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ObjectiveTo comprehensively evaluate the clinical application value of four types of Jinsang Kaiyin preparation（JSKYs） and the other two Chinese patent medicines（CPMs） in the treatment of acute pharyngitis/laryngitis，so as to provide evidence for their rational clinical use and regulatory decision-making. MethodAccording to the guideline for clinical comprehensive evaluation of CPM，the effectiveness，safety，economy，innovation，suitability and accessibility of four JSKYs and the other two CPM in the treatment of acute pharyngitis/laryngitis were comprehensively evaluated，which were ranked based on the quantitative scoring tool. Result① Effectiveness：Compared with the control group，JSKYs can improve the total effectiveness rate of acute pharyngitis/laryngitis and improve the symptoms. Network meta-analysis showed that the probability of JSKY ranked the first in terms of total effectiveness rate.② Safety：JSKYs did not show acute toxicity and long-term toxicity. The main adverse reactions were skin rash，abdominal pain，diarrhea，nausea and vomiting，etc，which were similar with the other two CPM.③ Economy：For patients with acute laryngitis（wind heat syndrome），compared with drug A，JinsangKaiyin capsule has the comparable cost-effectiveness. For patients with acute pharyngitis（wind heat syndrome），compared with drug B，JinsangKaiyin capsul has low cost and better effectiveness.④ Innovation：Compared with the other two CPM，the indications of JSKYs have their own unique population. JSKYs have six patent approval certifications and has been approved for sale in the Philippines.⑤ Suitability：Compared with the other two CPM，the investigated doctors，pharmacists and patients all believed that the instruction of JSKY was clearer and easier to understand，the use and storage conditions were more convenient，etc.⑥ Accessibility：JSKYs are included in the category B of the National Basic Medical Insurance（2022 edition），which has good cost-effectiveness and affordability for medical insurance and self paid patients. JSKYs do not contain endangered animals and plants. The supply of raw materials can meet the demand of production at present. ConclusionAs for the drug value calculation，JSKY obtained the highest score. Based on all dimensions of evidence，expert consensus on JSKY is class A，which can be directly converted into decision making.
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RESUMO Objetivo: Relatar o caso de um lactente que necessitou de intubação traqueal no setor de emergência pediátrica por conta de laringite aguda grave e que, após a extubação traqueal programada, fez uso, com sucesso, da cânula nasal de alto fluxo, a qual, possivelmente, evitou a falha da extubação traqueal. Descrição do caso: Paciente masculino, 8 meses de idade, admitido no pronto atendimento de pediatria com desconforto respiratório agudo por causa de obstrução alta de vias aéreas secundária à laringite aguda grave. Foi imediatamente intubado e encaminhado para a unidade de terapia intensiva (UTI) pediátrica. Apresentou falha de extubação em função de edema importante de laringe evidenciado por broncoscopia, o que contraindicou a extubação. Na segunda tentativa de extubação, o paciente apresentou desconforto respiratório, melhorando após uso da cânula nasal de alto fluxo, com redução da frequência cardíaca e respiratória, possibilitando a extubação com sucesso. Comentários: O uso da cânula nasal de alto fluxo foi eficaz e apresentou boa resposta nesse paciente com laringite aguda, sugerindo ser um possível adjuvante para o tratamento, evitando-se a piora do quadro respiratório e da necessidade de reintubação.
ABSTRACT Objective: To report a case of a patient who required tracheal intubation in a pediatric emergency department due to acute laryngitis and that, after the planned extubation, has successfully used the high-flow nasal cannula, which possibly prevented extubation failure. Case description: A male 8-month-old child was admitted to the pediatric emergency room with acute respiratory distress due to a high airway obstruction secondary to severe acute laryngitis. He was immediately intubated and referred to the pediatric intensive care unit. He presented extubation failure due to a significant laryngeal edema evidenced by bronchoscopy. In the second attempt to extubate, he presented respiratory distress, but, after the use of the high-flow nasal cannula, he became stable, reducing the heart and respiratory frequencies, and the extubation was successful. Comments: The use of the high-flow nasal cannula was effective and presented good response in this patient with acute laryngitis, suggesting that it is a possible adjuvant for the treatment, avoiding worsening respiratory conditions and the need for reintubation.
