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世聯翻譯公司完成視頻字幕中文翻譯
時間 原文 中文 00:00-00：07 World Health Organization 世界衛生組織 00：08-00：42 Management of The Young Child With Wheeze 幼兒氣喘病管理 00：43-00：57 This video illustrates the identification and management of the young child with wheeze，The use of rapid acting bronchodilators, and the assessment of the response to treatment. 這個視頻介紹的是如何識別并管理幼兒氣喘病，如何使用迅速生效的支氣管擴張劑，如何評估治療效果。 00：58-01：08 The video has been made for doctors, nurses, and other health staff working in small hospitals or health centers in developing countries. 該視頻的目標觀眾是發展中國家小醫院或衛生所工作的醫生、護士和其它工作人員。 01：09-01：19 It should be used as an introduction on how to assess and treat child with wheeze. It is intended to complement practical clinical experience. 該視頻應作為一個有關如何評估和治療幼兒哮喘病的介紹教程來使用。其目的是來補充實際臨床經驗。 01：20-01：30 We will look at this in three sections:
Assessment,
Treatment,
Response to treatment
For an acute episode of wheeze我們會從三個方面來介紹：
評估
治療
急性氣喘的治療效果01：31-01：40 For guidelines on the management of children with chronic wheeze, refer to the pocket book of Hospital Care for Children. 有關幼兒慢性氣喘的管理，請參閱袖珍書《Hospital Care for Children(兒童醫院護理)》 01：41-01:59 The video illustrates children with wheeze, shows the recommended equipment for their assessment and treatment. In particular, it deals with the correct use of meter-dose inhaler with a spacer devise and correct use of the nebulizer. 該視頻介紹了幼兒氣喘癥狀，并展示了氣喘病診斷和治療的推薦器材。尤其是，該視頻還展示了如何正確使用帶儲存腔的定量吸入器，以及如何正確使用噴霧器。 02:00-02:12 It is important to be able to assess a child with acute wheeze accurately so that correct decisions for treatment can be taken. 必須能夠精確診斷急性幼兒氣喘病，以便能做出正確的治療判斷，這一點很重要。 02:13-02：19 The Assessment of Wheeze 氣喘病的診斷 02：20-02：34 When a child is brought to you with cough or difficult breathing, you should examine the child to determine whether wheeze is present. The clinical signs of wheeze include
The wheeze sound on expiration當幼兒有咳嗽或呼吸困難的癥狀時，應檢查幼兒，并診斷是否有氣喘癥狀。
氣喘病的臨床癥狀包括：
呼氣時有呼哧呼哧的聲音
02：35-02：45 Before disturbing the child, listen to the child’s breathing. You would probably have to put your ear close to the child’s mouth or use a stethoscope to hear the sound clearly. 首先聽孩子的呼吸聲。把耳朵放在孩子的口邊或者使用一個聽診器，會聽得更清楚一些。 02：46-02：57 Listen to the sound as these children breathe out. The wheeze sound is often described as a musical sound made as the child breathes out. 聽一下這些孩子呼氣時的聲音。孩子呼氣時的呼哧呼哧聲經常被描述為音樂一樣很有節奏。 02：58-03：48 Notice that wheeze is whispered as the child breathes out, but the actual character of the wheeze sound can vary from child to child. 請注意：孩子呼氣時小聲發出呼哧呼哧聲。不過這種呼哧呼哧聲并不是每一個孩子都一樣。 03：49-04：13 Let’s look and listen again. 我們再觀察一次，再聽一次。 04：14-04:49 In addition to the wheeze,you may have observed the following features, look closely at the child’s chest, the child may be taking longer to breathe out and then breathe in. A child with wheeze may also have chest indrawing. The child may have to make an effort to breathe out.This may result in respiratory stress. With a child in obvious discomfort, and experiencing difficulty in talking, drinking, or breast feeding. In order to observe the additional signs, you must look carefully.
