布地奈德联合不同药物雾化吸入疗法在儿童哮喘急性发作期的疗效评价
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摘要
目的分析比较布地奈德联合特布他林与布地奈德联合复方异丙托溴铵雾化吸入治疗儿童哮喘急性发作期的临床效果,为儿童哮喘急性发作期临床效果更好的治疗方案提供参考。方法选择2013年8月-2017年6月中山大学附属第一医院收治的急性发作期中度哮喘患儿80例随机分为对照组和观察组各40例,在吸氧、止咳祛痰等常规治疗基础上,对照组患儿给予布地奈德联合特布他林雾化吸入,观察组患儿给予布地奈德联合复方异丙托溴铵雾化吸入,记录并比较两组患儿治疗后3 d和5 d临床症状及体征、肺功能改善情况、不良反应情况,并对两组患儿进行疗效判定。结果观察组患儿治疗总有效率为95. 0%,对照组总有效率为57. 5%,差异有统计学意义(P<0. 05)。两组患儿治疗后临床症状及体征、肺功能情况与治疗前相比均得到明显改善,且观察组患儿治疗后3、5 d的临床症状及体征、肺功能情况均优于对照组,差异均有统计学意义(P<0. 05)。对照组6例患儿于治疗第3天出现夜间喘息症状,8例患儿经治疗症状缓解,但于治疗第5天咳嗽、喘息复发,5例患儿出现心动过速表现。治疗组未出现其他不良反应。结论哮喘急性发作时雾化吸入布地奈德联合复方异丙托溴铵的治疗效果优于布地奈德联合特布他林,住院时间短,安全性好,值得推广。
Objective To analyze the curative effects of atomization inhalation of budesonide combined with different drugs( terbutaline,compound ipratropium bromide) in treatment of childhood asthma in acute attack period,provide a reference for treatment of childhood asthma in acute attack period with better clinical effect. Methods Eighty children with moderate asthma in acute attack period treated in the First Affiliated Hospital of Zhongshan University from August 2013 to June 2017 were selected and randomly divided into control group and observation group,40 children in each group. Based on conventional therapy( oxygen inhalation,cough expectorant,eliminating phlegm),the children in control group were treated by atomization inhalation of budesonide combined with terbutaline,and the children in observation group were treated by atomization inhalation of budesonide combined with compound ipratropium bromide. The clinical symptoms and signs,improvements of pulmonary function,and adverse reactions at 3 and 5 days after treatment in the two groups were recorded and compared,and the clinical curative effects in the two groups were evaluated. Results The total effective rates in observation group and control group were 95. 0% and 57. 5%,respectively,there was statistically significant difference between the two groups( P < 0. 05). After treatment,clinical symptoms and signs,and pulmonary function in the two groups were improved significantly. Clinical symptoms and signs,and pulmonary function at 3 and 5 days after treatment in observation group were statistically significantly better than those in control group( P<0. 05).In control group,nocturnal wheezing symptom was observed on the third day of treatment in 6 children; remission of symptoms was observed in 8 children,but recurrence of coughing and asthma was observed on the fifth day; tachycardia was observed in 5 children. There were no other adverse reactions in treatment group. Conclusion The curative effect of atomization inhalation of budesonide combined with compound ipratropium bromide is superior to atomization inhalation of budesonide combined with terbutaline in treatment of childhood asthma in acute attack period,the hospitalization time is short,the safety is good,which is worthy of population.
Objective To analyze the curative effects of atomization inhalation of budesonide combined with different drugs( terbutaline,compound ipratropium bromide) in treatment of childhood asthma in acute attack period,provide a reference for treatment of childhood asthma in acute attack period with better clinical effect. Methods Eighty children with moderate asthma in acute attack period treated in the First Affiliated Hospital of Zhongshan University from August 2013 to June 2017 were selected and randomly divided into control group and observation group,40 children in each group. Based on conventional therapy( oxygen inhalation,cough expectorant,eliminating phlegm),the children in control group were treated by atomization inhalation of budesonide combined with terbutaline,and the children in observation group were treated by atomization inhalation of budesonide combined with compound ipratropium bromide. The clinical symptoms and signs,improvements of pulmonary function,and adverse reactions at 3 and 5 days after treatment in the two groups were recorded and compared,and the clinical curative effects in the two groups were evaluated. Results The total effective rates in observation group and control group were 95. 0% and 57. 5%,respectively,there was statistically significant difference between the two groups( P < 0. 05). After treatment,clinical symptoms and signs,and pulmonary function in the two groups were improved significantly. Clinical symptoms and signs,and pulmonary function at 3 and 5 days after treatment in observation group were statistically significantly better than those in control group( P<0. 05).In control group,nocturnal wheezing symptom was observed on the third day of treatment in 6 children; remission of symptoms was observed in 8 children,but recurrence of coughing and asthma was observed on the fifth day; tachycardia was observed in 5 children. There were no other adverse reactions in treatment group. Conclusion The curative effect of atomization inhalation of budesonide combined with compound ipratropium bromide is superior to atomization inhalation of budesonide combined with terbutaline in treatment of childhood asthma in acute attack period,the hospitalization time is short,the safety is good,which is worthy of population.