Sujets)
Humains , Mâle , Nourrisson , Laryngite/thérapie , Obstruction des voies aériennes/thérapie , Extubation , Intubation trachéale , Indice de gravité de la maladie , Maladie aigüe , CanuleRésumé
Objective To investigate ht e clinical characteristics and treatment of children with acute laryn gitis comlp icated with negative pressure pulmno ary edema(NPPE),and the changes of inflammatory factosr w ere monitored.Methods Data of 9 cases with acute laryngitis complicated with NPPE in pediatric intensive care unit from August 2010 to March 2015 we re analyzde .The levelso f TNF -αand IL-6 of 8 cases were detected at admission and checked agani forty-eihg t horu s after therapy.Ten children of acute laryngitis wi thotu NPPE were selected as disease cotn rol group, and ten healthy children as normal control group. Results (1)The onset of NPPE varied from 8 minutes to 2 hours following relief of obstruction,and presen-ted with acute respiratory disrt ess, decreased xo ygen saturation, tachycardai , rales on chest auscultation.All thees patients received therapeutic measures icn luding mechna ical ventilation,limiting the fluid input volume. The disappearance of rales on chest auscultation varied from 6 hours to 30 hours.Duration of mechanical ven-tilation was lse s than 48 hours,and all the children were cured.(2) Compared with the children of disease control group and normal control group,in acute phase the plasma levels fo TNF-αand IL-6 in children with NPPE were significantly higher ( P<0.01 ) .The indicators of NPPE group significantly decreased after 48 hours therapy( P<0.01 ) .Conclusion NPPE is manifested by rapid onset of respiratory distress after relief of the airway obstruction.The symptoms resolve rapidly if early support of breath and limiting the fluid input volume are applied properly.The inflammatory response is one of the possible mechanisms of NPPE.
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Objective To explore the non-bacteria pathogens of acute laryngitis in children. Methods The clinical data and sputum sample were collected from 325 patients hospitalized due to acute laryngitis in consecutive 10 years from January 2006 to December 2015 . The multiple non-bacteria pathogens were detected and analyzed with clinical data. Seven types of respiratory viruses were detected by direct immunolfuorescence. Mycoplasma pneumoniae (MP), Chlamydia pneumoniae (CP), and Boca virus (HBoV) were detected by lfuorescence quantitative PCR. The rhinovirus (HRV) and human metapneumovirus (hMPV) were detected by RT-PCR. Venous blood was collected within 24 h after hospitalization and 7-10 d after treatment. The MP antibody of IgG and IgM were detected by ELISA. Results The detection rate of non-bacteria pathogens was 46 . 2%in 325 children with acute laryngitis ( 150/325 ), including 76 cases ( 23 . 4%) of virus and 99 cases ( 30 . 5%) of MP. Virus detection rate in 1-3 year old children was obviously higher than in 0-1 year old children and over 3 years old children (χ2?=?9 . 527 , P=?0 . 009 ). With the increase of age, the detection rate of MP increased gradually (χ2?=?10 . 132 , P=?0 . 006 ). The detection rates of RSV and hBoV were higher in under 3-year-old children. The detection rates of virus in winter and spring were signiifcantly higher than those in summer and autumn (χ2?=?5.064, P=?0.024). The detection rates of MP in winter, spring, summer, and autumn was 13.1%, 25 . 0%, 38 . 2%, and 44 . 9%respectively, and the MP detection rates were increased gradually over seasons (χ2?=?4 . 438 , P=?0 . 035 ). The detection rate of RSV was higher in winter, and hBoV was higher in summer. Conclusion Acute laryngitis mainly occurred in children under 3-years-old children, and the detected non-bacteria pathogens were different among different ages and seasons. Virus was the major pathogens in young children, while MP was more common in older children.