除了呼哧呼哧的聲音之外，你可能也觀察到了以下特征：仔細觀察孩子的胸部，孩子呼氣時可能需要花更長的時間。患有氣喘的幼兒胸部可能會下陷。孩子呼氣時必須使勁，從而導致呼吸窘迫。孩子明顯很難受，難以說話、飲水或喂奶。要了解更多的癥狀，你必須仔細觀察。 04：50-04：58 You should not expect to see or hear all of these signs in every child with wheeze. 并不是在每一個患有氣喘病的幼兒身上都能發現所有這些癥狀。 04：59-05：48 Watch this child: which of the signs of wheeze do you recognize in this child? 觀察這個小孩：你在這個小孩身上發現了氣喘病的什么癥狀？ 05：49-06：08 These are the signs we recognized: we heard the sound on expiration; longer to breathe out than to breathe in; chest indrawing; and making an effort to breathe out.You may need to wait until the child is relaxed to look and listen for wheeze. 以下是我們所識別的癥狀：呼氣時的呼哧呼哧聲，呼氣比吸氣時間長；胸部下陷；呼氣需要使勁；要觀察并聽到孩子的呼哧呼哧聲，要等孩子放松下來。 06：09-06：40 The commonest causes of wheeze in young children in developing countries are acute respiratory infections, such as cough, and cold and bronchoalveolitis and pneumonia and asthma. 發展中國家幼兒氣喘病最常見的原因是急性呼吸道感染,例如咳嗽，感冒和支氣管肺炎, 肺炎和哮喘病。 06：41-06：51 Since pneumonia is a major cause of death in young children in most developing countries, it is particularly important always to consider this diagnosis in children with wheeze. 由于肺炎是發展中國家幼兒死亡的主要原因，因此如果幼兒患了氣喘，一定要考慮是否患了肺炎。 06：52-07:05 Having examined the child presenting with cough or difficult breathing, and recognized the child has wheeze, decide upon the correct treatment for that child. 檢查了咳嗽或呼吸困難的孩子，診斷孩子患有氣喘之后，就需要給孩子采取一種正確的治療方式。 07：06-07：19 Wheeze is caused by narrowed air passages. In most children, this is due to the inflammation of the air ways, and spasm in the muscles in the walls of the air ways. 氣喘是由于呼吸道變窄而造成的，而對于大部分孩子而言呼吸道變窄又是由于呼吸道發炎以及呼吸道管壁肌肉痙攣而引起的。 07：20-07：34 The spasm should respond to the treatment with a bronchodilator. A bronchodilator is a drug that helps these children breathe more easily by opening the air passages of the lungs, and relaxing the bronchospasm. 呼吸道痙攣可通過支氣管擴張劑來治療。支氣管擴張劑是一種藥物，可打開肺部的呼吸道，放松支氣管痙攣，從而讓孩子的呼吸輕松一些。 07：35-07：41 And an essential step in the assessment of children with wheeze is to look at the response to bronchodilator treatment. 幼兒氣喘病診斷中的一個關鍵步驟就是查看支氣管擴張劑的治療效果。 07：42-07：53 It is important that small hospitals have not only oral salbutamol for the treatment of mild wheeze, but also a rapid acting bronchodilator available. 小醫院不僅需要治療輕度氣喘病的口服藥物舒喘靈，還必須準備一種速效支氣管擴張劑。這一點非常重要。 07：54-08:03 Rapid acting bronchodilators produce a response within 15 minutes, allowing you to make an assessment of the child’s wheeze within a short time. 速效支氣管擴張劑能在15分鐘內起效，這樣就能在很短時間內對幼兒氣喘病情做出診斷。 08：04-08：23 They are particularly useful in treating children with severe wheeze and helping to decide the cause of the wheeze. Those who respond to bronchodilator treatment are likely to have asthma, whereas those who do not are more likely to have pneumonia or bronchoalveolitis. 這樣的療法在治療嚴重氣喘幼兒的過程尤其有用，并有助于找到氣喘的病因。如果支氣管擴張劑治療有效，則幼兒可能患了哮喘��；如果支氣管擴張劑治療無效，則幼兒更可能患上了肺炎或支氣管肺炎。 08：24-08:44 It is therefore important that rapid acting bronchodilators be available in health centers, small hospitals, and the right equipment be available to use them properly and that doctors and nurses and other health workers are trained to administer them correctly. 因此衛生所、小醫院必須備有速效支氣管擴張劑以及相應的器材，而醫生、護士和其它醫療工作人員必須接受過專門培訓，知道如何正確使用支氣管擴張劑。 08：45-08：54 Rapid acting bronchodilator treatment methods 速效支氣管擴張劑治療方法 08：55-09:08 There are three methods of giving treatment with rapid acting bronchodilators for the assessment and treatment of wheeze that are recommended for use in health centers and small hospitals. These are: 有三種速效支氣管擴張劑治療方法, 推薦衛生所和小醫院用于氣喘病的診斷和治療之中。