引文
[1]中华医学会儿科学分会呼吸学组,中华医学会《中华儿科杂志》编辑委员会.儿童支气管哮喘诊断和防治指南[J].中华儿科杂志,2008,46(10):745.
[2]陈湘琦,林挺岩.支气管哮喘药物治疗的现状与发展[J].临床肺科志,2004,9(5):509-511.
[3]丁宝栋,王明伟,赵月华,等.IL-13基因+2044G/A多态性与儿童哮喘风险和血清IL-13水平的相关性研究[J].临床儿科杂志,2016,34(11):838-841.
[4]中华医学会呼吸病学分会哮喘组.支气管哮喘防治指南(支气管哮喘的定义,诊断,治疗管理方案)[J].中华结核和呼吸杂志,2008,31(3):177-185.
[5]万华林,周玉珍,戴新建.多索茶碱联合吸入用复方异丙托溴铵溶液治疗60例支气管哮喘急性发作的疗效和安全性[J].中国医院药学杂志,2015,35(16):1485-1487.
[6]Killeen K,Skora E.Pathophysiology,diagnosis,and clinical assessment of asthma in the adult[J].Nurs Clin North Am,2013,48(1):11-23.
[7]Sinha S,Singh J,Jindal K,et al.Association of 24 bp duplication of human CHIT1 gene with asthma in a heterozygous population of north India:a case-control study[J].Lung,2014,192(5):685-691.
[8]陈再历.哮喘药物的应用技术[J].中国实用儿科杂志,2001,16(12):760-762.
[9]何红霞.布地奈德混悬液联合硫酸特布他林雾化吸入治疗小儿中度哮喘的临床疗效观察[J].中国妇幼保健,2017,32(11):2404-2406.
[10]韩伟.吸入型糖皮质激素和长效β2受体激动药在哮喘治疗中的作用和相互影响[J].世界临床药物,2003,2(1):89.
[11]Guilbert TW,Morgan WJ,Zeiger RS,el al.Long-term inhaled corticosteroids in preschool children at high risk for asthma[J].New Engl J Med,2006,354(19):1985-1997.
[12]Watanasomsiri A,Phipatanakul W.Comparison of nebulized ipratropium bromide with salbutamol vs.salbutamol alone in acute asthma exacerbation in children[J].Ann Allergy Asthma Immunol,2006,96(5):701-706.
[13]杜志强,史家欣.吸人疗法在支气管哮喘中的应用进展[J].西北国防医学杂志,2007,28(4):287-289.
[14]何红霞.布地奈德混悬液联合硫酸特布他林雾化吸入治疗小儿中度哮喘的临床疗效观察[J].中国妇幼保健,2016,31(11):2307-2308.
[15]殷祖华.β2受体激动剂在哮喘防治中的作用[J].中华实用医药杂志,2005,5(17):326-328.
[16]安淑华,李金英,赵清娟,等.常规通气功能检测在儿童支气管哮喘治疗中的作用[J].实用儿科临床杂志,2011,4(26):257-259.
[17]Salpeter SR,Buckley NS,Ormiston TM,et al.Meta-analysis:effect of long-acting beta-agonists on severe asthma exacerbations and asthma-related deaths[J].Ann Intern Med,2006,144(12):904-912.
[18]Molise MC,Maffey AF,Ramos P,et al.Original salbutamol versus similar salbutamol in children with asthma exacerbation:a randomized,controlled,double-blind study[J].Arch Argent Pediatr,2012,110(4):285-290.
[19]O'Byrne PM,Naya IP,Kallen A,et al.Increasing doses of inhaled corticosteroids compared to adding long-acting inhaled beta-agonists in achieving asthma control[J].Chest,2008,134(8):1018.
