目的:探讨循证护理在气管切开术患者呼吸道管理中应用的效果及措施。方法:将104例患者随机分为观察组和对照组各52例。观察组重点从“气道湿化、肺部物理疗法、吸痰、气道感染的预防、口咽部护理”几个方面进行循证,获取最佳证据,指导临床护理,对照组按传统护理法。结果:观察组患者并发症的发生率、死亡率显著低于对照组,患者及家属对护理工作的满意率明显提高。结论:运用循证护理能减少患者并发症的发生,降低病死率,提高生存质量。
The clinical practice guideline on traditional Chinese medicine alone or combined with antibiotics for patients with acute upper respiratory infection in children was issued by China Association of Chinese Medicine in June 2017. Base on the evidence, consensus and experience, five manage groups, steering committee, consensus expert group, systematic review group, drafting group and secretary group, have promoted the project. The main work process refers to up-to-date clinical practice guideline definitions of institute of medicine and quick recommendations guide of guidelines international network and WHO. In order to provide readers with a better understanding of the guideline, the drafting process of guideline principle, main work process, and basis policy were described in detail in this paper. The guidelines’ scientific characteristics, accuracy and practicability were better exhibited in attempt to enhance its promotion and application.
Objective To evaluate the clinical efficacy and safety of domestic cefepime in the treatment of acute bacterial lower respiratory tract infection. Methods A randomized, single-blind, controlled clinical trial was performed. The positive control was imported cefepime. The dosages of cefepime were 1g for moderate infection and 2g for severe infection, twice a day intravenously. The duration of the treatment was 7-10 days. Results Thirty-one patients were enrolled in the trial, of whom 30 were evaluable (15 in the triagroup and 15 in the control group). No significant differences were observed between the trial group and the control group with respect to the cure rate (40% vs. 27%), the effective rate (80% vs. 87%), the bacterial clearance rate (92% vs. 100%), and the incidence of adverse drug reactions (12.5% vs. 13%) (Pgt;0.05). Conclusion Domestic cefepime injection is effective and safe in the treatment of acute bacterial lower respiratory tract infection.
【Abstract】 Objective To investigate the effects of respiratory syncytial virus ( RSV) infection on the dynamic changes of airway hyperresponsiveness ( AHR) in ovalbumin ( OVA) -induced asthma in mice.Methods 60 BALB/c female mice were randomly divided into PBS control group ( A group, n = 6) , OVA group, OVA/RSV group, dexamethasone group ( D group, n =6) . Kinetics of AHR of OVA group mice was carried out on day 21, 25, 29 and 33 ( B1, B2, B3, B4 groups, n =6) , and the same with the OVA /RSV group( C1, C2, C3, C4 groups, n = 6 ) . The mouse asthma model was established by OVA-sensitization of intraperitoneal injection and repeated inhalation of OVA while the mice in OVA/RSV group were treated with combined intranasal inoculation with RSV ( 1. 0 ×106 pfu/mL in 50 μL) . Airway resistance of expiringphase ( RL ) and compliance of throax and lung ( CTL ) with different doses of acetylcholine ( Ach) were measured. Lung tissue sections were stained with hematoxylin and eosin ( HE) and periodic acid-Schiff ( PAS) for general morphology. Results Compared with B1 group, RL increased and CTL decreased in C1 group when Ach dose is above 5 g/L ( P lt; 0. 05, respectively) , and the effects prolonged ( 6 d, 10 d after challenge with OVA, respectively) much more than B1 group ( 2 d after challenge with OVA) . Compared with C1 group, RL decreased and CTL increased in D group and the infiltration of inflammatory cells was obviously alleviated in C1 group after treatment with dexamethasone. Conclusions Airway hyperresponsiveness increases obviously in OVA-sensitized and RSV-infected mice. The prolonged increase inRL and decrease in CTL ( 6 d, 10 d, respectively) may imply that RSV infection aggravates airway inflammation. The small airway inflammation may play a critical role in the persistence of airway hyperresponsiveness.