這些方法是： 09:09-09：22 The inhalation of salbutamol aerosol or mist using a meter-dosing inhaler or a nebulizer or through the injection of epinephrine, also known as adrenalin. 使用定量吸入器或噴霧器吸入舒喘靈氣霧劑或噴霧或者注射腎上腺素。 09：23-09:32 In most circumstances, inhalation using an aerosol is the most effective and safest method of delivery. 在大部分情況下，氣霧吸入是最有效也最安全的給藥方式。 09：33-09：38 Aerosol delivery 氣霧給藥 09：39-09：59 The two methods of aerosol delivery currently available are meter-dose inhalation and nebulization. An additional method used by adults and older children： dry powder inhalation：is ineffective for most infants and young children, therefore will not be discussed in this video. 目前可用的兩種氣霧給藥方式包括定量吸入和噴霧。還有一種給藥方式：干粉吸入給藥，適合成年人和年齡較大的兒童，卻對大部分嬰幼兒完全無效，因此就不在這個視頻中討論了。 10：00-10：09 The meter-dose inhaler when used with a spacer devise, and nebulizer have both shown themselves to be effective treatment methods in young children. 帶儲存腔的定量吸入器和噴霧器都證明是非常有效的幼兒氣喘病治療方法。 10：10-10：15 Metered Dose Inhalers Using a Spacer Device 使用儲存腔的定量吸入器 10：16-10:34 Most children under seven or eight years of age will be unable to use metered dose inhaler effectively when they are wheezing, this is because they are not able to time everything correctly to breathe in the salbutamol aerosol when it is delivered by the metered dose inhaler. 七八歲以下的幼兒在氣喘時無法有效使用定量吸入器，因為他們無法正確計算時間來吸入舒喘靈氣霧。 10:35-10：44 However, metered dose inhaler can be successfully modified for use by infants and young children with addition of a spacer devise. 不過，如果使用了儲存腔，則定量吸入器可成功用于嬰幼兒氣喘病治療。 10：45-11：06 The jet of spray provided by the metered dose inhaler is trapped in the spacer chamber, the propellants and evaporates leaving only the bronchodilator particles. The small particles are more likely to reach deep into the child’s airways and so be more effective than leaving the ways. 定量吸入器的噴霧被限制在儲存腔中，氣霧噴射劑和蒸發物中含有大量支氣管擴張劑微粒。這些微粒會深入幼兒的呼吸道，從而更有效地治療幼兒氣喘，而不是逃逸到空氣中。 11：07-11:33 The metered dose inhaler is placed into the end of the spacer devise, the inhaler is depressed twice to generate two puffs.The child is instructed to take five full breaths with the mouth closed around the mouthpiece. The spacer devise creates a reservoir of spray for the child to breathe.It removes the need for the child to breathe in at the moment the inhaler is depressed. 定量吸入器安裝在儲存腔的一端，按壓定量吸入器兩次，噴出兩股藥物。孩子口含儲存腔的開口，按照醫護人員的說明吸入五大口藥物。儲存腔里保存著噴霧，供孩子吸入。儲存腔讓孩子不必在按壓定量吸入器的同時吸氣。 11：34-11:45 A spacer devise with a mask can be used with young children who cannot use a mouthpiece. If commercially manufactured spacer devise is not available, it is quite simple to make your own. 如果幼兒不會使用口銜，則可使用帶有面罩的儲存腔。如果市場上沒有儲存腔，制作一個也非常簡單。 11：46-12：06 Very effective spacer devises can be easily made from half or one litre plastic bottles. However, plastic spacer devises can build up electric static charge. The charge causes salbutamol to stick to the plastic spacer devise reducing the amount available to the child. 可以使用半升或一升裝塑料瓶輕松制成高效儲存腔。然而，塑料儲存腔會積累靜電。而靜電會造成舒喘靈黏到儲存腔里，從而降低了孩子吸入的藥物量。 12：07-12:21 Washing the spacer devise in household detergent solution or soap before use can stop this occurring. This simple measure can substantially improve the effectiveness of this treatment. 使用之前用家用洗滌劑溶液或肥皂清洗儲存腔能阻止靜電的產生。這個簡單的方法能大幅提升該療法的效果。 12：22-12：34 To make a spacer devise from a plastic bottle, use a pair of scissors or a sharp knife, to carefully cut out a shape similar in outline to the mouthpiece of the inhaler. 要用塑料瓶制成一個儲存腔，可使用一個剪刀或尖銳的刀子，仔細剪成一個和吸入器開口輪廓相似的口子。 