雾化吸入布地奈德对婴幼儿下呼吸道合胞病毒感染预后的影响

Influence of inhaling budesonide on prognosis of children＇s lower respiratory tract infected by respiratory syncyeial virus

目的 观察不同疗程雾化吸入布地奈德（普米克令舒）对下呼吸道合胞病毒（RSV）感染的毛细支气管炎患儿临床症状及远期预后的影响。方法 年龄〈1岁的毛细支气管炎患儿，均为初次发病，采末梢血用ELISA法进行呼吸道合胞病毒IgM抗体检测，抗体阳性者作为人选对象，共148例。随机分为两组：治疗组95例，分为治疗Ⅰ组和治疗Ⅱ组；对照组53例。三组患儿均采用相同的综合性治疗，并给予生理盐水、硫酸特布他林（博利康尼）及盐酸氨溴索（沐舒坦）雾化吸入7d，治疗Ⅰ组和治疗Ⅱ组在上述基础上加用布地奈德（普米克令舒）雾化吸入7d，治疗Ⅱ组继续普米克令舒雾化吸入8周；观察各组患儿咳嗽、喘憋及肺部哕音情况，并统计住院天数。所有病例均随访3年；记录各组患儿停药第1年、第2年、第3年喘息性疾病的患病人数及患病率。结果 ①治疗组在平喘、止咳、肺部哮鸣音及湿哕音消失时间与对照组比较有显著性差异（P均〈0．01），治疗组住院时间较对照组缩短，差异有显著性意义（P〈0．01）。②治疗Ⅰ组在停药后第1年、第2年、第3年喘息性疾病患病率分别为50％、40．4％、25％，较对照组（54．9％、41．2％、27．5％）稍降低，经统计学处理无显著性差异；治疗Ⅱ组在停药后第1年、第2年、第3年喘息性疾病患病率分别为26．3％、23．6％、13．2％，其中第1年、第2～3年喘息性疾病患病率与对照组相比，有显著性差异（X^2-10．3，P〈0．01、X^2=4．40，P〈0．05）。结论 呼吸道合胞病毒感染急性期应用布地奈德雾化吸入1周可有效的改善症状并缩短病程，减少住院时间，但对其预后无明显影响。布地奈德雾化吸入8周可降低因病毒感染而引起的气道高反应，减少肺功能损伤，可达到早期干预减低其婴幼儿哮喘发病率的目的。

Objective To observe the clinical characters and forward prognosis of bronchiolitis children infected by respiratory syncyeial virus（RSV） inhaled budesonide for different course of treatment. Methods The bronchiolitis children were all under one year old and the first time with pathogenesis. Using ELISA to determine the RSV-IgM, the positive children were 148 cases, and they were divided into two groups randomly： group of treatment, 95 cases, which were further divided into Ⅰ , Ⅱ treatment group; group of control,53 cases. Three groups were all treated by same synthetic therapy. The Ⅰ , Ⅱ treatment group inhaled budesonide additionally for seven days,while Ⅱ treatment group inhaled for eight weeks. The hospitalization days of all the children in three groups were counted, and their condition characters：cough, pant, pulmonary crackles were observed. All the cases were followed up for three years, the disease numbers and morbidity of children in each group were recorded when they had stopped therapy 1st year,2nd year and 3rd year. Results ①As for the effect time of drugs on clinical symptoms,treatment group was shorter than control group （ P 〈0.01）, the hospitalization time of treatment group was shorter than that of control group （ P 〈0.01）. QAfter stopping treatment for 1st year,2nd year,3rd year,treatment Ⅰ group had,the rates of wheezy disease, respectively 50%, 40.4%, 25%, which were a little lower than these of control group, respectively 54.9%,41.2%,27.5%, but no significant difference. The rates in treatment Ⅱ group were 26.3% ,23.6% ,13.2% and the rate of 1st year,2nd to 3rd year when compared to that of control group,had significant difference （X^2 = 10. 3, P 〈 0.01, X^2 = 4.4, P 〈 0. 05）. Conclusions In acute RSV infective phase,inhaling budesonide for one week can effectively improve the condition, shorten course and time in hospital,while it has no significant influence on prognosis; inhaling for eight weeks can reduce airway hyperresponsiveness, reduce the damage of pulmonary function, reduce the asthmatic rate in children.