Pediatric epidemic wheezing pneumonia

　　In 1971, the virus was isolated from throat swabs in Zhejiang, but it was not identified. In 1975, during the epidemic period, double serum samples were taken from the Shantou area of Guangdong, and the neutralization test showed that antibodies to the Long strain of parainfluenza virus increased ≥4-fold in 43%, suggesting that the parainfluenza virus may be the main pathogen of this epidemic. In early 1986 and during the winter of 1989, outbreaks occurred in Yuncheng area of Shanxi and suburban counties of Beijing, respectively, and were proven to be caused by RSV through rapid diagnosis and serological examination. In January 1992, the main pathogen in several regions of Hebei and suburban counties of Tianjin was RSV. The most recent outbreak was in November 1999 to January 2000, when an epidemic of wheezing pneumonia occurred in Ruyang County, Henan Province, with RSV as the pathogen.

　　1, Heart failure, also known as 'myocardial failure', refers to the inability of the heart to pump an adequate blood supply that is commensurate with venous return and body tissue metabolism. It is often caused by various diseases that weaken myocardial contractility, reducing cardiac output and insufficient to meet the body's needs, leading to a series of symptoms and signs.

　　2, Respiratory failure is a clinical syndrome characterized by severe respiratory dysfunction caused by various reasons, leading to a decrease in arterial oxygen partial pressure (PaO2) and, sometimes, an increase in arterial carbon dioxide partial pressure (PaCO2), accompanied by a series of pathophysiological disorders.

　　3, Metabolic acidosis is the most common type of acid-base disturbance, caused by an increase in extracellular H+ or a loss of HCO3-, leading to a primary decrease in HCO3-.

　　4, Normally, there is a certain amount of gas (about 100 to 200 ml) in the gastrointestinal tract of healthy people, most of which is located in the stomach and colon, and less in the small intestine. When an excessive amount of gas accumulates in the gastrointestinal tract, it is called abdominal distension (abdominal distension), abbreviated as bloating.

　　5, Many digestive tract lesions can cause bleeding, but most can be explained by a few diseases. The difference between upper and lower gastrointestinal bleeding depends on whether it is near or far from the Treitz ligament.

　　First, typing

　　This disease can be divided into common type, severe type, and extreme severe type according to the severity of symptoms:

　　1, Common type: Good spirit, rapid breathing, slight nasal flaring, no cyanosis, shortness of breath symptoms are mild and of short duration, the course of the disease is generally short, and the prognosis is good.

　　2, Severe type: Often accompanied by restlessness and drowsiness, rapid breathing, the infant's breathing rate is above 60 times/min, heart rate above 160 times/min, often accompanied by exacerbation of paroxysmal shortness of breath, with nasal flaring, tracheal depression, and cyanosis, some children may be found to have signs of heart failure, auscultation has wheezing sounds and dense medium and small bubble sounds, the lower boundary of the liver continues to decline.

　　3, Severe type: Common in young infants, the child's paroxysmal shortness of breath is difficult to relieve, breathing is very rapid, the infant's breathing rate can reach more than 70 times/min, nasal flaring, tracheal depression, cyanosis is very obvious, when severe lower respiratory tract obstruction occurs, breathing sounds and bubble sounds cannot be heard, heart sounds are dull, heart rate can reach 200 times/min, the liver rapidly increases in size, often accompanied by heart failure, respiratory failure, and often accompanied by metabolic acidosis, or abdominal distension and gastrointestinal bleeding.

　　Second, staging

　　Clinically, it can be roughly divided into several stages: onset, shortness of breath, improvement, and recovery:

　　1, Onset: Incubation period of 1 to 4 days, most children have an acute onset, only a small number of children have prodromal symptoms such as low fever, cough, runny nose, sneezing, etc., and about 24 hours after the onset, they quickly enter the stage of shortness of breath.

　　2, Shortness of breath period: Different degrees of shortness of breath and exacerbation of paroxysmal shortness of breath are characteristic of this disease. The child has cough, nasal flaring, rapid breathing, and during exacerbation of paroxysmal shortness of breath, there may be obvious restlessness and irritability, increased heart rate and breathing, pale complexion (some children may have a red face), cyanosis of the lips and fingers, marked tracheal depression, lung percussion presents hyperresonance, auscultation has wheezing sounds, most children still have medium and small bubble sounds, and during severe exacerbation of paroxysmal shortness of breath, there may be airway obstruction, breathing sounds and wheezing sounds cannot be heard, the lower boundary of the liver is lowered due to emphysema, severe cases may be accompanied by liver enlargement, the fever of this disease is usually between 37.5 to 39°C, a few children may have fever below 37°C or high fever, and shortness of breath usually resolves within 24 to 48 hours.

　　3, Remission period: After the shortness of breath and stridor subside, the general condition of the child improves, but the signs of pneumonia become more pronounced. The lungs can hear medium and small bubble sounds and crepitus, the liver is still large, about 2 to 4 days, the signs of pneumonia in most children gradually decrease.

　　4, Recovery period: Generally, after the 4th to 7th day of onset, the respiratory and mental conditions improve, the lung bubble sounds become coarse and eventually disappear, and the body temperature gradually returns to normal.

　　1. Widely promote the publicity of prevention and treatment methods.

　　2. Give full play to the role of rural doctors, achieve early detection, early reporting, early prevention and treatment, local isolation, and local treatment. For severe cases, transfer to a higher-level hospital in a timely manner.

　　3. Do a good job of home isolation for the children, do not visit patients' homes, reduce collective activities, and prevent the spread of the disease.