12：35-13:00 The spacer devise[C1] is then pushed into the hole you have created. The open end of the bottle is placed into the child’s mouth. The first time you use a homemade spacer devise, use three to four puffs, afterwards you only need two puffs. After this the child breathes in and out for thirty seconds. 接著將吸入器插入您所切開的口子里，而瓶口則放到孩子的嘴里。第一次使用自制儲存腔的時候，噴三到四下。此后只需噴兩下。接著讓孩子呼氣吸氣三十秒的時間。 13：01-13：04 The Nebulizer 噴霧器 13：05-14：00 The nebulizer consists of a container into which a liquid mixture of salbutamol and water is placed. The salbutamol and water is placed here. A flow of six to eight litres per minute of oxygen or compressed air is then introduced here into the pipe which runs up to the center of the nebulizer. The flow of the oxygen or air into the nebulizer draws the salbutamol and water up the outer section of the central pipe. When it reaches the top of the pipe, it meets the oxygen or air here, the oxygen or air breaks up the salbutamol and water against this section of the nebulizer and turns it into a fine mist. The mist is then forced by the flow of oxygen or air out of the top section of the nebulizer, the child then inhales the mist. 噴霧器有一個容器，里面放入舒喘靈和水的混合液體。舒喘靈和水的位置在這里。每分鐘六到八升氧氣或壓縮空氣被壓入管道，這個管道直通到噴霧器的核心位置。氧氣或空氣流入噴霧器，將舒喘靈和水沿著中央管道的外層區域吸了上來。當舒喘靈和水抵達了管道的頂部，就遇到了這里的氧氣或空氣，這些氧氣或空氣將舒喘靈和水在噴霧器的這個部分不斷激蕩，將之變成細霧，接著氧氣或空氣激流將舒喘靈和水的細霧噴出去，讓幼兒吸入。 14：01--14：37 It is important that the nebulizer is filled and used correctly.Unscrew the top of the plastic nebulizer, and add the salbutamol solution, 0.5 milliliters of liquid salbutamol should be used for children under five years. Add 2 milliliters of normal saline or sterile water, if normal saline or sterile water is not available, drinking water should be used after it has been strained with a cloth, boiled for twenty minutes, and cooled. 正確填裝和使用噴霧器非常重要。擰開塑料噴霧器的頂部，倒入舒喘靈溶液，五歲以下的兒童應使用0.5毫升液體舒喘靈。倒入2毫升普通鹽水或無菌水，如果沒有普通鹽水或無菌水，則可使用飲用水，不過飲用水在使用之前必須經棉布過濾、煮開20分鐘，并冷卻。 14：38-14:58 Do not overfill the nebulizer. Attach one end of the tubing to the bottom of the nebulizer and the other to an oxygen supply with a flow of six to eight litres per minute or an electric air compressor, if available, a mask or TPS may be used. 不要在噴霧器中倒入過多的液體。將軟管的一端插入噴霧器底部，另一端插入到氧氣瓶中，每分鐘氣流達到六到八升，或者插入到電動空氣壓縮器中，如果有的話，可以使用一個面罩。 14:59-15：17 The child should be treated until the liquid in the nebulizer has been nearly used up. This usually takes about ten minutes. It is not necessary to nebulize until all the liquid has been used. In practice about 0.5 milliliters will be left in the nebulizer bowl. 幼兒在氣霧治療時，要用掉噴霧器中的大部分液體。這個過程一般需要10分鐘。沒有必要將噴霧器中的液體全部用完，在實踐中，噴霧器容器中會留下大概0.5毫升的液體。 15：18-15：29 You can tell when this point is reached as splattering sound will occur, and at this stage, little of the residual fluid is being nebulized. 到時候你就知道了，因為這時你會聽到有潑濺的聲音。在這個時候，剩余的一點點液體幾乎沒有氣霧化。 15：30-15：46 After each use, wash the mask the tubing and the nebulizer with dish-washing detergent or soap and dry thoroughly. Do not boil or steam clean the tubing or nebulizer, as this may damage them. 每次使用之后，請使用洗潔精或肥皂清洗面罩、軟管和噴霧器,并徹底晾干。不要水煮或蒸汽潔凈軟管或噴霧器，因為可能會對這些器材造成損壞。 15：47-15：50 Subcutaneous epinephrine (adrenaline) 腎上腺素 15：51-16：06 Subcutaneous epinephrine, which is also known as adrenaline, is given to young children by subcutaneous injection. It is also a rapid acting bronchodilator, which will act in about 15 minutes. 可以給氣喘幼兒皮下注射腎上腺素。這是一種速效支氣管擴張劑。只需15分鐘就會生效。 16：07-16：30 Great care needs to be taken when administering epinephrine. It is vital to check that correct strain of solution is used. 1 : 1000 dilution should be used and
0.1 ml per kg of body weight
A one-ml syringe should be used. And the dose measured very carefully.
