长期家庭雾化布地奈德治疗哮喘预测指数阳性婴幼儿喘息的效果
|
摘要
目的观察长期家庭雾化吸入布地奈德混悬液治疗哮喘预测指数(API)阳性婴幼儿喘息的临床效果。方法选择我中心儿科门诊2014年1月～2016年1月收治的67例API阳性婴幼儿喘息患儿作为研究对象,随机分为观察组(34例)与对照组(33例)。观察组在喘息急性发作控制后采取长期家庭雾化吸入布地奈德混悬液治疗,按症状控制效果,调整布地奈德吸入剂量,从1 mg/d逐渐减量至0.25 mg/d,疗程3～9月。对照组在患儿每次喘息发作时给予高剂量布地奈德混悬液联合硫酸沙丁胺醇溶液和异丙托溴铵溶液等药的治疗,症状控制后停药。随访12个月,观察比较两组患儿的喘息复发次数、喘息发作持续时间和喘息严重发作时全身激素的使用率。结果观察组喘息复发(1.5±0.3)次,明显少于对照组的(3.5±0.6)次,差异有统计学意义(P<0.05)。观察组的喘息发作持续时间为(3.7±0.8)d,短于对照组的(6.2±0.6)d,差异有统计学意义(P<0.05)。观察组的全身激素使用率为6.3%,显著低于对照组的15.1%,差异有统计学意义(P<0.05)。疗程结束后,两组患儿均未见明显不良反应。结论长期家庭雾化吸入布地奈德混悬液治疗API阳性婴幼儿喘息能有效预防喘息复发,并能减轻喘息发作程度,疗效显著,安全性好。
Objective To observe the clinical effect of long-term home atomization inhaled Budesonide in the treatment of infants wheezing with positive asthma predictive index(API). Methods A total of 67 API positive patients visited the pediatric clinic at our center from January 2014 to January 2016 were selected and randomly divided into the observation group(n=34) and the control group(n=33). The observation group was treated with long-term home atomization inhaled Budesonide after acute asthma attack control, according to the effect of symptom control, the inhalation dose of Budesonide was adjusted from 1 mg/d to 0.25 mg/d. The course of treatment was from March to September. The control group was treated with high dose Budesonide suspension combined with Salbutamol Sulfate Solution and Ipratropium Bromide Solution at each wheezing attack, and the drug was discontinued after symptom control. Following up for 12 months, the number of wheezing relapses, duration of wheezing attacks and the use rate of systemic corticosteroids in severe wheezing attacks were observed and compared between the two groups. Results The recurrence times of wheezing in the observation group was(1.5±0.3) times, which was significantly less than(3.5±0.6) times in the control group, the difference was statistically significant(P<0.05). The duration of wheezing attacks in the observation group was(3.7 ±0.8)days, which was shorter than(6.2±0.6) days in the control group, the difference was statistically significant(P<0.05).The use rate of systemic corticosteroids in the observation group was 6.3%, which was significantly lower than that in the control group(15.1%), the difference was statistically significant(P<0.05). After the course of treatment, there were no obvious adverse reactions in both groups. Conclusion Long-term home atomization inhaled Budesonide can effectively prevent the recurrence of asthma and alleviate the degree of asthma attack in API positive infants and young children, the curative effect is remarkable and the safety is good.
Objective To observe the clinical effect of long-term home atomization inhaled Budesonide in the treatment of infants wheezing with positive asthma predictive index(API). Methods A total of 67 API positive patients visited the pediatric clinic at our center from January 2014 to January 2016 were selected and randomly divided into the observation group(n=34) and the control group(n=33). The observation group was treated with long-term home atomization inhaled Budesonide after acute asthma attack control, according to the effect of symptom control, the inhalation dose of Budesonide was adjusted from 1 mg/d to 0.25 mg/d. The course of treatment was from March to September. The control group was treated with high dose Budesonide suspension combined with Salbutamol Sulfate Solution and Ipratropium Bromide Solution at each wheezing attack, and the drug was discontinued after symptom control. Following up for 12 months, the number of wheezing relapses, duration of wheezing attacks and the use rate of systemic corticosteroids in severe wheezing attacks were observed and compared between the two groups. Results The recurrence times of wheezing in the observation group was(1.5±0.3) times, which was significantly less than(3.5±0.6) times in the control group, the difference was statistically significant(P<0.05). The duration of wheezing attacks in the observation group was(3.7 ±0.8)days, which was shorter than(6.2±0.6) days in the control group, the difference was statistically significant(P<0.05).The use rate of systemic corticosteroids in the observation group was 6.3%, which was significantly lower than that in the control group(15.1%), the difference was statistically significant(P<0.05). After the course of treatment, there were no obvious adverse reactions in both groups. Conclusion Long-term home atomization inhaled Budesonide can effectively prevent the recurrence of asthma and alleviate the degree of asthma attack in API positive infants and young children, the curative effect is remarkable and the safety is good.
引文
[1]赵德育,段庆宁.婴幼儿喘息的病因及分析[J].中国小儿急救医学,2017,24(12):898-900.
[2]洪建国.哮喘预测指数对婴幼儿哮喘临床应用及评价[J].中国实用儿科杂志,2011,26(4):241-242.