Objective To evaluate and select essential medicine for children with fever and adult gastrointestinal flu caused by common cold using evidence-based approaches based on the burden of disease for township health centers located in eastern, central and western regions of China. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) 12 guidelines were included, 11 of which were evidence-based or based on expert consensus. We offered a recommendation for medicines used in the treatment including analgesics and antipyretics, decongestants, antihistamines, cough-relieving drug, phlegm-removing drug and drug for gastrointestinal symptoms. (2) A result of four RCTs (very low quality) indicated that in the treatment of children with cold, ibuprofen suspension had an antipyretic effect similar to paracetamol solution (for oral use) with a pooled result of 6-hour efficiency in relieving fever (RR 1.48, 95%CI 0.66 to 3.30, P=0.34). The major adverse effects of ibuprofen suspension included gastrointestinal reaction and profuse sweats (RR=1.23, 95%CI 0.72 to 2.11, P=0.45). With good applicability, ibuprofen suspension (for oral use with no need to be supervised) cost 1.93 yuan daily. (3) A result of three RCTs (low quality) indicated that after given for 30 minutes and one hour, paracetamol solution (suppository) was fairly superior to ibuprofen suspension in lowering the high temperature caused by fever (given for 30 min: MD= –0.16°C, 95%CI –0.21 to –0.11, Plt;0.01; given for one hour: MD= –0.19°C, 95%CI –0.28 to 0.10, Plt;0.01). As to adverse reaction, paracetamol solution (suppository) mainly included anal irritation, skin rashes and profuse sweats, which had a comparative result of incidence with ibuprofen suspension (RR=1.84, 95%CI 0.62 to 5.44, P=0.27). For children with fever, paracetamol solution (suppository) cost 0.90 yuan daily. With good applicability, paracetamol solution (suppository) was administered via the anus. Conclusion (1) We offer a b recommendation for ibuprofen suspension (2 g/100 mL) or acetaminophen (0.1 g/suppository) as symptomatic treatment used in children with fever, pain and discomfort caused by common cold, and for Huo Xiang Zheng Qi Jiao Nang (0.3 g/ capsule) used in adults with gastrointestinal flu. We also offer a weak recommendation for acetylcysteine (injection, 300 mg/mL, 10 mL/ampoule) used in patients with paracetamol poisoning. (2) In order to produce high-quality local evidence, we proposed that large-scale, well-designed, high-quality clinical and pharmacoeconomic studies on ibuprofen suspension and acetaminophen suppository in the treatment of children with fever, pain and discomfort caused by common cold should be further carried out. Besides, we proposed that large-scale, well-designed, high-quality clinical and pharmacoeconomic studies on Chinese patent drugs of Huo Xiang Zheng Qi used in chidren and Huo Xiang Zheng Qi Jiao Nang used in adults should further carried out. Moreover, we suggest that epidemiological investigation as well as clinical and pharmacoeconomic studies of acetylcysteine injection for paracetamol poisoning should be carried out and the instructions of acetylcysteine injection should be added in the guidelines of essential medicine in China. Finally, further studies on evidence of oxymetazoline, dextromethorphan and other Chinese patent drugs with the effect of relieving cough and treating cold should be carried out.
ObjectiveTo evaluate clinical efficacy of mannatide for recurrent respiratory tract infection (RRTI) and its influence on immune function. MethodsThe Cochrane Library (Issue 12, 2013), PubMed, EMbase, CNKI, CBM, VIP and WanFang Data were searched for the randomized controlled trials (RCTs) that investigated the clinical and immune effect of mannatide in RRTI from inception to December 2013. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of included studies. Then meta-analysis was performed using the software RevMan 5.1.0. ResultsA total of 18 studies involving 1 481 patients were included. The results of meta-analysis showed that compared with the placebo group, the mannatide group was superior in total effectiveness and improving the levels of T-lymphocyte subsets and antibody (P < 0.05); compared with the levomisole group, the mannatide group was superior in total effectiveness and improving the level of T-lymphocyte subsets (P < 0.05), but not in improveming antibody level. ConclusionMannatide improves clinical efficacy in the treatment of RRTI and patients' immune function.
吸入疗法是治疗呼吸系统疾病的常用方法, 包括气雾吸入、经储雾罐气雾吸入、干粉吸入以及雾化吸入等, 而以雾化吸入疗效最确切, 适应证也最广泛。但是, 关于雾化吸入治疗的用药方案以及药物配伍信息却非常有限。近期美国卫生系统药师协会发表的常用雾化吸入药物混合配伍指南[ 1 ] 提出了可供雾化吸入的药物及其配伍的各种推荐意见, 并采用表格形式便于临床医生理解和掌握。成人慢性气道疾病雾化吸入治疗专家组在该指南的基础上, 结合中国呼吸道疾病雾化吸入治疗现状, 制定了雾化吸入药物治疗共识, 同时根据不同的疾病提出雾化治疗推荐方案, 以供临床医师参考。