不同治疗方案对婴幼儿哮喘重度发作疗效的对比研究

A comparison of different protocols in treatment of infant asthma at severe attack

将81例哮喘重度发作婴幼儿按就诊顺序分为3组，分别采用布地奈德混悬液＋硫酸沙丁胺醇雾化（布地奈德组，28例）、硫酸沙丁胺醇雾化＋静脉用甲泼尼龙（甲泼尼龙组，34例）、硫酸沙丁胺醇雾化（硫酸沙丁胺醇组，19例）治疗，对其临床症状、血气变化进行比较。结果组内不同治疗时间患儿呼吸频率、心率、哮鸣音及自我感觉评分均随时问延长而逐渐降低，与治疗前比较差异有统计学意义（q=2．96～163．37，P〈0．05或0．01）；组间治疗后4h时，硫酸沙丁胺醇组呼吸频率、心率明显高于布地奈德组（q=3．08、4．10，P〈0．05）和甲泼尼龙组（q=3．24、3．34，P〈0．05），治疗后4、12h时哮鸣音、自我感觉评分硫酸沙丁胺醇组明显高于布地奈德组（q=5．63～23．63，19〈0．01）和甲泼尼龙组（q=6．76～23．72，P〈0．01）。提示婴幼儿哮喘重度发作时，采用布地奈德混悬液吸入治疗可达到与静脉用甲泼尼龙基本相同的效果；单纯支气管扩张剂不能有效控制大多数婴幼儿重度哮喘的发作。

Eighty one infants with severe asthma attacks were randomly divided into three groups： budesonide group （budesonide suspension ＋ ventolin inhalation）, methylprednisolone group （Ventolin inhalation ＋ intravenous methylprednisolone ） and ventolin group （ ventolin inhalation alone）. Compared with the pre-treatment, the respiratory rate, heart rate, wheeze score, self-feeling score of three groups were gradually reduced （q = 2. 96 - 163.37, P 〈 0. 05 or 0. 01 ）. The respiratory rate, heart rate of ventolin group was significantly higher than those of budesonide group （q = 3.08,4. 10, P 〈 0. 05） and methylprednisolone group （ q =- 3.24,3.34 ,P 〈0. 05 ） 4 h after treatment, wheeze score, self-feeling score of ventolin group was significantly higher than budesonide group （ q = 5.63 - 23.63, P 〈 0. 01 ） and methylprednisolone group （q = 6. 76-23.72,P 〈0. 01 ） 4 and 12 h after treatment. Results indicate that budesonide suspension can achieve the same effect as intravenous methylprednisolone and bronchodilators alone may not effectively control the severe asthma attack in infants.