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1.
Chinese Critical Care Medicine ; (12): 87-90, 2019.
Article in Chinese | WPRIM | ID: wpr-744674

ABSTRACT

Objective To investigate the clinical significance of children bronchial asthma detection by using negative expiratory pressure (NEP) technique.Methods The children with bronchial asthma admitted to Department of Pediatrics of Zhejiang Provincial Integrated Traditional Chinese and Western Medicine Hospital from March 2016 to March 2018 were enrolled.They were divided into mild group (0-4 scores) and severe group (5-12 scores) according to asthma clinical scoring criteria.The children undergoing physical examination at the same period were served as healthy control group.NEP technique and tidal volume (VT) were detected by the pulmonary function instrument.Respiratory flow-volume curves (F-V curves) without NEP were compared with tidal F-V curves after NEP application to assess expiratory flow limitation (EFL).EFL index was calculated according to the percentage of expiratory VT after EFL and expiratory VT when NEP was not used.Pearson correlation method was used to analyze the relationship between EFL index and severity of bronchial asthma.Receiver operating characteristic (ROC) curve was plotted to analyze the value of EFL index in evaluating the severity of bronchial asthma in children.Results A total of 86 children with bronchial asthma were enrolled in the study,and 84 patients completed the test and 2 children withdrew due to other diseases.Finally,84 patients were included in the final analysis,including 41 mild and 43 severe children.Forty-two healthy children in the same period were served as healthy control group.There was no significant difference in gender or age among the groups,and no adverse reactions occurred during the test.The EFL index of children with bronchial asthma was significantly higher than that of the healthy control group,and it was increased with the severity of the disease [mild group compared with healthy control group:(30.60± 6.03)% vs.(6.64 ± 2.37)%,severe group compared with healthy control group:(33.70 ± 5.41)% vs.(6.64 ± 2.37)%,both P < 0.05].There was no significant difference in respiratory rate (RR) or VT between mild group or severe group and healthy control group [RR (times/min):31.45 ± 4.18,32.81 ± 4.07 vs.31.97 ± 4.01,VT (mL/kg):6.29 ± 1.14,5.96 ± 0.90 vs.6.30 ± 1.20,all P > 0.05].It was shown by the correlation analysis that EFL index was positively correlated with the severity of asthma (r =0.836,P =0.000).It was shown by ROC curve analysis that the area under ROC curve (AUC) of EFL index for predicting the severity of bronchial asthma in children was 0.801 [95% confidence interval (95%C/) =0.725-0.878];when the best cut-off value of EFL index was 29.21%,the sensitivity was 85.7%,the specificity was 69.2%,the positive predictive value was 75.1%,and the negative predictive value was 60.2%.Conclusions The EFL index measured by NEP technology was closely related to the severity of bronchial asthma.The higher the EFL index,the more serious of the condition.The severity of bronchial asthma could be early judged by EFL index,which provided a basis for the evaluation and treatment of bronchial asthma.

2.
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care ; (6): 129-132, 2017.
Article in Chinese | WPRIM | ID: wpr-505712

ABSTRACT

Objective To approach the clinical features of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children and provide evidence for clinical treatment.Methods A retrospective analysis was conducted.Two hundreds and twenty children with Mycoplasma pneumoniae pneumonia (MPP) admitted to the Integrated Chinese and Western Medicine Hospital of Zhejiang Province were enrolled from January 2013 to June 2016.According to the criteria of diagnosis of MPP and RMPP,the patients were divided into a general group (172 cases) and a refractory group (48 cases).Their general information,incidence of pulmonary positive sign,laboratory data,radiological findings,complications,therapeutic situations and prognoses,etc.between the two groups were observated.Results There were no significant difference in gender distribution between the two groups,but the age of the refractory group was much older than that of the general group (years:7.15 ± 1.89 vs.4.86±2.16),and the fever duration in the refractory group was obviously longer than that in the general group (days:11.17±2.82 vs.6.27±2.29,P < 0.01).the levels of C-reactive protein [CRP (mg/L):46.8 ± 18.6 vs.13.5 ± 8.4],erythrocyte sedimentation rate [ESR (mm/1 h):56.9 ± 14.8 vs.28.7 ± 10.2],incidence of positive pulmonary sign [100.0% (48/48) vs.33.7% (58/172)],the incidence of pulmonary segmental consolidation [81.3% (39/48) vs.27.9% (48/172)] and incidence of extra-pulmonary complications [83.3% (40/48) vs.16.3% (28/172)] were all higher in refractory group than those in general group (all P < 0.01).All the patients were treated with macrolide antibiotics and traditional Chinese medicine,the patients in the refractory group was additionally treated with glucocorticoids,and a few of them were treated with gamma immunoglobulin and bronchoalveolar lavage;all of them recovered well,high temperature had returned to normal and the imageology findings recovered well,then they all discharged without any sequela such as bronchiectasis and pulmonary atelectasis.Conclusions Physicians should pay more attention to the MPP patients with longer fever duration (especially longer than 10 days),serious signs and symptoms,more complications,higher CRP and ESR and severe radiological findings.Besides early application of macrolide antibiotics,rational use of glucocorticoids,gamma immunoglobulin and bronchoalveolar lavage can be considered.

3.
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