在注射腎上腺素時必須非常小心。必須仔細檢查，確保使用的溶液品種正確。應使用1：1000的稀釋溶液，確保每公斤體重使用0.1毫升, 同時應使用一毫升注射器。劑量必須仔細衡量。 16：31-16：40 Follow up treatment 后續治療 16：41-16：57 Reassess the child after 15 minutes. A child with the first episode of wheezing and no respiratory stress after nebulization can usually be managed at home with oral salbutamol and supportive care only. 15分鐘后再次檢查幼兒。如果幼兒只是第一次出現呼哧呼哧的氣喘癥狀，而氣霧治療后沒有呼吸窘迫的情況，則可在家治療，只需口服舒喘靈和支持性護理即可。 16：58-17：14 If the child is still in respiratory stress,or has recurrent wheezing, give salbutamol by metered-doze inhaler or by nebulizer. If salbutamol is not available, give the child subcutaneous epinephrine. 如果幼兒仍然呼吸窘迫，或者不斷出現呼哧呼哧的氣喘癥狀，則使用定量吸入器或噴霧器給藥舒喘靈。如果沒有舒喘靈藥物，則給幼兒注射腎上腺素。 17：15-17：38 Reassess the child after another 15 minutes to determine subsequent treatment. If respiratory stress has been resolved, and the child has not fast breathing, advise the mother on home care with oral salbutamol syrup or tablets. If the respiratory stress persists, admit the child in the hospital for treatment. 過15分鐘再次檢查幼兒，并決定以后的治療方法。如果呼吸窘迫的癥狀消失而幼兒不再呼吸急促，則建議母親在家護理幼兒，只需口服舒喘靈糖漿或藥片。如果呼吸窘迫的癥狀仍然存在，則讓幼兒住院治療。 17：39-17：47 If the child has central cyanosis, or unable to drink, the child should be admitted in the hospital for treatment. 如果幼兒中樞性發紺或者無法飲水，則住院治療。 17：48-18：08 In children admitted to hospital, give oxygen, a rapid acting bronchodilator, or a first dose of oral prednisolone or another steroid.
The child should be given
1 milligram of oral prednisolone for every kilogram of weight once a day for 3 days.幼兒住院后，應給幼兒輸氧，速效支氣管擴張劑，或者第一劑口服脫氫皮質醇（強的松龍）或另一劑類固醇。
應給幼兒服用
每公斤體重1毫克強的松龍
一天一次，連續3天18：09-18：21 A positive response should be seen within thirty minutes. If this does not occur, give rapid acting bronchodilator at up to one hourly intervals 三十分鐘后應該就能看到幼兒病情好轉；如果幼兒病情并沒有好轉，則每隔一個小時給藥速效支氣管擴張劑。 18：22-18：54 If there is no improvement after three doses of rapid acting bronchodilator, plus oral prednisolone, give IV aminophylline. Intravenous aminophylline can be dangerous in overdose or when given too rapidly.
Weigh the child
And give the IV dose over at least 20 minutes.
