毛细支气管炎诊疗方法选择

发布时间：2018-12-26 13:24

【摘要】：毛细支气管炎是呼吸道合胞病毒（RSV）引起的婴幼儿常见下呼吸道感染性疾病，好发于2岁以下特别是6个月内的婴儿，临床表现为咳嗽、喘憋，严重者出现呼吸困难、合并心力衰竭，甚至发展成哮喘，严重威胁婴幼儿的健康。目前其诊断主要依靠病史及临床表现，无特异性指标及诊断性检查。尚无特殊治疗方法且住院费用昂贵，，不合理治疗会加重家庭、社会经济负担。不合理的检查和治疗明显增加患儿的住院费用，增加药物毒副作用。目的: 本课题从病毒检测、胸部X线检查、不同的雾化治疗药物、抗生素的使用几方面观察病人住院时间、喘息缓解时间、肺部体征消失时间的差异，寻求更加合理的诊疗方案，为规范毛细支气管炎的诊断和治疗提供依据。方法: 2012年12月到2013年2月东阿县人民医院儿科199例毛细支气管炎患儿，年龄1个月-24个月。分组施行雾化治疗（沙丁胺醇、沙丁胺醇+布地奈德、异丙托溴氨）和抗生素治疗（头孢哌酮、哌拉西林、阿奇霉素），并对患儿进行呼吸道病毒检测、胸部X线检查，观察住院治疗时间、喘息缓解时间、肺部体征消失时间的差异。结果: 1.呼吸道合胞病毒组、呼吸道病毒检测阴性组、副流感病毒的住院治疗时间、喘息缓解时间、肺部体征消失时间无明显差异，无统计学意义； 2.支气管炎组和肺炎组，住院治疗时间、喘息缓解时间、肺部体征消失时间无明显差异，无统计学意义； 3.使用不同雾化治疗药物后，住院治疗时间、喘息缓解时间、肺部体征消失时间无明显差异，无统计学意义； 4.抗生素使用组其住院时间比无使用抗生素组减少，有统计学意义，同时使用抗生素组白细胞计数及CRP增高，有统计学意义。结论: 1.感染状态不同的患儿，经雾化吸入、抗生素控制感染等综合治疗后住院治疗时间、喘息缓解时间、肺部体征消失时间无明显差异，表明呼吸道病毒检测对毛细支气管炎患儿治疗无指导意义。 2.胸片检查诊断为支气管炎和肺炎的两组患儿，住院治疗时间、喘息缓解时间、肺部体征消失时间无明显差异，说明胸片检查对患儿治疗无特殊意义，且放射线危害健康，不应作为毛细支气管炎患儿的常规检查。 3.对于雾化治疗的患儿应用激素组和其他两组住院治疗时间无明显差异，同时激素的长期副作用不肯定，故激素不能用于毛细支气管炎患儿的治疗。 4.抗生素组其住院治疗时间明显减少，故对于毛细支气管炎患儿感染指标增高者，应合理选用抗菌药物，减少住院日。
[Abstract]:Bronchiolitis is a common infective disease of lower respiratory tract caused by respiratory syncytial virus (RSV) in infants. Heart failure, or even asthma, is a serious threat to the health of infants and young children. At present, its diagnosis mainly depends on the history and clinical manifestations, no specific indicators and diagnostic examination. There is no special treatment and the cost of hospitalization is expensive. Unreasonable treatment will increase the burden of family and social economy. Unreasonable examination and treatment significantly increased hospitalization costs and side effects of drugs. Objective: the purpose of this study was to observe the differences of hospitalization time, gasping remission time, lung signs disappearance time from the aspects of virus detection, chest X-ray examination, different atomization therapy drugs and antibiotic use. To seek more reasonable diagnosis and treatment plan, to provide the basis for standardized diagnosis and treatment of bronchiolitis. Methods: from December 2012 to February 2013, 199 pediatric children with bronchiolitis in Donga County people's Hospital, aged from 1 month to 24 months, were enrolled. The patients were treated with atomization (salbutamol, budesonide, ipratropium) and antibiotics (cefoperazone, piperacillin, azithromycin). The time of hospitalization, relief of wheezing and disappearance of pulmonary signs were observed. Results: 1. Respiratory syncytial virus group, respiratory virus negative group, parainfluenza virus hospitalization time, gasping remission time, lung signs disappeared, there was no significant difference; 2. Bronchitis group and pneumonia group, hospitalization time, gasping remission time, lung signs disappeared time, there was no significant difference; 3. There was no significant difference in hospitalization time, wheezing remission time and disappearance time of pulmonary signs after the use of different atomization drugs. 4. The hospitalization time of antibiotic group was significantly lower than that of no antibiotic group, and the white blood cell count and CRP in antibiotic group were significantly higher than those in control group. Conclusion: 1. There was no significant difference in the time of hospitalization, relief of wheezing and disappearance of pulmonary signs after comprehensive treatment, such as atomization inhalation, antibiotic control infection and so on. It indicated that the detection of respiratory tract virus had no guiding significance for the treatment of bronchiolitis. 2. There was no significant difference between the two groups of children diagnosed as bronchitis and pneumonia by chest radiography. The time of hospitalization, remission of wheezing and disappearance of pulmonary signs were not significantly different, which indicated that chest radiography had no special significance for the treatment of children, and radiation was harmful to health. Should not be used as a routine examination of children with bronchiolitis. 3. There was no significant difference in hospitalization time between the hormone group and the other two groups, and the long-term side effect of the hormone was uncertain, so the hormone could not be used in the treatment of bronchiolitis. 4. The hospitalization time of antibiotic group was obviously reduced, so for the children with bronchiolitis, antibiotics should be selected reasonably and the hospitalization days should be reduced.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.6

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