Recurrent respiratory infection (RRI) is a common clinical disease in pediatrics, with an incidence of about 20%. It refers to frequent upper respiratory tract infections or lower respiratory tract infections in a year, exceeding a certain range of respiratory tract infections, referred to as recurrent respiratory children.
Notes.
1, at least 7 days between the 2 times on the sense of at least 7 days;
2.If the number of upper infections is not enough, the number of lower respiratory tract infections can be added.
But not vice versa;
3, need to observe 1 year.
Diagnostic criteria The diagnostic criteria for RRI developed by the National Pediatric Respiratory Diseases Conference held in Chengdu in 1987, see Table 1
Etiology Anatomical features
The etiology is complex and is the result of a combination of multiple factors.
The thorax is short and barrel-shaped;
The reserve capacity of each lung function index is low. The above characteristics make children susceptible to respiratory tract infections, and secretions are easily blocked and the infection is easily spread.
Etiology Immune function
It is closely related to the imperfect immune function and abnormal immune function of the pediatric organism: the systemic immune function and the local immune function of the respiratory tract are insufficient in pediatric patients, especially in infants. For example, the number of alveolar macrophages and T lymphocytes is low and their function is poor, and their bactericidal and phagocytic abilities are low.
Relationship between RRI and immune function
I. Domestic materials
1. Zhang Ji (1995) reported that serum IgA and IgG were reduced in 30 cases of children with RRI.
2. Wei Yuzhe (1996) reported that salivary SIgA in 75 children with RRI was lower than that in healthy children.
3. Feng Xue-Bin (1996) reported that the CD3 and CD4 percentages, CD4/CD8 ratio and proliferation function of peripheral blood T-cell subsets in 92 children with RRI were lower than those in normal controls.
4. Yu Guijie (1994) reported that NK cell activity in 20 children with RRI was 25.02 ± 2.99%, compared with 40.6 ± 14.2% in normal control children (P breastfeeding;
Lack of ability to adapt to the external environment;
42% of the children had a history of close contact with respiratory infections;
Malnutrition is an important risk factor for recurrent upper respiratory tract infections in infants and children.
Prevention and treatment
Prevention and treatment
Since the formation of RRSI is the result of a combination of factors, we should find out the causes, remove susceptible factors, prevent and control infections, and enhance the immune function of the body. Promote breastfeeding, strengthen nursing care, improve nutritional status, and actively exercise.
Prevention and treatment
Immunotherapy: After immunological examination, we can understand the immune function status of the children and choose different methods.
1. Transfer factor (TF): a small molecule peptide extracted from healthy human leukocytes, which can transfer cellular immune activity to the receptor to improve the cellular immune function of the receptor. It also induces interferon production and can also prevent and treat viral infections. It is non-antigenic and is a stimulant and enhancer of cellular immunity. It is administered 1-2 times a week, 2ml each time, intramuscularly or subcutaneously under the groin of the inner upper buttock or inner thigh. 1 month is a course of treatment.
In recent years, there is also the use of transfer factor oral liquid preparations, 1 stick/day, 3 months as a course of treatment.
2.Thymus extract: including thymosin, thymus peptide, thymus factor, etc. This product is extracted and purified from animal (calf, pig) or human embryonic thymus. It can induce T lymphocyte differentiation and development. 1-5mg intramuscular injection, once a day or once every other day, 10-12 times for a course of treatment. Skin test should be done before use.
3.Biostim: a glycoprotein extracted from Klebsiella pneumoniae, is a biological immunomodulatory stimulant, which can enhance the chemotaxis of macrophages and increase the secretion of interleukin I, thus improving the cellular and humoral immune functions, preventing and treating RRSI. In the second and third months, take the drug for 8 days at 1mg per day, and stop the drug for 3 weeks.
4, interferon: broad-spectrum antiviral and regulation of host immune function, enhance macrophage function and antibody production. 100,000 U – 500,000 U intramuscular injection, once a day, 3-5 days for a course of treatment. Interferon is also used for nebulized inhalation to prevent and control respiratory tract infections.
5.Gammaglobulin: It is used for children with secondary hypogammaglobulinemia, 100mg/kg intramuscularly once a month or 25-50mg/kg intramuscularly once a week, and can be given intravenously if the infection is serious.
6, whey solution: direct supplement SIgA is 5mg/ml, oral twice a day, 5ml each time, for 1-2 weeks.
7, levamisole: chemical agent, restore the function of suppressed giant cells, improve the function of T cells, restore their regulatory B cell function. Small oral dose can improve IgA and cellular immune function, non-specifically enhance phagocytosis and regulate antibody production, prevent RRSI, 1-1.5mg/kg per day, divided into 2-3 oral doses, 2 days per week, 3 months as a course of treatment. May have headache general discomfort, a few have white blood cells and platelet reduction.
8, Sophora japonica yellow granules The main ingredient Sophora japonica contains a highly active biological response regulator called PS-T (polysaccharide protein), which can stimulate many links in the body’s immune system.
Such as activating macrophages or neutrophils, activating natural killer cells, improving humoral immunity, inducing the production of alpha and gamma interferon, etc., thus fundamentally improving the immunity of the body. In addition, there are inactivated BCG vaccine, bronchitis vaccine injection, nuclear cheese injection or oral solution, Kadroxol oral solution and mushroom polysaccharide punch, etc., which have the effect of enhancing the immune function of the body.
Pidotimod (Primo, Vancian) can promote the phagocytic activity of macrophages and neutrophils and improve their chemotaxis; activate natural killer cells; promote mitogen-induced lymphocyte proliferation and normalize the ratio of supportive T cells (CD4+) to suppressor T cells (CD8+), which is reduced in immune deficiency; promote cell proliferation by stimulating interleukin- 2 and γ-interferon to promote cellular immune response
Second, appropriate supplementation of essential trace elements: if the child lacks zinc, iron, calcium, phosphorus, etc. should be supplemented to improve and enhance the body’s immune function, promote the growth and development of children and digestive function, promote metabolism, improve the general condition. Zinc sulfate 5mg/kg daily, 2 weeks as a course of treatment, 1-2 courses of treatment.
Anti-infection treatment: Effective antibiotics or antiviral drugs should be chosen for bacterial or viral infections, and long-term repeated blind use of antibiotics should be avoided.
Chinese herbal medicine treatment: Chinese herbal medicines such as Yu Ping Feng San, Huang Qi Fang Feng San, Huang Qi Shi Wu Jia, Sheng Yue San, etc. or decoction of Huang Qi 6-9g/d for 3 months.
Chinese medicine preparation
Mainly to strengthen the spleen, promote blood circulation, remove blood stasis, nourish Yin and replenish blood
Fangfengtongxun (Fangfeng, Thornbush, Ephedra, forsythia, angelica, rhubarb)
Jianbao Compound (Astragalus membranaceus, Radix et Rhizoma Polygonati)
Compound Agaricus Syrup (White Ginseng, Red Ginseng, Radix Codonopsis, Shengdi, Hawthorn, Agaricus)
Fuxianlin (Ghost Needle Leaf, Wild Chrysanthemum, Astragalus, American Ginseng, Panax quinquefolium)
Astragalus Extract (Astragalus membranaceus)
Spleen Kexin (white lentil, yam, hen’s-eye gold, atractylodes, mucuna pruriens, Sichuan scabious, NaHco3, artificial oxalis)
Others Yu Ping Feng (Astragalus + Atractylodes) Astragalus strengthens the spleen and tonifies the qi, while Atractylodes strengthens the spleen and enhances the qi, helping Astragalus strengthen the function of benefiting the qi and fixing the surface.