儿童哮喘急性发作处理.ppt

儿童哮喘急性发作处理
内容提要
哮喘的诊断和鉴别诊断
哮喘急性发作的定义和鉴别诊断
哮喘急性发作严重度的评估
哮喘急性发作的处理
1、不同程度发作的处理
2、急诊处理流程
3、家庭初步处理
4、雾化吸入药物在缓解急性发作的作用地 asthma
 全球约有3亿哮喘患者1
 发病率仍在上升，儿童哮喘患病上升明显，尤其是年幼儿童1
 沉重的经济负担1
2013年我国第3次城市儿童哮喘流行病学
调查显示2：
1、%
2、20年内我国儿童哮喘患病率以每10年增加
50%以上的幅度上升
3、%，
近1/3患儿未得到及时和准确诊断,哮喘的用药
和管理状况亟待改进
1、GINA 2014
2、全国儿科哮喘协作组，中国疾病预防控制中心环境与健康
相关产品安全所. 第三次全国城市儿童哮喘流行病学调查
[J]. 中华儿科杂志，2013，51(10)：729-735.
Prevalence of asthma in children aged 13-14 years
GINA 2014
2022/6/22
哮喘急性发作在哮喘管理中至关重要
哮喘急性发作导致哮喘直接和间接
经济负担增加2
哮喘急性发作对肺功能下降的影响1
TR,et Respir ;30(3):452-6.
;51(2):90-95
2022/6/22
常用国外指南对ICS在哮喘急性发作中
地位的描述
当前指南
GINA 2012
ICSs are effective as part of therapy for asthma exacerbation
GINA 2014
＞ 5 years old: ICSs are well tolerated. The agent ,dose, and duration of treatment with
ICS in the management of asthma in the emergency department remain unclear.
≤5years old: The clinical benefit of these interventions has not been impressive. Some
studies have used high dose ICS as this may reduce the need for OCS.
International consensus on pediatric asthma (ICON) 2012
Very high-dose ICS may also be effective during the exacerbation or preemptively after
a common cold.
ERP3(NAEPP 2007)
High doses of an ICS may be considered in the ED, although current evidence is
insufficient to permit conclusions about using ICSs rather than oral systemic
corticosteroids in the ED (Evidence B).
BTS 2014 (Children aged over 2 years)
Children aged over 2 years: Children with chronic asthma not receiving regular
treatment will benefit from starting ICS . It is good practice to continue with their usual
maintenance doses.
Australian Asthma Handbook 2014
Do not use inhaled corticosteroids as a substitute for systemic corticosteroids.
2022/6/22
儿童哮喘急性发作治疗
---中国儿童支气管哮喘诊断与防治指南（2008年）