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Objective:To explore the efficacy of andrographolide sulfonate(ADS) nebulized inhalation on pediatric moderate to severe acute respiratory distress syndrome(ARDS) requiring invasive mechanical ventilation.Methods:We conducted a prospective randomized controlled single-blind study.Children with moderate-to-severe ARDS admitted to the PICU at Beijing Children′s Hospital of Capital Medical University from November 1, 2018 to December 31, 2019, aging from 29 days to 18 years, and requiring invasive mechanical ventilation therapy were collected.The experimental group received ADS, while the control group received normal saline.Bronchoalveolar lavage fluid was collected to detect cytokines before and after the experiment.The differences of demography, cytokines and management between two groups were analyzed.Results:Twenty children with a median age of 2.15(1.48, 8.01)years were included and 15(75.00%)cases were boys.Median score of pediatric index of mortality-2 was 12.25(4.53, 16.30). There was no significant differences in demography, basic clinical data and prognosis between two groups( P>0.05). Monocyte chemoattractant protein-1 decreased in the experimental group while increased in the control group with statistic difference[967.50(119.25, 5 206.00)pg/mL vs.-945.00(-3 935.50, 495.09)pg/mL, P=0.041]. Interleukin(IL)-8 decreased in the experimental group but increased in the control group[303.22(-452.00, 1 172.38)pg/mL vs.-490.14(-780.25, 240.52)pg/mL, P=0.151]; and the IL-6 increase of the experimental group was lower than that of the control group[-24.53(-501.76, 135.27)pg/mL vs.-325.85(-633.22, 133.75)pg/mL, P=0.364]; all with no statistic differences( P>0.05). The oxygenation index[11.35(6.00, 15.83) vs.20.65(6.23, 38.35), P=0.374] and the improvement rate of ARDS(80%vs.60%, P=0.628) of the experimental group was better than that of the control group, but with no statistic difference( P>0.05). There was no statistic difference of mortality and mechanical ventilation time between two groups( P>0.05). Conclusion:Inhalation of ADS might reduce the increase of IL-6 and the concentration of monocyte chemoattractant protein-1 and IL-8 in bronchoalveolar lavage fluid of children with ARDS, and might improve pulmonary oxygenation function.Further research is needed to verify the above conclusion.
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Objective To evaluate the clinical effect of milrinone nebulized inhalation for improving intraoperative cardiac function and pulmonary arterial pressure in the patients with chronic obstructive pulmonary disease (COPD) complicating pulmonary hypertension (PH).Methods Forty-four surgical patients with COPD complicating PH in the Chongqing Municipal Medical Emergency Center from June 2015 to June 2016 were chosen,including 23 cases of thoracic surgery,13 cases of abdominal surgery and 8 cases of lower extremity fracture surgery.The patients were divided into the control group and treatment group,22 cases in each group.The control group received the routine comprehensive treatment.In addition receiving the conventional comprehensive treatment,milrinone nebulized inhalation in the treatment group was given before general anesthesia.Both of the two groups were imbedded with floating catheter in the right internal jugular vein for detecting the clinical indexes:cardiac output (CO),pulmonary artery systolic pressure (PASP),pulmonary artery mean pressure (PAMP) and pulmonary capillary wedge pressure (PCWP).Results Compared with before treatment,CO after treatment in the treatment group was significantly increased (P＜0.05),PASP,PAMP and PCWP after treatment in the treatment group were significantly decreased(P＜0.05).CO,PASP,PAMP and PCWP in the control group had no statistical difference between before and after treatment,the difference was not statistically significant (P＞0.05).Conclusion Intraoperative milrinone nebulized inhalation in the patients with COPD complicating PH can effectively improve the patient's cardiopulmonary function.
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Bronchiolitis is the most common acute infection of the lower respiratory tract in infancy,characterized by rhinorrhea,cough,Wheezing,respiratory distress and hypoxemia,and is most often caused by the respiratory syncytial virus (RSV).Some patients may develop into asthma,which is serious threat to the health of infants and young children.It is one of the focal points of pediatric clinical research.For the treatment of bronchiolitis,there is still no specially good effects of the treatment,the goal is to remove the obstruction of respiratory tract,improve ventilation and control the wheezing,prevent complicated by heart failure and respiratory failure.Medication mainly includes antiviral medication,and asthma and immunotherapy.The inhalation therapy is to put the drugs as a particulate directly into target tissue,acting on the trachea with drug receptors to play curative efficacy,which has rapid absorption.Thus nebulized medication therapy has been more and more recognized clinically.There are a wide variety of nebulized drugs.Commonly used in the literature are β2 agonists,epinephrine,corticosteroids,magnesium sulfate,ambroxol,ribavirin and hypertonic saline,etc.The Mechanism of various nebulized inhalation drug commonly used in the treatment of bronchiolitis recent years are reviewed.
