【摘要】：毛細支氣管炎是呼吸道合胞病毒（RSV）引起的嬰幼兒常見下呼吸道感染性疾病，好發(fā)于2歲以下特別是6個月內的嬰兒，臨床表現為咳嗽、喘憋，嚴重者出現呼吸困難、合并心力衰竭，甚至發(fā)展成哮喘，嚴重威脅嬰幼兒的健康。目前其診斷主要依靠病史及臨床表現，無特異性指標及診斷性檢查。尚無特殊治療方法且住院費用昂貴，，不合理治療會加重家庭、社會經濟負擔。不合理的檢查和治療明顯增加患兒的住院費用，增加藥物毒副作用。 目的: 本課題從病毒檢測、胸部X線檢查、不同的霧化治療藥物、抗生素的使用幾方面觀察病人住院時間、喘息緩解時間、肺部體征消失時間的差異，尋求更加合理的診療方案，為規(guī)范毛細支氣管炎的診斷和治療提供依據。 方法: 2012年12月到2013年2月東阿縣人民醫(yī)院兒科199例毛細支氣管炎患兒，年齡1個月-24個月。分組施行霧化治療（沙丁胺醇、沙丁胺醇+布地奈德、異丙托溴氨）和抗生素治療（頭孢哌酮、哌拉西林、阿奇霉素），并對患兒進行呼吸道病毒檢測、胸部X線檢查，觀察住院治療時間、喘息緩解時間、肺部體征消失時間的差異。 結果: 1.呼吸道合胞病毒組、呼吸道病毒檢測陰性組、副流感病毒的住院治療時間、喘息緩解時間、肺部體征消失時間無明顯差異，無統(tǒng)計學意義； 2.支氣管炎組和肺炎組，住院治療時間、喘息緩解時間、肺部體征消失時間無明顯差異，無統(tǒng)計學意義； 3.使用不同霧化治療藥物后，住院治療時間、喘息緩解時間、肺部體征消失時間無明顯差異，無統(tǒng)計學意義； 4.抗生素使用組其住院時間比無使用抗生素組減少，有統(tǒng)計學意義，同時使用抗生素組白細胞計數及CRP增高，有統(tǒng)計學意義。 結論: 1.感染狀態(tài)不同的患兒，經霧化吸入、抗生素控制感染等綜合治療后住院治療時間、喘息緩解時間、肺部體征消失時間無明顯差異，表明呼吸道病毒檢測對毛細支氣管炎患兒治療無指導意義。 2.胸片檢查診斷為支氣管炎和肺炎的兩組患兒，住院治療時間、喘息緩解時間、肺部體征消失時間無明顯差異，說明胸片檢查對患兒治療無特殊意義，且放射線危害健康，不應作為毛細支氣管炎患兒的常規(guī)檢查。 3.對于霧化治療的患兒應用激素組和其他兩組住院治療時間無明顯差異，同時激素的長期副作用不肯定，故激素不能用于毛細支氣管炎患兒的治療。 4.抗生素組其住院治療時間明顯減少，故對于毛細支氣管炎患兒感染指標增高者，應合理選用抗菌藥物，減少住院日。
[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.
【學位授予單位】：泰山醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R725.6

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