Give
Initial dose 5-6 mgs/kg
(up to a maximum of 300 mg)如果三個劑量的速效支氣管擴張劑和口服強的松龍之后仍然沒有起色，則靜脈注射氨茶堿。靜脈注射氨茶堿過量或過快的話會非常危險。
量一下幼兒的體重
在至少20分鐘的時間范圍內靜脈注射氨茶堿。
初始劑量5-6毫克/（幼兒體重）公斤
（最多300毫克）
18：54-19：24 This is followed by a maintenance dose of 5 mg/kg every 6 hours.
Administer the initial dose, if the child has received any form of aminophylline in the previous 24 hours. Stop giving intravenous aminophylline immediately if the child:
Starts to vomit
Has a pulse rate of greater than 180 per minute
Develops a headache
Has a convulsion
接下來每6個小時注射5毫克/（幼兒體重）公斤的維持劑量。如果在之前的24小時之內幼兒接受過任何形式的氨茶堿治療，則給藥初始劑量。如果幼兒出現了以下癥狀，則立刻停止給藥：
開始嘔吐
脈搏數超過180次每分鐘
開始頭疼
抽搐19：25-19：49 All the techniques shown in the video have a role in the management of wheeze in young children. In terms of easy administering, availability and cost, metered-dose inhaler with spacer devises may be the most appropriate method for administering rapid acting bronchodilator to young children with wheeze in our patient facilities. 本視頻中所介紹的所有技術在幼兒氣喘病治療中都起著重要的作用。
就給藥容易、可用性和成本而言，帶儲存腔的定量吸入器是我們醫療單位給幼兒給藥速效支氣管擴張劑的最合適方法。19：50-20：10 However, in making your choice ,you must consider any local factor, which may influence your decision.Implementing the recommended procedures in this video will allow the correct treatment of wheeze in children with cough and difficult breathing. 然而在選擇療法的時候，還是要考慮本地因素，這會影響到你的決定。使用本視頻所推薦的療法會讓你能正確治療咳嗽和呼吸困難幼兒的氣喘癥狀。 20：11-20：23 This is an essential element in the management of children with acute respiratory infection and acute wheeze. Further information is contained in the pocket book Hospital Care for Children. 這在急性呼吸道感染和急性氣喘的幼兒治療中是個關鍵因素。進一步相關信息，請參閱袖珍書《Hospital Care for Children（醫院兒童護理）》 20：24-20:40 And the technical review paper Bronchodilators and Other Medications for the treatment of wheeze-associated illnesses in young children prepared by the WORLD HEALTH ORGANIZATION Department of Child and Adolescent Health Development. 同時請參與世界衛生組織兒童和青少年健康與發展部門所發表的論文：Bronchodilators and Other Medications for the treatment of wheeze-associated illnesses in young children（幼兒氣喘相關疾病的支氣管擴張劑治療和其它藥物治療）。 20：41-21：23 Narrated by
Maggie Mash
This video was produced by the world health organization Department of Child and Adolescent Health and Development, with assistance from
Dr. Janet Cumberland,
Sheffield Children’s Hospital
Sheffield UK
Hamish Simpson, Professor
David Thomas, Research Fellow
University Department of Child Health
Leicester, UK
And with the help and support of the staff and patients of
Al Anfushi Children’s Hospital
Alexandria Egypt
Childrens Hospital Bangkok
Thailand
El Chatby Hospital
Egypt
Leicester Royal Infirmary
Leicester UK
Sheffield Children’s Hospital
Sheffield UK
Directed by
Chris Dent
Produced by
World Health Organization
旁白：
Maggie Mash
本視頻的制作方是世界衛生組織兒童和青少年健康與發展部門，得到了以下個人和單位的協助：
Janet Cumberland博士
Sheffield Children’s Hospital
Sheffield 英國
Hamish Simpson教授
David Thomas, 研究員
University Department of Child Health
Leicester, 英國
并且得到了以下醫院員工和病人的幫助和支持：
Al Anfushi Children’s Hospital
Alexandria，埃及
曼谷兒童醫院
泰國
El Chatby Hospital
埃及
Leicester Royal Infirmary
Leicester 英國
Sheffield Children’s Hospital
Sheffield 英國
導演：
Chris Dent
制作方：
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