药师联合诊治1例慢性咳嗽患儿的临床经验探讨

目的:通过医师、药师联合儿童咳喘门诊诊治1例慢性咳嗽患儿,初步探讨适用于基层医疗机构细菌生物膜检测及针对生物膜包裹细菌所致慢性感染的诊疗方法,为进一步完善并促进联合门诊健康可持续发展所引发的思考与探索。方法:药师通过联合门诊参与药物重整、合理用药宣教、辅助医师制定诊疗方案、用药指导、随访等各项工作,针对1例慢性咳嗽患儿,利用痰液染色镜下观察的方式初筛了细菌生物膜的存在,并采用以高压氧为驱动力的雾化吸入乙酰半胱氨酸、吸氧辅助治疗,初步探讨了迁延性细菌性支气管炎等生物膜包裹细菌所致慢性气道炎症患儿的辅助检查与治疗方案。结果:患儿入院前接受多种药物治疗,通过联合门诊医师专业诊断,药师有效药物重整,入院后明确病因、对因治疗及后期随访等各项工作,减少患儿联合用药品种至2种,缩短抗菌药物应用时间至10天,1月后随访未见反复,治疗有效。结论:痰液染色镜下观察初筛生物膜及氧化雾化乙酰半胱氨酸、氧疗的诊疗方案值得临床进一步应用研究。药师联合门诊医师是推进儿童安全、合理、规范用药,减少药物相关损伤风险的重要举措。药师积极介入首诊及后续诊治全过程,提高患者用药依从性及药物治疗的安全性、有效性,可作为助推基层医疗机构医院药学事业发展及服务模式转型的重要契机和有效途径。

Manipulation parameter optimization in Liu's back tuina therapy for kids'cough variant asthma in remission stage

Objective:To determine the optimal manipulation parameters in Liu's back tuina therapy for remission-stage cough variant asthma(CVA)in kids.Methods:A 5-factor 3-level L18(37)orthogonal design was adopted.The experimental factors and levels were selected:A,the number of times of Rou-kneading Feishu(BL 13);B,the frequency of Rou-kneading Feishu(BL 13);C,the number of times of Tui-pushing in a'介'-like pattern;D,the frequency of Tui-pushing in a'介'-like pattern;E,the intensity of red color after Ca-scrubbing Feishu(BL 13)with salt.A1,A2 and A3 stood for 10 times,20 times and 30 times,respectively;B1,B2 and B3 stood for 200 times/min,240 times/min and 280 times/min,respectively;C1,C2 and C3 stood for 50 times,75 times and 100 times,respectively;D1,D2 and D3 stood for 150 times/min,175 times/min and 200 times/min,respectively;E1,E2 and E3 stood for pinkish,bright red and dark red,respectively.A total of 108 kids with CVA in remission stage were divided into 18 groups using the random number table method,with 6 cases in each group.Changes in the cough score and fractional exhaled nitric oxide(FENO)level were observed after 15-day treatment.Results:The cough score and FENO level changed significantly in every group after treatment(all P<0.01).By the effect in improving cough score,the factors were listed as D,B,A,C and E in descending order;the most optimal manipulation parameter combination was group 17(A3B2C1D3E1);the second optimal parameter combinations were group 7(A3B1C2D1E3),group 13(A2B1C2D3E1)and group 14(A2B2C3D1E2).Regarding the effect in down-regulating the level of FENO,the factors were listed as C,A,E,B and D in descending order;the most optimal manipulation parameter combination was group 13(A2B1C2D3E1);the second optimal parameter combinations were group 18(A3B3C2D1E2),group 16(A3B1C3D2E3)and group 14(A2B2C3D1E2).Conclusion:Two most effective manipulation parameter combinations were selected out of 18 different parameter combinations in Liu's back tuina therapy for remission-stage CVA in kids.Doctors can choose an appropriate manipulation based on the symptom features of the disease.

Therapeutic efficacy and safety rating of Tui-Pushing chest-back manipulation for children with cough variant asthma Therapeutic efficacy and safety rating of Tui-Pushing chest-back manipulation for children with cough variant asthma

Objective:To observe and evaluate the clinical efficacy and safety of using pediatric Tuina(Chinese therapeutic massage),Tui-Pushing chest-back manipulation,in treating children with cough variant asthma(CVA).Methods:Seventy-two kids with CVA were divided into two groups using the random number table method,with 36 cases in each group.The control group received the conventional Tuina treatment,and the observation group received additional Tui-Pushing chest-back manipulation.The clinical efficacy and adverse reactions were observed and recorded for the two groups.Results:After three treatment courses,compared with the control group,the observation group showed advantages in the total effective rate,reducing the number and intensity of cough and improving the nature of cough(P<0.05).However,at the one-month follow-up,there were no significant differences between the two groups in these parameters(P>0.05).Regarding the adverse reaction rate,there was no significant between-group difference(P>0.05).Conclusion:It is effective and safe to use pediatric Tuina,Tui-Pushing chest-back manipulation,plus the conventional treatment protocol to treat CVA in children.