　　1. General examination

　　The total white blood cell count of most children is normal or slightly low, about half of the cases are below 10×109/L, rarely reaching 20×109/L. The classification of neutrophils and eosinophils does not increase, and the urine examination is mostly normal. Some cases have trace protein and a few white blood cells.

　　2. Pathogenic examination

　　Perform viral isolation or immunofluorescence antibody tests on the nasopharyngeal secretions of children to prove the presence of respiratory syncytial virus or other viruses; take two blood samples from the child for specific antibody detection, especially for respiratory syncytial virus. For those who cannot get two blood samples, a specific 1gM determination can be made on a single blood sample taken at the onset of the disease. In the acute stage, most X-ray chest films show enlargement of the hilum shadow, thickening and blurring of pulmonary vessels, with the lesions mostly bilaterally. The shadows around the bronchi are small, patchy, and irregular in density. Part of the vessels have interstitial lesions, and generally, there is significant emphysema. Some may show pleural reaction between the right upper and middle lobes. A few may have atelectasis.

　　The diet of pediatric epidemic wheezing pneumonia should be light and nutritious, with a variety of vitamins, such as fruits, apples, peaches, bananas, pears, cherries, oranges. Eat more lean meat to increase physical fitness. Try to eat less spicy and刺激性 foods. For example: onions, pepper, chili, Sichuan pepper, mustard, fennel. Quit smoking and drinking, as well as stimulants such as coffee.

　　I. Ordinary type

　　Primarily use traditional Chinese herbal medicine, supplemented by symptomatic therapy. It is generally not recommended to use antibiotics or intravenous fluid therapy, and penicillin can be used in places with poor isolation conditions.

　　1. Ensure an adequate intake of fluids, and encourage oral intake as much as possible.

　　2. For those with shortness of breath and restlessness, chlorpromazine (Hypnotic), and promethazine (Phenergan) mixture (Winter Sleep II) can be used, each at 1mg/kg intramuscular injection, and if necessary, add chloral hydrate enema or oral administration.

　　3. Traditional Chinese herbal medicine is mainly used for clearing heat and detoxifying, cough and expectoration, and relieving asthma. For general cases, the Modified Shaoyao Ma Huang Decoction can be used. For those with obvious heat signs such as yellow fur and red tongue, the Modified Mahuang Xiangsuan Shanggan Decoction can be used.

　　4. For cough and expectoration, in addition to traditional Chinese medicine decoction, bromhexine (Bisolvon) or bamboo decoction can be added.

　　II. Severe type

　　In addition to the use of general treatment measures, atomization inhalation can be added and attention should be paid to the following aspects.

　　1. Whey or secretory IgA extracted from colostrum atomization inhalation therapy.

　　2.Ribavirin (triazino nucleoside) atomization inhalation therapy.

　　3. Maintain appropriate humidity indoors and strengthen humidification of the airway to dilute sputum and facilitate its excretion. For sputum that is particularly thick, bromhexine (Bisolvon) or bamboo decoction can be used. For those with poor response to traditional Chinese medicine, chymotrypsin ultrasonic atomization inhalation therapy can be considered, 2-4 times per day.

　　33. 4. If the effects of chlorpromazine (Hypnotic), promethazine (Phenergan) in alleviating severe dyspnea are not satisfactory, hydrocortisone can be added intravenously at 5mg/kg each time, and if the condition is still not relieved, 5% sodium bicarbonate 3 to 5ml/kg can be administered slowly intravenously. Phenylephrine can also be tried in combination with metaraminol (阿拉明) injection (1mg/kg phenylephrine and 0.5mg/kg metaraminol dissolved in 20ml of 10% glucose for intravenous infusion or slow intravenous push); or scopolamine injection can be tried (0.03 to 0.05mg/kg diluted in 30ml of 10% glucose for intravenous infusion).

　　32. 5. In cases where it is difficult to take oral fluids and prolonged inability to eat, intravenous infusion should be performed, generally using a 10% glucose and normal saline solution in a 4:1 ratio, with the total fluid volume for severe cases calculated at 60 to 90 ml/kg per day, administered slowly intravenously. In cases of dehydration, rehydration can be performed according to the pneumonia dehydration plan.

　　31. 6. Cardiotonic drugs should be applied promptly in cases of heart failure or suspected heart failure, such as digoxin (Cedilanide) or ouabain (Strophanthin K).

　　30. In cases suspected of secondary bacterial infection, corresponding antibiotics should be applied.

　　3. Severe type

　　Further treatment for severe complications.

　　27. Oxygen therapy by ultrasonic nebulization, 3 to 4 times/day, each time 15 to 20 minutes, followed by back tapping and sufficient sputum aspiration to ensure respiratory tract patency.

　　26. In cases of circulatory failure, Shengmai Decoction (ginseng, ophiopogon, schisandra) and other vasoactive drugs should be administered intravenously.

　　25. In suspected DIC cases,活血化瘀 herbal medicine, or low molecular weight dextran, or heparin (see DIC) can be applied.

　　24. In cases with signs of cerebral edema, diuretics should be administered, generally with a 20% mannitol intravenous push, 1g/kg each time, initially once every 8 or 6 hours, and then gradually reduce the frequency.

　　23. In cases with明显 metabolic acidosis, appropriate sodium bicarbonate can be added to intravenous infusion fluids, and potassium chloride should be applied promptly if blood potassium levels decrease.

　　22. Respiratory failure continues to worsen, general measures are difficult to control, and artificial respirators should be applied to those who meet the application criteria.