[20]赵扬,洪爽.沙丁胺醇联合布地奈德治疗小儿哮喘急性发作的疗效及其对肺功能的影响[J].中国妇幼保健,2017,32(8):1668-1671.
[21]Bacharier LB,Boner A,Cadsen KH,et al.Diagnosis and treatment of asthma in childhood:a PRACTALL consensus report[J].Allergy,2008,63(1):5-34.
[2]陈湘琦,林挺岩.支气管哮喘药物治疗的现状与发展[J].临床肺科志,2004,9(5):509-511.
[3]丁宝栋,王明伟,赵月华,等.IL-13基因+2044G/A多态性与儿童哮喘风险和血清IL-13水平的相关性研究[J].临床儿科杂志,2016,34(11):838-841.
[4]中华医学会呼吸病学分会哮喘组.支气管哮喘防治指南(支气管哮喘的定义,诊断,治疗管理方案)[J].中华结核和呼吸杂志,2008,31(3):177-185.
[5]万华林,周玉珍,戴新建.多索茶碱联合吸入用复方异丙托溴铵溶液治疗60例支气管哮喘急性发作的疗效和安全性[J].中国医院药学杂志,2015,35(16):1485-1487.
[6]Killeen K,Skora E.Pathophysiology,diagnosis,and clinical assessment of asthma in the adult[J].Nurs Clin North Am,2013,48(1):11-23.
[7]Sinha S,Singh J,Jindal K,et al.Association of 24 bp duplication of human CHIT1 gene with asthma in a heterozygous population of north India:a case-control study[J].Lung,2014,192(5):685-691.
[8]陈再历.哮喘药物的应用技术[J].中国实用儿科杂志,2001,16(12):760-762.
[9]何红霞.布地奈德混悬液联合硫酸特布他林雾化吸入治疗小儿中度哮喘的临床疗效观察[J].中国妇幼保健,2017,32(11):2404-2406.
[10]韩伟.吸入型糖皮质激素和长效β2受体激动药在哮喘治疗中的作用和相互影响[J].世界临床药物,2003,2(1):89.
[11]Guilbert TW,Morgan WJ,Zeiger RS,el al.Long-term inhaled corticosteroids in preschool children at high risk for asthma[J].New Engl J Med,2006,354(19):1985-1997.
[12]Watanasomsiri A,Phipatanakul W.Comparison of nebulized ipratropium bromide with salbutamol vs.salbutamol alone in acute asthma exacerbation in children[J].Ann Allergy Asthma Immunol,2006,96(5):701-706.
[13]杜志强,史家欣.吸人疗法在支气管哮喘中的应用进展[J].西北国防医学杂志,2007,28(4):287-289.
[14]何红霞.布地奈德混悬液联合硫酸特布他林雾化吸入治疗小儿中度哮喘的临床疗效观察[J].中国妇幼保健,2016,31(11):2307-2308.
[15]殷祖华.β2受体激动剂在哮喘防治中的作用[J].中华实用医药杂志,2005,5(17):326-328.
[16]安淑华,李金英,赵清娟,等.常规通气功能检测在儿童支气管哮喘治疗中的作用[J].实用儿科临床杂志,2011,4(26):257-259.
[17]Salpeter SR,Buckley NS,Ormiston TM,et al.Meta-analysis:effect of long-acting beta-agonists on severe asthma exacerbations and asthma-related deaths[J].Ann Intern Med,2006,144(12):904-912.
[18]Molise MC,Maffey AF,Ramos P,et al.Original salbutamol versus similar salbutamol in children with asthma exacerbation:a randomized,controlled,double-blind study[J].Arch Argent Pediatr,2012,110(4):285-290.
[19]O'Byrne PM,Naya IP,Kallen A,et al.Increasing doses of inhaled corticosteroids compared to adding long-acting inhaled beta-agonists in achieving asthma control[J].Chest,2008,134(8):1018.
[20]赵扬,洪爽.沙丁胺醇联合布地奈德治疗小儿哮喘急性发作的疗效及其对肺功能的影响[J].中国妇幼保健,2017,32(8):1668-1671.
[21]Bacharier LB,Boner A,Cadsen KH,et al.Diagnosis and treatment of asthma in childhood:a PRACTALL consensus report[J].Allergy,2008,63(1):5-34.