[3]申昆玲,邓力,李云珠,等.糖皮质激素雾化吸入疗法在儿科应用的专家共识[J].临床儿科杂志,2014,32(6):504-511.
[4]中华医学会儿科学分会呼吸学组.儿童支气管哮喘诊断与防治指南[J].中华儿科杂志,2008,46(10):745-754.
[5]陈志敏,刘金玲.雾化吸入临床应用注意点[J].中国实用儿科杂志,2016,31(12):887-888.
[6]王慧敏,朱雯靓,刘传合,等.年幼儿童反复喘息发作的转归及不同表型的危险因素[J].临床儿科杂志,2018,36(6):272-274.
[7]全国儿科协作组,中国疾病预防控制中心环境与健康相关产品安全所.第3次中国城市儿童哮喘流行病学调查[J].中华儿科杂志,2013,10(51):729-735.
[8]Grad R,Moran WJ.Long-term outcomes of early-onset wheeze and asthma[J].J Ailergy Clin Immuno,2012,130(2):299-307.
[9]中华医学会儿科学分会呼吸组,《中华儿科杂志》编辑委员会.儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志,2016,54(3):167-181.
[10]林海庆,江浩,李谷芬,等.家庭雾化吸入治疗在哮喘预测指数阳性患儿急性发作中的应用研究[J].临床肺科杂志,2016,21(8):1378-1380.
[11]邬宇芬,袁姝华,殷勇,等.家庭雾化治疗在儿童呼吸系统疾病中的临床应用[J].中国小儿急救医学,2013,20(6):631-633.
[12]王爱琼,萨日娜,董娜,等.家庭雾化吸入治疗反复喘息患儿疗效观察[J].临床肺科杂志,2015,20(9):1694-1695.
[13]Zeiger RS,Mauger D,Bacharier LB,et al.Daily or intermittent budesonide in presehool children with recurrent weezing[J].N Engl J Med,2011,365:1990-2001.
[14]赵艳,黄英.间断吸入糖皮质激素在反复喘息儿童中的应用[J].儿科药学杂志,2016,22(6):59-61.
[15]张维溪,李昌崇.5岁以下儿童支气管哮喘诊断和治疗的挑战及应对策略[J].国际呼吸杂志,2014,34(3):222-224.
[16]中华医学会儿科学分会呼吸组哮喘协作组.低剂量吸入糖皮质激素的长期治疗对中国轻中度哮喘儿童身高的影响[J].中国实用儿科杂志,2018,33(8):606-617.
[2]洪建国.哮喘预测指数对婴幼儿哮喘临床应用及评价[J].中国实用儿科杂志,2011,26(4):241-242.
[3]申昆玲,邓力,李云珠,等.糖皮质激素雾化吸入疗法在儿科应用的专家共识[J].临床儿科杂志,2014,32(6):504-511.
[4]中华医学会儿科学分会呼吸学组.儿童支气管哮喘诊断与防治指南[J].中华儿科杂志,2008,46(10):745-754.
[5]陈志敏,刘金玲.雾化吸入临床应用注意点[J].中国实用儿科杂志,2016,31(12):887-888.
[6]王慧敏,朱雯靓,刘传合,等.年幼儿童反复喘息发作的转归及不同表型的危险因素[J].临床儿科杂志,2018,36(6):272-274.
[7]全国儿科协作组,中国疾病预防控制中心环境与健康相关产品安全所.第3次中国城市儿童哮喘流行病学调查[J].中华儿科杂志,2013,10(51):729-735.
[8]Grad R,Moran WJ.Long-term outcomes of early-onset wheeze and asthma[J].J Ailergy Clin Immuno,2012,130(2):299-307.
[9]中华医学会儿科学分会呼吸组,《中华儿科杂志》编辑委员会.儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志,2016,54(3):167-181.
[10]林海庆,江浩,李谷芬,等.家庭雾化吸入治疗在哮喘预测指数阳性患儿急性发作中的应用研究[J].临床肺科杂志,2016,21(8):1378-1380.
[11]邬宇芬,袁姝华,殷勇,等.家庭雾化治疗在儿童呼吸系统疾病中的临床应用[J].中国小儿急救医学,2013,20(6):631-633.
[12]王爱琼,萨日娜,董娜,等.家庭雾化吸入治疗反复喘息患儿疗效观察[J].临床肺科杂志,2015,20(9):1694-1695.
[13]Zeiger RS,Mauger D,Bacharier LB,et al.Daily or intermittent budesonide in presehool children with recurrent weezing[J].N Engl J Med,2011,365:1990-2001.
[14]赵艳,黄英.间断吸入糖皮质激素在反复喘息儿童中的应用[J].儿科药学杂志,2016,22(6):59-61.
[15]张维溪,李昌崇.5岁以下儿童支气管哮喘诊断和治疗的挑战及应对策略[J].国际呼吸杂志,2014,34(3):222-224.
[16]中华医学会儿科学分会呼吸组哮喘协作组.低剂量吸入糖皮质激素的长期治疗对中国轻中度哮喘儿童身高的影响[J].中国实用儿科杂志,2018,33(8):606-617.