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AIM:To observe the change of nitric oxide(NO)and hydrogen sulfide(H_2S)in blood and lung homogenate of hypoxic pulmonary hypertension(HPH)rat model,and to discuss the meaning of inhalation sodium nitrite and these factors in the treatment of HPH. METHODS:Fifty healthy male Wistar rats were assigned randomly into 5 groups(10 rats each):normoxia control group(NC),normoxia sodium nitrite group(NNI),hypoxic control group(HC),hypoxic normal saline group(HNS)and hypoxic sodium nitrite group(HNI). The mean pulmonary arterial pressure(mPAP),weight of right ventricle,weight of left ventricle plus septum,and the ratio of the weight of right ventricle to that of left ventricle plus septum(right ventricle hypertrophy index,RVHI)were also determined. The serum level of NO and plasma level of H_2S were measured,and at the same time the levels of NO in the lung homogenate were detected. The structures in pulmonary arteries were examined using optical microscope. RESULTS:After model established,compared to that in the normoxia groups,the body weight decreased significantly in hypoxia groups(P<0.05),although no difference of body weight in five groups before producing model was observed. Compared to that in normoxia groups,the levels of mPAP and RVHI increased significantly in hypoxia groups,and compared to that in hypoxia control groups and hypoxia normal saline group,mPAP and RVHI levels decreased significantly in hypoxia sodium nitrite group(P<0.05). Compared to that in normoxia groups,the serum level of NO decreased significantly in hypoxia groups(P<0.05). NO level in lung homogenate decreased significantly in hypoxia control group and hypoxia normal saline group as compared to that in normoxia groups(P<0.05),and no obvious difference between hypoxic sodium nitrite group and normoxia groups was found. The plasma level of H_2S was decreased significantly in hypoxia groups(P<0.05)as compared to that in normoxia groups. H_2S level increased significantly in hypoxia sodium nitrite group as compared to that in hypoxia control groups and hypoxia normal saline group(P<0.05). Observation under optical microscope,the lumen structure of lung in normoxia control group was normal. No significant change in normoxia sodium nitrite group was found. The proliferation of smooth muscle cells(SMCs),the collagen fiber deposition in the vessel wall and every caliber thickening was observed in hypoxic control group. The same changes were also observed in hypoxic normal saline group. The thickened caliber was relieved significantly in hypoxic nitrite group. CONCLUSION:Pulmonary hypertension and right ventricle reconstitution can be relieved by inhalation of sodium nitrite,and can be regulated by the level of NO and H_2S in rats. Above all,inhalation of sodium nitrite may degrade HPH directly or by affecting the externalization and synthesizing of gas signaling molecule indirectly.
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Objective To investigate the influence of nebulized Pulmieort respules inhalation after endoscopic sinus surgery (ESS)on the expression of epithelial Na~+ channel(ENaC)protein in nasal mucosa. Methods Forty-four patients with nasal polyps undergoing ESS were randomly divided into Pulmieort respules treatment group(n=21,nebulized Pulmieort respules inhalation for 10 d after ESS)and Rhinocort control group(n=23,Rhinoeort aqueous nasal spray for 10 d after ESS).All the patients were performed biopsy of membrane on the residual middle turbinate 14 d after ESS,eosinophils (Eos)and neutrophils(Neu)per hundred inflammation cells were counted under microscope during ESS and after ESS,and the expression of ENaC protein was detected by immunofluorescence assay. Results The percentages of Eos and Neu decreased in two groups after treatment,and the percentage of Neu in Pulmieort respules treatment group was significantly lower than that in Rhinoeort control group(P<0.05).The expression of ENaC protein after treatment in Pulmieort respules treatment group was significantly lower than that in Rhinoeort control group(P<0.01). Conclusion Application of pulmieort respules after ESS can decrease Neu infiltration and inhibit expression of ENaC protein,which can relieve acute inflammation and edema of nasal mucosa.
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Objective:To search for therapeutic effect of lidocaine in the treatment of acute episode of chronic asthmatic bronchitis.Methods:The 58 cases of patients with acute episode of chronic asthmatic bronchitis admitted to this hospital from August,2004 to July,2007 were divided into group A and group B.Besides group A with lidocaine and group B as control with sodium chloride solution,there were no difference in the other therapeutic measures between group A and Group B.Oxygen was used as the power of spray or aerosolizer,the flow volume of oxygen was 8-10L/min.Group A patients were given 5 milliliters of 2% lidocaine(100mg) by nebulized inhalation three times a day for three days,and Group B patients received 5 milliliters of 0.9% sodium chloride solution by nebulized inhalation three times a day for successive three days.The changes of heart rate,respiratory frequency,forced expiratory volume in one second(FEV1),peak expiratory flow(PEF),partial pressure of oxygen in artery(PaO2) and partial pressure of carbon dioxide in artery(PaCO2) were determined in the group A and B before and after the nebulized inhalation therapy.Results:The results of the heart rate,respiratory frequency,FEV1,PEF,PaO2 and PaCO2 before and after the treatment of the nebulized inhalation were showed as follows,improvement of heart rate and respiratory frequency was more significant in the group with the nebulized inhalation treatment of lidocaine than that in the group as control after 30 minutes,one day and three days of therapy(P
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AIM To explore the effect of long-term nebulized inhalation of nitroglycerin (Neb-NTG) on high pulmonary blood flow-induced pulmonary artery hypertension (PAH). METHODS 24 male Wistar rats were randomly divided into shunting group, Neb group and control group. An arteries-venous shunt was performed between the abdominal aorta and inferior vena cava shunting was produced in rats of Neb and shunt groups. Twelve weeks after the operation, nebulized nitroglycerin was inhaled by rats in the Neb group using pressurized air ejection mobilization, while nebulized saline was inhaled by rats of the other two groups. Ten minutes inhalation was given each day for each rat. After three weeks of inhalation, pulmonary artery systolic pressure (PASP) and mean pressure (PAMP) of each rat were evaluated by using a right cardiac catheterization procedure. Systemic arterial pressure (SAP) was reorded continuously by catheterization procedure. The ratio of right ventricular mass to body weight (RV/BW) and the ratio of right ventricular mass to left ventricular plus septal mass (RV/LV+S) were detected. Pulmonary vascular microstructure was measured. RESULTS PASP, RV/BW and RV/LV+S were significantly increased in shunt rats as compared with those of normal controls (P0.05). Muscularization of small pulmonary artery was obviously decreased in Neb-group compared with shunt group. CONCLUSION Long-term Neb-NTG ameliorates high pulmonary blood flow-induced PAH and pulmonary vascular remodeling.