布地奈德、特布他林联合异丙托溴铵雾化吸入治疗儿童哮喘急性发作的疗效观察

Observation of the efficacy of budesonide and terbutaline combined with ipratropium bromide inhalation in the treatment of acute asthma in children

目的观察布地奈德(普米克令舒)、特布他林(博利康尼)联合异丙托溴铵(爱全乐)雾化吸入治疗儿童哮喘急性发作的临床疗效。方法选取2014年4月-2016年11月厦门长庚医院收治的儿童哮喘急性发作患儿92例,采用随机数字表法分为试验组和对照组各46例。对照组给予布地奈德联合特布他林雾化吸入治疗,试验组在对照组基础上给予异丙托溴铵雾化吸入治疗。比较2组临床疗效、临床症状消失时间、治疗前后肺功能指标[第1秒用力呼气量占用力肺活量比值(FEV1/FVC)、第1秒用力呼气容积(FEV1)及用力呼气50%时瞬间流速(PEF50%)]、血清炎性因子[嗜酸性粒细胞(EOS)、白细胞介素-13(IL-13)、干扰素-γ(IFN-γ)]及不良反应发生情况,并随访1年,比较2组复发率。结果试验组治疗总有效率为96.65%高于对照组的71.74%(P<0.01)。试验组患儿喘息、呼吸困难及肺部哮鸣音消失时间均短于对照组(P<0.05)。治疗后2组FEV1/FVC、PEF50%及FEV1水平均升高(P<0.05),且试验组高于对照组(P<0.01)。治疗后2组血清EOS、IL-13水平低于治疗前(P<0.05),血清IFN-γ水平高于治疗前(P<0.05),且试验组变化幅度大于对照组(P<0.01)。2组头痛、头晕及过敏反应等不良反应发生率比较差异无统计学意义(χ^2=0.492,P>0.05)。随访1年,无病例脱落。试验组复发率为2.17%低于对照组的17.39%(χ^2=4.433,P=0.035)。结论布地奈德、特布他林联合异丙托溴铵治疗儿童哮喘急性发作期效果好,可缓解患儿临床症状,改善肺功能,降低复发率,可能与上调血清IFN-γ表达、降低EOS、IL-13水平有关。

Objective To observe the clinical efficacy of budesonide(pulmicort respules)and terbutaline combined with ipratropium bromide(atrovent)inhalation in the treatment of acute asthma in children.Methods 92 children with acute exacerbation of asthma who were treated in Xiamen Chang Geng Hospital from April 2014 to November 2016 were selected,and they were randomly divided into test group(46 cases)and control group(46 cases).The control group was given budesonide combined with terbutaline inhalation,and the test group was given ipratropium bromide on the basis of the control group.The clinical efficacy,clinical symptoms disappearance time,pulmonary function indexes[FEV1/FVC,FEV1,PEF50%],serum inflammatory factors[EOS,IL-13,IFN-γ]and adverse reactions before and after treatment were compared between the two groups,and the recurrence rate after 1 year was followed up.Results The total effective rate of treatment in the test group(96.65%)was higher than in the control group(71.74%)(P<0.01).The wheezing,dyspnea,and lung wheezing disappeared in the test group were shorter than those in the control group(P<0.05).After treatment,the levels of FEV1/FVC,PEF50%,and FEV1 increased in both groups(P<0.05),and the test group was higher than the control group(P<0.01).After treatment,the serum EOS and IL-13 levels in the two groups were lower than before treatment(P<0.05),and the serum IFN-γlevels were higher than before treatment(P<0.05),and the change in the test group was greater than that in the control group(P<0.01).There was no significant difference in the incidence of headache,dizziness,and allergic reactions between the two groups(χ2=0.492,P>0.05).Followed up for 1 year,no cases fell off.The recurrence rate in the test group(2.17%)was lower than the control group(17.39%)(χ2=4.433,P=0.035).Conclusion Budesonide and terbutaline combined with ipratropium bromide inhalation have a good effect in treating children with acute asthma,it can alleviate the clinical symptoms of children,improve lung function,reduce the recurrence rate,it may be related to the up-regulation of the expression of serum IFN-γand the reduction of the level of IL-13 and EOS.