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Objective To investigate the clinical characteristics and treatment of negative pressure pulmonary edema (NPPE) with acute laryngitis in children,and to monitor the change of inflammatory factors.Methods The data of 9 cases with NPPE and acute laryngitis in Pediatric Intensive Care Unit of Xuzhou Children's Hospital from August 2010 to March 2015 were analyzed.Ten children of acute laryngitis without NPPE in our hospital were selected as the control group.The changes of the TNF-α and IL-6 between the 2 groups were compared before and after treatment.Results (1) All the 9 children in NPPE group were associated with third degree laryngeal obstruction.The onset of NPPE in 8 cases varied from 8 minutes to half an hour following relief of obstruction,and 1 child with NPPE occurred 2hours after relief of obstruction.Four of the 9 children had pink frothy pulmonary secretions but the other 5 children did not.NPPE chest radiograph showed diffuse interstitial and alveolar infiltrates.All these patients received these therapeutic measures including mechanical ventilation,retaining high positive end expiratory pressure (PEEP) (5-8 cmH2O,1 cmH2O =0.098 kPa),glucocorticoids,limiting the fluid input volume to 60-80 mL/(kg · d).Three of the 9 cases were treated with diuretics.The disappearance of rales on chest auscultation varied from 6 hours to 30 hours.Duration of mechanical ventilation was less than 48 hours,and all the children were cured.(2) The levels of TNF-α and IL-6 in NPPE group were significantly higher than those in the control group before treatment [(369.16 ± 48.19) ng/L vs(281.77 ± 45.59) ng/L,(30.39 ± 9.60) ng/L vs (20.43 ± 4.80) ng/L,P ＜ 0.05].After 48-hour treatment,the levels of TNF-α and IL-6 in both groups significantly decreased compared with before treatment (all P ＜ 0.01);and the levels of TNF-α and IL-6 in NPPE group were (281.10 ±47.45) ng/L and (20.04 ±5.87) ng/L,respectively,which were also significantly higher than those in the control group(P ＜ 0.05).Conclusions NPPE is manifested by rapid onset of respiratory distress rapidly after relief of the airway obstruction.Imaging suggested edema change.The prognosis will be good if early support of breath and limiting the fluid input volume are applied properly.The inflammatory response is one of the possible mechanisms of NPPE.
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To compare the clinical efficacy and safety of atomization inhalation of epinephrine combined with budes-onide and dexamethasone in the treatment of children with acute laryngitis. Methods:Totally 68 cases of children with acute laryngitis were randomly divided into two groups. The two groups were given the conventional therapy, and 30 cases in the control group were giv-en dexamethasone inhalation additionally, and the treatment group was given epinephrine combined with budesonide inhalation addition-ally. The clinical effect in 12, 24 and 72h, clinical symptom disappearance time and adverse reactions in the two groups were ob-served. Results:The clinical effect of the treatment group in 12, 24 and 72h was better than that in the control group. 72h after the treatment, 17 cases in the control group were cured, and the curative rate was 56. 67%, while 27 cases in the treatment group were cured with the curative rate of 71. 05%. The disappearance time of dyspnea and stridor, barking cough, hoarseness and the other clini-cal symptoms in the treatment group was significantly shorter than that in the control group, and the difference was statistically signifi-cant (P<0. 05). The two groups had no obvious adverse reaction. Conclusion:The clinical effect of the combination of epinephrine and budesonide inhalation in the treatment of children with acute laryngitis is better than that of dexamethasone inhalation, and the combination is safe and effective, which is worthy of clinical application.
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Objective To compare Pulmicort and Dexamethasone’s curative effects for acute laryngitis in children. Method Children with acute laryngitis were divided into PUL group and DEX group according their therapy methods. The curative effects and recurrence time were compared. Results The efficiency rate in PUL group was significantly higher than in DEX group (P<0.05). The therapy 3 d and post-therapy dyspnea, hoarseness, bark-like cough and stridor score in PUL group were significantly lower than in DEX group (P<0.05), and the recurrence time of dyspnea, hoarseness, bark-like cough and stridor was significantly shorter (P<0.05). Conclusion Pulmicort could significantly improve the symptoms and signs for children with acute laryngitis with few side effects. Its curative effects are better than dexamethasone.
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A 36 year old woman, at 37 week gestation, had admitted to our Obstetric-Gynecology department. On her admission, she complained mild fever, neck pain and severe hoarsness. Laboratory test demonstrated increased level of activated partial thromboplastin time 40.2 second(control 26), aspartate aminotransferase 685 IU/L(normal range 10~50), alanine aminotransferase 404 IU/L(normal range 5~45). The diagnosis, acute fatty liver of pregnancy was made by ultrasound of the liver and clinical and laboratory findings. Also the diagnosis, acute laryngitis was made by laryngoscopic and clinical and laboratory findings. On her 3rd day of admission, she complained labor pain. An emergency cesarean section was performed under spinal anesthesia. After delivery, her postoperative prognosis was uneventful, and she discharged from the hospital on postoperative 8th days.