediatrics, 16th edition, 2000, p1272 闭塞性毛细支气管炎的治疗 通常是困难且不成功 无世界公认的治疗准则 早期干预可能阻断进程？ 持续应用皮质激素口服或吸入 支气管扩张药 大环内酯类口服 白三烯受体拮抗剂 其它 中华儿科杂志，2008;46(10): 745 Moonnumakal SP, et al. Curr Opin Pediatr, 2008;20(3): 272. 总结 婴幼儿喘息是异质性群体，但病毒是其最重要病因或诱因； 对婴幼儿喘息应进行相应的病因检查与分析及定期随访评估，必要时诊断性药物治疗。 谢谢！ * Slide 5 RSV is a common agent causing bronchiolitis in children: In a multicentre study in Argentina, involving 1,278 children aged 5 years hospitalised due to acute lower respiratory infection, RSV was detected in 78.2% of all viral positive cases (viral positive cases represented 32% of the total cases). The incidence of RSV was statistically greater than that of the other viruses (p0.001).4 A study at a private paediatric practice in North Carolina included all children (aged 15 years) seeking care for acute respiratory disease over a period of 11 years (1964-1975). There were a total of 6,155 episodes, of which 1,851 episodes were associated with wheezing. Of these, RSV was the most commonly isolated agent, being isolated in 34% of all cases (135/1,851) and 44% of children aged 2 years (90/909).5 Another study analysed oropharyngeal swabs from 14,293 infants and young children up to 6 years of age who were treated for respiratory tract disease at the Children’s Hospital in Washington, D.C., between 1957 and 1970. Serum samples were also collected for analysis from 4,387 of these patients. Overal